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Pharm 323 Spring 22 > diabetes - insulin > Flashcards

diabetes - insulin Flashcards

1
Q

s+s of hyperglycemia

A

“warm + dry…. sugar’s high!”

polyphagia, polyuria, polydipsia, weight loss, fatigue

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2
Q

s+s of hypoglycemia

A

“cold + clammy…. need some candy!”

tremors, diaphoresis, tachycardia, hunger, HA, difficulty concentrating (not enough glucose to brain)

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3
Q

actions of insulin (5) + what is main goal ?

A
  1. helps glucose get into cells
  2. prevent breakdown of fat (for other energy source)
  3. prevent breakdown of glycogen (to make more glucose)
  4. inhibits gluconeogenesis
  5. increases protein synthesis

main goal = lower blood sugar + help body use energy sources properly

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4
Q

what is most common route of insulin?

A

subQ

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5
Q

short duration insulin can be broken down into which 2 categories?

A

rapid-acting + slow acting

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6
Q

what is our prototype for short-duration rapid-acting insulin?

A

aspart (Novolog)

others: lispro (Humalog)
inhaled insulin

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7
Q

inhaled insulin is contraindicated in which patient population?

A

COPD or other respiratory disorders

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8
Q

what is onset of aspart?

A

10-20 mins (rapid acting)

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9
Q

what is peak of aspart?

A

1-3 hrs

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10
Q

what is the duration of aspart?

A

3-5 hours (short duration)

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11
Q

this insulin is used frequently b/c it’s a very “natural” response and closely mimics pancreas action r/t blood sugar rise

A

aspart ◡̈

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12
Q

when should aspart be given? what’s a mnemonic to remember this?

A

5-10 mins before meals (rapid acting!)

“give the shot while the tray is hot!!”

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13
Q

what is the prototype of the short-duration slow-acting insulin?

A

regular insulin (Humulin R, Novolin R)

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14
Q

what is our drug of choice for insulin drips?

A

regular insulin (Humulin R, Novolin R)

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15
Q

what is onset of regular insulin?

A

30-60 mins

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16
Q

what is peak of regular insulin?

A

1-5 hrs

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17
Q

what is duration of regular insulin?

A

up to 10 hrs (“short” duration - 2x longer duration than aspart)

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18
Q

when should regular insulin be given in regards to meals?

A

30-60 mins before

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19
Q

MOST regular insulin is which concentration?

A

U-100

20
Q

insulin is a high alert med. what should you be doing before administration?

A
  1. check current CBG
  2. draw up insulin
  3. take vial and syringe to another RN - show what you drew up, give CBG value, and have them check independently!!
21
Q

what is our prototype for intermediate-acting insulin?

A

NPH (Humulin N, Novolin N)

22
Q

what is the NPH combo?

A

regular insulin + protamine (protein) to slow down absorption

23
Q

what is onset of NPH?

A

1-2 hrs (intermediate acting)

a step up from regular insulin b/c of that protamine added

24
Q

what is peak of NPH?

A

6-14 hrs

25
Q

what is duration of NPH?

A

16-24 hrs

26
Q

NPH is commonly given (dosing interval)?

A

BID (b/c peak is around 12 hours)

27
Q

when should NPH be given?

A

30 mins before meals

I’m asking Knowlton about this b/c why give 30 mins before meals when onset is 1-2 hours??? don’t we risk hypoglycemia???

28
Q

if mixing NPH with regular insulin, what are your steps?

A

roll cloudy
air in cloudy then air in clear
draw up clear (regular) then draw up cloudy (NPH)

“you have to see things CLEARLY before you can draw up the insulin”

29
Q

what is our prototype for our long-acting insulin?

A

glargine (Lantus)

30
Q

what is our GoLd StAr insulin? why?

A

glargine (Lantus)

b/c it mimics the body’s basal control of insulin + there is no peak, which means low risk of hypoglycemia….therefore SAFER!

31
Q

what is onset of glargine?

A

70 mins

32
Q

what is peak of glargine?

A

trick question! there is NO PEAK

33
Q

what is duration of glargine?

A

18-24 hours

34
Q

glargine is used for _______ ________ of blood glucose

A

basal control

35
Q

what is important factor of glargine administration?

A

given @ same time each day - doesn’t matter when, just as long as it’s consistent

36
Q

what is our prototype for ultra-long duration insulin?

A

glargine U-300

37
Q

what is duration of glargine U-300?

A

over 24 hrs (U-300 is 3x the concentration of glargine, so it has a longer duration by 3x)

38
Q

how often is glargine U-300 dosed?

A

q 24 (B/c of ultra-long duration)

39
Q

what is our prototype for combination insulin?

A

NPH + regular 70/30 (an example)

40
Q

what is an insulin that’s “good for patients with routine lives (diet and exercise) with not much variability”?

A

NPH + regular

(b/c it’s a set dose and no titration is needed(

KNOWLTON SAYS WE DON’T NEED TO WORRY ABOUT THIS OR KNOW THIS

41
Q

correction doses of insulin are based on what?

A

patient’s weight + current blood sugar

used much more often

42
Q

if discontinuing an insulin drip, what is the protocol?

A

have a longer-acting insulin on board, then titrate off; DON’T stop all at once!

43
Q

what type of insulin device can be used for home management of DM? what do they deliver?

A

insulin pump

basal dose w/ rapid-acting doses for meal coverage

44
Q

what should be checked EVERY TIME before insulin administration?

A

CBG !!!

45
Q

insulin is good for how long @ room temp? how should it be stored?

A

30 days; upright

also, 1-2 weeks in syringe if mixed

46
Q

when are patients at highest risk of hypoglycemia with insulin administration?

A

when insulin is PEAKING

always know onset, peak + duration of insulin

47
Q

what is a SE of insulin? (r/t injection site) + what should we do?

A
  1. lipodystrophy –> can cause hard spots @ injection sites

rotate sites, and assess - palpate - sites before admin

Pharm 323 Spring 22 (18 decks)

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