lispro (Humalog) is what action of insulin?
what is the onset, peak, and duration of lispro (Humalog)
- onset 5-15 min
- peak 0.5-1 hr
- duration 3-4 hrs
what is the action of regular insulin (Humulin R, Novolin R)?
what are the onset, peak, and duration of regular insulin (Humulin R, Novolin R)
- onset 30-60 min
- peak 2-4 hrs
- duration 5-7 hrs
what is the action of NPH insulin?
what is the onset, peak, and duration of NPH insulin?
- onset 1-2 hrs
- peak 4-12 hrs
- duration 18-24 hrs
what is the action of detemir (Levemir) insulin?
what is the onset, peak, and duration of detemir (Levemir) insulin?
- onset gradual: over 24 hrs
- peak 6-8 hrs
- duration to 24 hours
what is the action of Lantus insulin?
what is the onset, peak and duration of Lantus insulin?
- onset gradual: begins at 1.1 hrs
- peak - no peak
- duration to 24 hrs
what happens when a client takes insulin and exercises or skips a meal?
- body uses glucose for energy
- decreases blood sugar = hypoglycemia
what are the s/s of hypoglycemia?
- BS <70
- confusion, dizziness, shakiness
- tachycardia, palpitations
- pale, cool skin
what is the treatment for mild hypoglycemia?
- glucose gel
- 15 gm sugar
- 8 oz skim milk
- 1/2 C OJ
- 608 life savers
- 2-3 tsp sugar
what is the 15-15-15 rule for hypoglycemia treatment?
- give 15 gm sugar
- wait 15 min
- monitor BS
- give 15 gm additional sugar
what is the treatment of severe hypoglycemia BS <40?
- IV 50% Dextrose & Water
- if no IV then Glucagon 1mg IM (side lying-pt will vomit)
what are the consequences of untreated hypoglycemia
name the drug classes for the pneumonic "Some Mothers Buy Toy Animals"
- alpha-glucose inhibitors
what is the action of sulfonylureas (chlorpropamide, glimepiride, glipizide)
- stimulates insulin from pancreas beta cells
- increase sensitivity of insulin receptors
"IDE" rather have my pancreas secrete insulin
what are the side effects of sulfonylureas?
- weight gain
- heart burn
what are the black box warnings of sulfonylureas?
- blood dyscrasias (aplastic anemia, agranulocytosis, leukopenia, pancytopenia, thrombocytopenia)
- drug-induced hepatitis
what is the action of meglitinides?
stimulates mealtime insulin from pancreatic islet cells
name some meglitinides
- prandin (Repaglinide)
what are the adverse effects of meglitinides (prandin Repaglinide)?
nursing implications for meglitinides (prandin Repaglinide)?
- take same time each day
- must eat before med taken
- short duration of action 2-4 hrs
what is the action of biguanides (glucophage Metformin)
- prevents the liver from breaking down glycogen into glucose
- increases the sensitivity to insulin
what are the side effects of biguanides (glucophage Metformin)?
- GI (N&V, diarrhea, anorexia)
what is the black box warning of biguanides (glucophage Metformin)?
what is the action of thiazolidinediones (pioglitazone Actos, rosiglitazone Avandia)
- inhibits hepatic gluconeogenesis
- lowers insulin resistance
what are the side effects of thiazolidinediones (pioglitazone Actos, rosiglitazone Avandia)?
- dark urine
what are the names of two thiazolidinediones?
- pioglitazone (Actos)
- rosiglitazone (Avandia)
what is the action of alpha-glucosidase inhibitors (acarbose Precose, miglitol Glyset)?
- interferes with enzymes in the intestines which break down complex CHO into monosaccharides
- delays CHO digestion (binds with carbs)
name two alpha-glucosidase inhibitors
- acarbose (Precose)
- miglitol Glyset
what are the side effects of alpha-glucosidase inhibitors (acarbose Precose, miglitol Glyset)?
- GI - cramping, diarrhea, flatulence
- increase LFT's
what is the action of pramlinitide (Symlin)?
slows rate at which food (including glucose) is absorbed from the intestine
what are the adverse effects of pramlinitide (Symlin)?
- GI (N&V, anorexia, abd pain)
what is the black box warning of pramlinitide (Symlin)?
hypoglycemia - most all diabetic drugs!
why is pramlinitide (Symlin) prescribed therapeutically?
indicated for Type I and Type II, if unable to achieve BS control on insulin alone
what should be done with insulin orders for pts started on Symlin?
decrease dosing (by 50% to prevent hypoglycemia)
what is the action of exenatide (Byetta)?
enhance insulin secretion after release from the gut into systemic circulation (enhances incretins)
what drug do we refer to as "bye bye appetite - bye bye fat?"
what are the adverse effects of exenatide (Byetta)?
- hypoglycemia (increased with other agents)
- GI (N/V/D, anorexia)
- inj site reactions
- antibody formation
what is the action of sitagliptin phosphate (Januvia)?
blocks DPP-4 which wants to inactivate incretins (GLP-1)
what are the adverse effects of sitagliptin phosphate (Januvia)?
- hypoglycemia with metformin & sulfonylureas
- GI (abd pain, diarrhea)
- Stevens-Johnson syndrome
what is the concept of the Incretin glucose control mechanism?
- to lower blood sugar, incretin either:
- stimulates insulin release
- inhibits glucagon release
what is the reason for taking increatin enhancers (GLP-1 agonists or DPP-4 inhibitors)?
- take a drug that either:
- enhances incretin (GLP-1)
- or inhibits incretin (DPP-4)
what are the labs to monitor DM?
- random capillary glucose
Humalog KwikPen and U-100 insulin device pt teaching
- inject 1-60 units at a time (may dial backward to correct)
- must prime with 2 units to a stream of insulin
- this ensures the correct amount of insulin each time
- needle replaced after each injection
why is the TDD (total daily dose) of basal-bolus insulin protocols adjusted?
- adjust TDD up or down based on:
- past response to insulin
- presence of hyperglycemia inducing agents/stress