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Pt.2 PHRM/PHYS/NS > Week 1 Glucose Regulation > Flashcards

Week 1 Glucose Regulation Flashcards

1
Q

Review of glucose regulation :
what is alpha cells ?
what is beta cells ?
what does lysis means ?
what does genesis mean ?
what is ketogenesis?

A

alpha cells secretes and makes glucagon

beta cells secretes and makes insulin

lysis means breaking

genesis means making

ketogenesis is the byproduct o fat breakdown

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2
Q

Review of glucose regulation :
Once the cells are fed ( after eating a meal) what happens to glucose ( what does it convert to? ) and what does it mean ?

A

glucose is converted to glycogen, this is the storage form of glucose

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3
Q

true or false. When you have been asleep for hours, this typically results in a lower blood sugar due to not eating or no nutrients entering the body.

A

this is true

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4
Q

what is the normal range of blood sugar ?

A

4-6 mmol/L

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5
Q

Review of glucose regulation.
Try to revise the diagram given in the slides, ( make it simple )

A

Glucose is going to be converted to glycogen ( keep it reserve when blood sugar drops we have something to use –> keeping in in storage)

the body has the capacity to maintain energy and impulse of energy in order to function.

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6
Q

Glucose regulation continued ; hormones
What causes increase blood glucose?

A

epinephrine
cortisol
growth hormone
glucagon

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7
Q

does epinephrine and no epinephrine cause an increase in blood glucose? and if so why?

A

yes it does, i gets released by physiological stress

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8
Q

what type of hormones decreases blood glucose?

A

GLP 1 ( glucagon like peptide 1 ) and insulin

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9
Q

What is this describing : a hormone that inhibits the normal action of glucagon which slows gastric emptying and increases pancreatic insulin secretion

A

glucagon like peptide 1 ( GLP 1 )

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10
Q

describe what glucagon like peptide 1 ( GLP 1 ) mean?

A

a hormone that lives in the gut that secreted when we eat : what it does is that inhibits the normal action of glucagon which slows gastric emptying and increases pancreatic insulin secretion

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11
Q

this is a condition where by normal glucose regulation is malfunctioning

A

diabetes mellitus

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12
Q

True or false. Glucosuria is a major symptom and along with sweet swelling pee.

A

true

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13
Q

what are the major complications for hyperglycemias

A

microvascular and macrovascular

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14
Q

what are the acute complications for hyperglycemia

A

polyuria
polydipsia
polyphagasia
glucosuria

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15
Q

what is this describing : no endogenous ( completely stop ) secreting insulin

A

type 1 diabetes

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16
Q

Describe what type 1 diabetes mean?

A

pancreas’s failure to produce enough insulin due to loss of beta cells

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17
Q

describe what type 2 diabetes mean ?

A

insulin resistance contributes to high glucose levels in the blood

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18
Q

true or false. Type 2 diabetes, is an inappropriate glucose production by the liver.

A

this is true

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19
Q

goals of treatment for diabetes

A

manage symptoms of hyperglycemias

prevent long term complications of hyperglycemias

maintain euglycemia and glucose regulation

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20
Q

symptoms of acute hyperglycemia

A

significantly increased thirst
frequent urination
weight gain or loss
extremely tired or no energy
blurred vision

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21
Q

Why does blurred vision occur as a symptoms during an acute hyperglycemia

A

because swelling may occur in the lens ( and the lens is in charge of focusing, therefore blurred vision may occur )

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22
Q

What are the 3 P’s and G symptoms of acute hyperglycemia

A

polyuria
polydipsia
polyhagia

glosuria

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23
Q

long term complications of hyperglycemia

major complications of diabetes
name what undergoes microvascular and macrovascular

A

microvascular
1. eye
2.kidney
3.neuropathy

macrovascular
1.brain
2.heart
3.extremities

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24
Q

Re-call the eye, kidney, and neuropathy undergoes microvascular ( describe each and how it contributes to the long term complications of hyperglycemia)

A

eye
- high blood glucose and high blood pressure can damage eye blood vessels, causing retinopathy, cataracts, and glaucoma

kidney
- high blood pressure damages small blood vessels and excess blood glucose overworks in the kidneys, resulting in nephropathy

neuropathy
- hyperglycemia damages nerves in the peripheral nervous system. This may result in pain and or numbness. Feet wounds may go undetected, get infected and lead to gangrene.

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25
Q

describe what undergoes macro-vascular in terms of major complications of diabetes, and describe each of the category.

A

brain
- increased risk of stroke and cardiovascular disease, including transient ischemic attack, cognitive impairment

heart
- high blood pressure and insulin resistance increase risk of coronary heart disease

extremities
-peripheral vascular disease results from narrowing of blood vessels increasing the risk for reduced or lack of blood flow in legs. Feet wounds are likely to heal slowly contributing to gangrene and other complications

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26
Q

true or false. Insulin is released in a basal/bolus fashion, meaning insulin release is close to meals or stressors ( and there is a background always secreting at a lower level )

A

true

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26
Q

the role of insulin in the body :
metabolic actions of insulin
what are the substance affected ?

A

carbohydrates
amino acids
lipids

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26
Q

the role of insulin in the body: metabolic actions of insulin insulin action that undergoes the substance of carbohydrates

A

increase glucose uptake
increase glucose oxidation
increase glucose storage
increase glycogen synthesis
decrease glycogenolysis
gluconeogenesis

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27
Q

site of action of the following insulin in the body: carbohydrates and insulin action

A

increase glucose uptake - muscle, adipose tissue
increase glucose oxidation - muscle
increase glucose storage
increase glycogen synthesis
decrease glycogenolysis
- muscle, liver
gluconeogenesis
- liver

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28
Q

the role of insulin in the body substance affected : amino acids and proteins
describe what is happening in the insulin action

A

increase amino acid uptake
decrease acid release
increase protein synthesis

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29
Q

where is the site of action for the increase amino acid uptake
decrease acid release
increase protein synthesis that undergoes amino acids and protein

A

all muscle

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30
Q

the role of insulin in the body: metabolic actions of insulin what is the insulin action ? (lipids)

A

increase triglyceride
decrease release of FFA and glycerol
decrease oxidation of FFA to ketoacids

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31
Q

the role of insulin : metabolic actions of insulin of lipids : where is the site of action?

A

adipose tissue
adipose tissue and liver

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32
Q

insulin therapy: who needs it and who might need it ?

A

type 1 diabetes - pancreatic no longer secretes insulin therefore these patients needs endogenous insulin to survive insulin independent diabetes mellitus

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33
Q

true or false:
1. NPH insulin is intermediate acting and is approved for mixture with rapid and short acting insulins
2. Glargine should be administered once daily and peaks within 10 hours
3. Insulin is a high alert medication
4. after administering insulin, the nurse will monitor for signs and symptoms of hypoglycemia. these include thirst, blurred vision and increased urination
5. if after giving insulin the patient becomes hypoglycaemic and loses consciousness, I will give them an oral glucose source such as: glucose tablets, orange juice or candies
6 beta blockers mask sympathetic nervous system warning signs of hypoglycemia
7. being 30 mins early or late in administering my patients insulin is not a serious problem. I am still within my “window”

A
  1. true
  2. false
  3. true
  4. false
  5. false
  6. true
  7. false
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34
Q

insulin therapy continued , what are the adverse effects ?

A

hypoglycemia
hypokalemia
lipodystrophy

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35
Q

what is recumbent

A

exogenous ( injectable insulin made using recumbent dna technology ) another word for artificial ( mimics the insulin )

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36
Q

what are the four categories under non-insulin diabetic medications?

A

insulin sensitizers
incretin agents
insulin secretagogues
miscellaneous (glucose wasters)

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37
Q

Insulin is also used to treat what ?

A

elevated serum potassium (hyperkalemia)

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38
Q

what falls under insulin sensitizers?

A

biguanide (metformin)
TZDs (Rosigilitazone)

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39
Q

Types of insulin

A

short duration, rapid acting
short duration
intermediate duration
long duration
ultra long duration
combination insulin

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40
Q

what falls under incretin agents?

A
  • GLP 1 receptor agonists (Liraglutide)
  • DPP 4 Inhibitors (Sitagliptin)
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41
Q

what falls under insulin secretagogues?

A
  • Sulfonylureas (Glyclazide)
  • Meglitinides (Repaglinide)
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42
Q

what falls under miscellaneous (Glucose wasters)?

A
  • SGLT 2 Inhibitors (Canagliflozin)
  • Alpha- glucosidase Inhibitors (Acarbose)
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43
Q

generic brand/name of types of insulin for short duration, rapid acting

A

insulin lispro ( humalog)
insulin aspart ( novolog )

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44
Q

go more into depth with insulin sensitizers metformin and thiazolidinediones/TZDs Rosiglitazone?

A

Biguanides Metformin (Glucophage):
MOA: 1)Decreases glucose production in the liver
2) Decreasing insulin resistance in muscle and fat cells
3) Slightly reduces glucose absorption in the gut

Side Effects: GI upset, lactic acidosis, decreased appetite

Thiazolidinediones /TZDs
Rosiglitazone (Avandia)
MOA: 1) Decreasing insulin resistance in
muscle and fat cells
2) Decreases glucose production in the liver

Side Effects:
- most common URTI, HA,
sinusitis, and myalgia.
- greatest risk is heart failure

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45
Q

generic/brand name for short duration, short acting

A

regular insulin ( humulin R )

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46
Q

types of insulin : intermediate duration what is the generic/brand name for it

A

neutral protamine hagedorn insulin suspension ( NPH )

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47
Q

types of insulin : long duration : what is the generic/brand name

A

insulin giargine ( lantus)

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48
Q

what is GLP 1 Receptor Agonists
Liraglutide (Victoza)?

A

MOA: Activates
receptors for GLP-1
Side Effects: GI upset, allergic rxn, pancreatitis, thyroid Ca

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49
Q

what is DPP 4 Inhibitors Sitagliptin (Januvia)?

A

MOA: inhibiting DPP 4 (blocks the breakdown of GLP 1 incretins)
Side Effects:
pancreatitis, allergic rxn

essentially shuts it downnnn!!

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50
Q

types of insulin : ultra-long duration -> what is the generic/brand name

A

insulin degiudec ( tresiba)

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51
Q

what is Sulfonylureas Gliclazide (Diamicron)?

A

MOA: Stimulation of pancreatic insulin release
may also increase target cell sensitivity to insulin
Side Effects: hypoglycemia, weight gain

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52
Q

what is Meglitinides Repaglinide
(GlucoNorm)?

A

MOA: Stimulation of pancreatic insulin release

Side Effects:
hypoglycemia, weight gain

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53
Q

types of insulin : combination insulin –> what is the generic/brand name

A

humulin 50/50

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54
Q

what is SGLT 2 Inhibitors Canagliflozin (Invokana)?

A

MOA: Inhibits SGLT-2 in the kidney→reduces reabsorption of glucose
Increases urinary glucose excretion
Side Effects:
Yeast infections, UTIs, Dehydration, Hyponatremia

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55
Q

what is the indication for short duration, rapid acting (inuslin lispro, insulin aspart )

A

used to control post prandial ( post meal ) increases in blood glucose

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56
Q

what is Alpha-Glucosidase Inhibitors Acarbose (Glucobay)?

A

MOA:
Delays absorption of dietary carbohydrates
Side Effects:
GI upset, anemia, liver dysfunction

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57
Q

connection between beta blockers and blood glucose?

A

if on beta blocker - they wont have early signs of hypoglycemia

58
Q

what is the indication for short duration, short acting ( regular insulin ( humulin R )

A

used to control post prandia ( post meal) increases in blood glucose when given via subcut injection

59
Q

what is the indication for intermediate duration ( neutral protamine gagedorn insulin suspension NPH )

A

used to control blood sugars between meals and during the night

60
Q

what is indication for long duration ( insulin giargine ( lantus )

A

used to achieve basal coverage for full 24 hours

61
Q

what is indication ultra long duration ( insulin degiudec ( tresiba )

A

used to achieve basal coverage for full 24 hours

62
Q

what is the indication combination insulin ( humulin 50/50 )?

A

a single vial or cartridge contains a fixed ration of insulin ( % of rapid acting or short acting insulin to % of intermediate- acting insulin )

63
Q

what is basal and bolus in terms of insulin?

A

basal: This is long-acting insulin that you get once or twice a day. It gives a small but constant stream of insulin.

bolus: This is short-acting insulin that you get at mealtime. It gives your body an extra burst of insulin.

64
Q

what are the bolus insulins?

A

short duration, rapid acting
( insulin lispro -> humalog)
( insulin aspart –> novolog )

short duration, short acting
(regular insulin, humulin R )

65
Q

what are the basal insulins

A

intermediate duration ( NPH)
long duration ( insulin giargine Lantus)
ultra-long duration ( insulin degludec - tresiba )

66
Q

what are the premixed insulins

A

combination insulin ( humulin 50/50)

67
Q

route for short duration, rapid acting
( insulin lispro )

A

usually subcut injection or subcut infusion pump

68
Q

route for short duration, short acting
( regular insulin ) ( humulin R )

A

can be used for subject injection, subcut infusion pump, and intravenous

69
Q

What is the route for intermediate duration ( NPH )
long duration ( insulin giargine ( lantus )
ultra long duration ( insulin degludec ( tresiba )

A

intermediate duration
1. subcut injection only
Long duration
1. subcut injection
ultra-long duration
1.subcut injection ( prefilled pens only )

70
Q

what is the route for premixed insulins ( combinations insulin )

A

subcut injection

71
Q

when to administer short duration, rapid acting ( insulin lispro ( humalog ) , insulin aspart ( novolog )

A

within 15 minutes before or just after the meals
5- 10 mins before meals

72
Q

when to administer short duration. short acting ( regular insulin –> Humulin R )

A

30 minutes before meals

73
Q

why is peak and onset key consideration for general practice nurses ?

A

this tells us when the patient will be risk for hypoglycemia

74
Q

when to administer basal insulins :
intermediate duration (NPH)
long duration (insulin giargine (Lantus)
ultra-long duration ( insulin degludec ( tresiba)

A
  1. twice daily at the same times each day ( am + pm)
  2. once or twice daily at same times each day ( morning, afternoon, or evening )
  3. once daily
75
Q

when to administer combination insulin ( humulin 50/50)

A

twice daily

76
Q

indicate the onset for bolus insulins
short duration, rapid acting ( insulin lispro ( humalog )
- insulin aspart ( novolog )

short duration, short acting ( regular insulin ( humulin R)

A

15-30 mins
10-20 mins

short duration, short acting
30-60

77
Q

indicate the basal insulins onset :

intermediate duration ( NPH )
Long duration ( insulin giargine (lantus )
Ultra-long duration ( insulin degludec ( tresiba)

A

NPH = 60-120
long duration ( insulin giargine ( lantus) =70
ultra long duration ( insulin degludec( tresiba )= 30-90

78
Q

indicate the premixed insulins
combination insulin ( humulin 50/50) onset

A

15-30

79
Q

true or false. insulin R can also be given via IM although this s quite rare ( this can also be given through IV during acute situations)

A

true

80
Q

what is the main difference between bolus insulin and basal insulin ?

A

main difference is their chemical structure

81
Q

isophane insulin paired by regular insulin for prodiamine ( large protein) , now the presence of this large protein does what ?

A

decrease the solubility which delays the reabsorption, onset is also delayed and cannot be administered during meal times ( it’s not going to hit that spike

81
Q

true or false. long duration, slowest acting should always be done at the same time

A

true

82
Q

what is the only insulin applicable to mix with acute short acting insulin ?

A

NPH

83
Q

true or false. Patients with type 1 diabetes, needs an intense basal bolus strategy ( need to get on top) since there is no endogenous insulin being secreted.

A

true

84
Q

what are different types of devices for insulin?

A

insulin syringe
insulin pen
jet injector
insulin pump

85
Q

name one of the most important nursing considerations for insulin therapy

A

injections within the chosen area should be made in different parts even an inch apart and this should be changed up once a month if not more often

86
Q

nursing consideration for insulin therapy: ultra long insulin can come in much higher concentration (name the range)

A

100 to 300 mL

87
Q

true or false. nursing considerations for insulin therapy. it is important to be well aware of the concentration of the insulin your are administering

A

true

88
Q

Amongst all the considerations we talked about previously, what is another thing we should consider when doing an insulin therapy?

A

next thing to consider is the site for the administration ( sub cut , etc)

89
Q

how should insulin be stored?

A

insulin should be stored unopened ( stored in a refrigerator) vial should never be opened, and insulin can be used up to the expiration date to vial

90
Q

how should vial that has been used be kept ?

A

vial in use however should be kept in room temperature up to a month without significant lose of activity

91
Q

true or false. Pen insulin are common used, and they do not contain a disposable needle on the end.

A

false, they do contain a needle on the end

92
Q

true or false. jet injector shoots insulin indirectly though the skin ( subcut ) there is no needle

A

false, jet injector shoots insulin directly though the skin

93
Q

what are the recommended devices used as an insulin therapy for people who suffers within needle phobia?

A

jet injector, however it is expensive, and include a high pressure ( known to sting, burn, and pain ) initially causing a bruise.

94
Q

This is a computer like insulin device, deliver basal and infusion of insulin ( bolus dose before meals )

A

insulin pumps

95
Q

what are the five main categories or types of insulins ?

A

short duration, rapid acting
short duration, short acting
intermediate duration
long duration
ultra long duration

extra good to know ! = combination insulin

96
Q

how do nurses know when an insulin is at its highest potential to cause hypoglycemia after administration?

A

peak and onset

97
Q

name the non insulin medications used to treat DM

A

biguanides ( metformin )
sulfonylureas ( gliclazide )
TZDs
GLP 1 receptor agonists
DPP 4 inhibitors
Meglitinides
SGLT 2 inhibitors
Alpha glucosidase inhibitors

98
Q

Anti hyperglycemic medications

name what is under the categories:

  1. Insulin sensitizers
  2. Incretin agents
  3. Insulin secretagogues
  4. Miscellaneous ( glucose waters )
A
    • biguanide ( metformin )
      - TZDs ( Rosiglitazone )
  2. GLP 1 receptor agonists ( Liraglutide )
    - DPP 4 inhibitors ( Sitagliptin )
  3. Sulfonylureas ( Gliclazide )
    - Meglitinides ( Repaglinide )

4.SGLT 2 inhibitors ( canagliflozin)
- Alpha glucosidase inhibitors ( acarbose)

99
Q

DRUG CARD REVIEW : Metformin ( Glucophage )
what is the MOA
Indication for the med
Nursing considerations
Therapeutic effect
Adverse effects

A

MOA : lowers blood glucose and improve glucose tolerance in 3 ways
1. it inhibits glucose production in the liver
2. It sensitizes insulin receptors in target tissues ( fat and skeletal muscle )–> increasing glucose uptake
3. Slightly reduces glucose absorption in the gut

Indication: Diabetes type 2

nursing consideration : consider renal functioning

therapeutic effect : glycemic control

adverse effects :
GI disturbances
apetite suppression and weight loss
Vit B and folic acid deficiencies
lactic acidosis ( rare)

100
Q

DRUG CARD : Thiazolidinediones ( TZDs ) : glitazone is highly prescribed true or false.

A

true

101
Q

DRUG CARD : Thiazolidinediones ( TZDs ) : Glitazones

what is the exemplar
MOA
Indication
Therapeutic effect
Adverse effect

A

exemplar :
rosiglitazone ( avandia ) & Pioglitzone ( Actos)

MOA : Primary : decreasing insulin resistance in muscle and fat cells
secondary : decreases glucose production in the liver

indication: diabetes type 2 ( used as an add on to metformin )

therapeutic control : glycemic control

adverse effects :
upper respiratory tract infection, headache, sinusitis

heart failure secondary to renal retention of fluid

should not be used in combination with insulin –> increased fluid retention

102
Q

DRUG CARD: GLP- 1 receptor agonists : incretin memetic

what is the exemplar
MOA
indication
therapeutic effect
adverse effects

A

liraglutide ( victoza )
MOA: activate receptors for GLP-1
Remember: GLP 1

inidcation :
diabetes type 2

therapeutic effect: reduction in blood sugar induce weight loss

adverse effects : pain at injection site
diarrhea, nausea, and constipation anaphylaxis
pancreatitis
black box warning re: thyroid cancers

103
Q

true or false. Ozempic is a GLP 1 receptor ?

A

yes this is true

104
Q

what does incretin usually do in the body ?

A

they slow gastric emptying and they stimulate glucose dependent
this is important to note ( the food inhibits glucose secretion and suppresses appetite)

105
Q

what is th noninsulin injectable agents ?

A

incretin receptor agonists : incretin memetic

106
Q

what is the nursing consideration when it comes to GLP 1 receptor agonists : incretin memetic

A

slow gastric emptying and therefore slow absorption o other drugs ( taking meds relying on the peak plasma levels ) antibiotic or oral contraceptives

107
Q

true or false. GLP 1 receptor agonists : incretin memetic do not cause hypoglycemia on it’s own, however when it’s used with combination when it increases the risk

A

true

108
Q

DRUG CARD: DIPEPTIDYL peptidase-4 ( DPP 4 ) inhibitors : (Gliptins)
what is examplar
MOA
Indication
Therapeutic effect
Adverse effects

A

Exemplar : Sitagliptin ( Januvia)

MOA : Prevent glucose levels from climbing high after eating

DPP-4 is an enzyme that inactivates incretin hormones

the drug inhibits DPP 4, therefore incretin hormones are not inactivated

enhances the actions of incretin hormones
- increase insulin secretion
-suppress glucagon secretion
-reduces liver production of glucose
-delays gastric emptying

Indication : diabetes type 2

therapeutic effect : reduction in blood

adverse effects:
hypoglycemia when used with a sulfonylurea

pancreatitis ( severe yet rare)

hypersensivity ( anaphylaxis and stevens johnston’s )

109
Q

DRUG CARD : SULFONYLUREAS

what is the exemplar
MOA
Indication
Nursing considerations
Therapeutic effect
adverse effects

A

exemplar: gliclazide ( diamicron )

MOA: stimulates the release of insulin from pancreatic beta cells, and may increase target cell sensitivity to insulin ( secretagogues- drugs that increase insulin secretion )

indication : diabetes type 2

nursing consideration : alcohol consumption can potentiate hypoglycemic effect of this drug

Therapeutic effect: glycemic control

adverse effects : hypoglycemia - delivers a dose dependent reduction in blood glucose
-weight gain

110
Q

DRUG CARD : MEGLITINIDES ( may be prescribed with metformin or glitazones)

what is the exemplar
MOA
indication
therapeutic effect
adverse effects

A

exemplar: repaglinide ( GLucoNorm)

MOA: stimulation of pancreatic insulin release
more short acting than glyburide

indication : Diabetes type 2

therapeutic effect: glycemic control -> lower blood sugar levels in patients with diabetes type 2

adverse effects: hypoglycemia -> patients must eat within 30 mins of taking this drug

weight gain

111
Q

additional information about meglitinides

A

shorter acting ( 30 min0 1 hr)
rapidly absorbed and then eliminated rapidly
peak within 1 hour, returning to baseline by after 4 hours

112
Q

why is hypoglycemia an adverse effect when utilizing meglitinides

A

because it’s stimualting that pancreatic insulin resistance -> hypoglycemic is at risk

113
Q

Alpha Glucosidase Inhibitors what type of breakdown is occurring?

A

breakdown of polysaccharide and disaccharide to monochasaride

114
Q

DRUG CARD : Alpha Glucosidase Inhibitors
exemplars
MOA
indication
therapeutic effect
adverse effects

A

exemplar : acarbose ( glucobay )

MOA: delays absoprtion of dietary carbohydrates, thereby reducing increase in blood glucose after a meal

Alpha-glucosidase is an enzyme located in the intestine that normally breaks down carbohydrates for absorption –> the drug inhibits enzyme, slowing digestion of carbohydrates

indication : diabetes type 2

therapeutic effect
reduction in postprandial rise in blood sugar
reduced A1C levels
overall improving glycemic control

adverse effects :flatulence, cramps. distension, hyperactive bowel sounds, and diarrhea

anemia
long term use can lead to liver dysfunction

115
Q

Alpha Glucosidase Inhibitors. true or false. Asymptomatic has occurred 50% patients before we wanna monitor liver function tests every 3 months

A

true

116
Q

true or false. An adverse effect for alpha glucoside inhibitors would be a decrease absorption of iron?

A

true

117
Q

Description : We must give glucose for hypoglycemia, not sucrose because it will have delayed absorption. Under which non insulin medications does this fall under?

A

alpha glucoside inhibitors

118
Q

Sodium-Glucose Co transporter 2 ( SGLT 2 ) inhibitors , where does this work?

A

they work on the kidney

119
Q

DRUG CARD : Sodium-Glucose Co transporter 2 ( SGLT 2 ) inhibitors
exemplar
MOA
Indication
Therapeutic effect
adverse effect

A

exemplar: canagliflozin ( invokana )
MOA: Inhibits SGLT -2 in the kidney -> reduces reabsorption of glucose
increases urinary excretion
indication : diabetes type 2

therapeutic effect : improves glycemic control
improve weight loss

adverse effect :
yeast infections in females
urinary tract infections
increased urination ( dehydration)
hyponatremia
Postural hypotension and dizziness

120
Q

what are the different kinds of insulin in terms of action?

A
  • Rapidacting
  • Short acting
  • Intermediateacting
  • Longacting
  • Ultra-longacting
  • Combo
121
Q

what are the different kinds of non insulin DM meds ?

A
  • Insulinsensitizers
  • Incretin Agents
  • InsulinSecretagogues
  • Miscellaneous
122
Q

review: where is insulin synthesized? by what cells?

A

done in the pancreas, beta cells within the islets of Langerhans

123
Q

true of false: Normally, when we eat a meal, there is increased insulin release

A

true

124
Q

true or false: insulin happening even when theirs no spike in sugar

A

true

125
Q

Which of the following is a consequence of insulin deficiency?
select all:
a. Increased serum blood glucose
b. Decreased gluconeogenesis
c. Decreased cellular glucose uptake
d. Increased glycogen breakdown

A

a, c and d

126
Q

the body needs more insulin in which of the following situations?
Select all That Apply:
a. During exercise
b. Infection
c. During an exam period
d. When fasting
e. Overnight

A

b and c (exercise is complicated)

127
Q

what do insulin lispro and aspart fall under?

A

short duration: RAPID acting insulin

128
Q

go more int depth with insulin lispro ?

A

brand name: Humalog
onset: 1/2 to 2.5 hrs
duration: 3-6 hr

nursing considerations:
* SC inj: ~15 min before or JUST after meals
* Subcut pump: provide continuous glucose control
* Common sliding scale insulin choice

129
Q

what drug (generic) is this? onset: 1/2 to 2.5 hrs
duration: 3-6 hr

A

both insulin lispro and aspart

130
Q

go more int depth with insulin aspart?

A

brand name: Novolog
onset: 1/2 to 2.5 hrs
duration: 3-6 hr
* SC inj: 5-10 mins before meals
* Subcut pump: provide continuous glucose control
* Common sliding scale insulin choice

131
Q

true or false: you give insulin aspart SC 5-10 mins after meals

A

false its only before

132
Q

nursing consideration for which kind of insulin?
* 30 min pre-meal subcut injection for postprandial control
* Subcut pump: provides continuous glucose control (not as popular as rapid acting for this)
* Sometimes used as a sliding scale insulin
* IV route: in acute care settings

A

short acting insulin: regular insulin, very similar to natural insulin made in body

133
Q

nursing considerations:
16-24 hrs
* Subcut inj: twice daily at the same times each day
* Gently agitate before use
* “cloudy insulin”
* Can be mixed with rapid or short acting insulins

key word cloudy!!

A

NPH insulin
brand name:
Humulin N, Novolin N

intermediate acting insulin

134
Q

what re the two drugs the are long acting?

A

insulin glargine and insulin detemir

135
Q

what nursing consideration does this fall under?

  • Subcut inj: typically, ONCE daily at the same times each day
  • Clear insulin
A

insulin glargine and insulin detemir

136
Q

which onset is quicker? glargine or detemir

A

glargine

137
Q

what drug is the ultra long acting?

A

Insulin degludec
Tresiba
30-90 min
None
> 24hrs
Once daily at same time

138
Q

is there such thing as combination insulin, if so give an example?

A

70% NPH insulin/30% regular insulin
Humulin 70/30 Novolin 70/30
better because you need to only give one needle

139
Q

what are bolus insulins? basal insulins? why is that

A

short duration - bolus insulins: insulin lispro, aspart, regular

intermediate and long duration: basal: NPH, insulin Glargine
Insulin degludec

140
Q

what are some non insulin medications used to treat DM?

A
  1. Biguanides
  2. Sulfonylureas
  3. TZDs
  4. GLP 1 receptor agonists
  5. DPP 4 inhibitors
  6. Meglitinides
  7. SGLT2inhibitors
  8. Alpha glucosidase inhibitors
141
Q

what is sliding scale insulin?

A

A sliding scale varies the dose of insulin based on blood glucose level. The higher your blood glucose the more insulin you take.

142
Q

To control postprandial glucose spikes, the healthcare team decides to add which type of insulin before meals?
A) Insulin aspart
B) Insulin glargine
C) NPH insulin
D) Insulin degludec

A

a)

Pt.2 PHRM/PHYS/NS (14 decks)

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