Injectable and Inhaled Insulins Flashcards Preview

Endocrine 1 > Injectable and Inhaled Insulins > Flashcards

Flashcards in Injectable and Inhaled Insulins Deck (23):

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

about 1%


Contraindications to GLP-1 agonists

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


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


Additional contraindication to Byetta (GLP-1)

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


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)


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)


What are the rapid acting insulin preps?



What are the long acting insulin preps?



short acting insulin prep

Regular (Humalin R and Novalin R)


intermediate acting insulin prep

NPH (Humalin N and Novalin N)


Bolus insulin



Basal insulin



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

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


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


What is the purpose of rotating insulin injection sties?

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


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)


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)


which insulins should be clear vs. cloudy?

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


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


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%


titration options

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


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


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