Diabetes 2 Flashcards
(45 cards)
If DM2 pt doesn’t respond to non-insulin therapy in 3-6 months, what do you do?
add another drug or insulin, can use PO and insulin together
If DM2 pt is very symptomatic, what can you do?
start with insulin, skip PO
What is recommended for DM2 pt w/ dec renal function?
glipizide, glimepiride, insulin, TZDs, not glyburide or metformin
What is recommended for DM2 pt w/ dec hepatic function?
insulin, miglitol, sitagliptin, not TZDs, metformin, or glyburide
What is recommended for obese DM2 pts?
metformin, acarbose, not sulfonylureas, TZDs
what is recommended in DM2 pt when hypoglycemia is a concern?
metformin, not insuling, sulfonylureas
When to use short term insulin in DM2 pt?
acute illness, surgery, stress, er, preg, breast-feeding, severe metabolic decompensation aka diabetic ketoacidosis, hyperosmolar nonketotic coma, lactic acidosis, severe hypertriglyceridemia
when to use long term insulin in DM2 pt
if target is not reached after optimal dose of combo therapy, consider change to multi-dose insulin therapy, when initiating, insulin secretagogues should be stopped and insulin sensitizers should con’t
Short acting insulin drugs
Insulin aspart (Novolog), insulin lispro (Humalog), regular insulin (humulin R, novolin R), insulin glulisine (Apidera), insulin inhalation (Afrezza)
Intermediate acting insulin
NPH (Humulin N)
Long acting insulin
Insulin detemir (Levemir), insulin glargine (Lantus)
Clinical uses of insulin
DM1, DM2, hyperkalemia, short term hospitalized pts that are insulin naive
What is the onset, peak of action and duration of short acting insulin? Dosing schedule?
.5-1 hr, 2-4 hrs, and 5-8 hrs, take 30 mins before eating
What is the onset, peak of action and duration of intermediate acting insulin, Dosing schedule?
1-3 hrs, 5-8 hrs, up to 18 hrs, taken at bedtime or twice a day
What is the onset, peak of action and duration of fast acting insulin, Dosing schedule?
90 mins, no peak, 24 hr duration, usually taken once or twice a day
Factors that alter insulin action
route of admin (IV fastest), site of injection (stomach fastest), heat can increase rate of absorption and action, low doses are absorbed more rapidly, pt errors, irregular diet/exss, renal function, stress, drugs
at what conditions is insulin stable?
stable at room temp for 28 days once the vial is open, prefilled syringes are stable 28 days when refrigerated, otherwise 10-28 days
What are advantages of short acting insulin?
decreases post prandial hyperglycemia because of shorter duration, flexibility of schedule (can be given right after meals
What are disadvantages of short acting insulin?
risk of hypoglycemia if planned meal not consumed, needs combined with long acting for optimal BG control, $$
What are advantages of long acting insulin
closely mimics normal physiologic basal pancreatic insulin release, provides 24 hr coverage with a constant absorption and no pronounced peak, good for pts suffering from nocturnal hypoglycemia
What are disadvantages of long acting insulin?
longer hypoglycemia episode in event of too much dose or dec caloric intake, $$$$$
What is insulin glargine (Toujeo)
insulin that is available as 300 units/ml, confusing because there is also insulin glargine (Lantus) which is 100 units
what is a good starting point for insulin dosing?
.1-.2 units/kg/day, or about 10 units daily, always start low and be pt specific
What is once daily injection of long acting insulin good for?
DM2 pts or short term for newly diagnosed DM1 pts
