Injectable and Inhaled Insulins Flashcards Preview

Endocrine 1 > Injectable and Inhaled Insulins > Flashcards

Flashcards in Injectable and Inhaled Insulins Deck (23):
1

What is the expected clinical effect of the GLP-1 agonists on blood glucose control

about 1%

2

Contraindications to GLP-1 agonists

-Type 1 DM
- Ketoacidosis
- Severe GI dz
- Hx of pancreatitis

3

MoA of GLP-1 Agonist

- Activate GLP receptors on the cell surface of beta cells → insulin release in the presence of elevated BG
- Decreases glucagon secretion in a glucose-dependent manner
- Lowers blood glucose by delaying gastric emptying

4

Additional contraindication to Byetta (GLP-1)

ESRD or severe renal impairment (CrCl <30 ml/min)

5

Additional contraindication to Victoza (GLP-1)

Hx or fam hx of medullary thyroid cancer (MTC) or hx of multiple endocrine neoplasia syndrome type 2 (MEN 2)

6

ADRs of GLP-1 Agonist

-MC: dose-dependent nausea
-nausea, HA, diarrhea
-hemorrhagic and necrotizing pancreatitis
-serious hypoglycemia (when used in combo w/ SU or meglitinide)

7

What are the rapid acting insulin preps?

-Novolog
-Humalog
-Apidra

8

What are the long acting insulin preps?

-Lantus
-Levamir

9

short acting insulin prep

Regular (Humalin R and Novalin R)

10

intermediate acting insulin prep

NPH (Humalin N and Novalin N)

11

Bolus insulin

-Novolog
-Humalog
-Apidra
-Regular

12

Basal insulin

-Lantus
-Levamir
-NPH

13

Given a regimen of bolus insulins, select the appropriate administration time.

-rapid acting: 15 min. before meal
-short acting: 30 min. before meal

14

Given a regimen of basal insulins, select the appropriate administration time.

-basal are injected once or twice daily (12 hrs apart) without regard to meals
-the injections should be at the same time daily

15

What is the purpose of rotating insulin injection sties?

to avoid or decrease the development of lipodystrophy (hypotrophy or atrophy)

16

Define U-100, U-200, U-300

-U = number of units of insulin per milliliter of fluid
- Ex: U-100 means there are 100 units of insulin per mL of fluid (same for 200 and 300)
- All vials are 10 mL (1,000 units of insulin per vial)

17

Insulin storage

-unopened vials should be kept in the fridge not freezer
-open vials can be kept at room temp (60-75 degrees) **except Lantus which has to be refrigerated
-discard after 28-30 days
-pens have expiration dates (10-14 days once used)
-keep out of sun and humidity
-avoid excess agitation (don't shake)

18

which insulins should be clear vs. cloudy?

-clear: lantus, regular, humalog, nocolog
-cloudy: NPH

19

clinical indications for the use of insulin in T2D

-severe hyperglycemia (glucose toxicity) BG > 300 mg/dl
-temporary situations like pregnancy
-when co-morbid chronic conditions such as CHF, renal insufficiency or liver dz exists that makes it hard to use oral agents safely
-for tx of acute hyperglycemia complications such as hyperosmotic syndrome

20

Choose the appropriate starting dose and monitoring parameters for a patient with T2DM starting insulin

1. start w/ bedtime basal insulin - 10U or 0.1-0.2 u/kg
2. check fasting BG daily and increase dose 2U q 3 days until fasting levels are in target range
2. if hypoglycemia occurs then decrease dose by 10%

21

titration options

-2U every 3 days
-per the chart: 10-15% or 2-4U once-twice weekly

22

How to initiate a bolus insulin dose in a patient who is already using basal insulin

- Add a rapid acting insulin for post-prandial control
- Start with the time of day blood sugar is highest
- Start with 4 Units, 0.1 U/kg, or 10% of basal dose (Letassy says 5-10 units is fine)
- Adjust dose by 1-2 U or 10-15% once or twice weekly until reach target glucose levels
- Dosing is best based on CHO counting

23

given a pt. on a basal bolus insulin regimen, convert to a split mixed insulin product

-divide current basal dose into 2/3 AM 1/3 PM or 1/2 and 1/2
-increase dose 1-2U or 10-15% once-twice weekly until target is reached