Insulin therapy for T1D + T2D Flashcards
(41 cards)
Rapid acting insulin analog
- name
- method
- onset of action
- duration
Humalog
Novolog
Glulisine
subcutaneous injxn
onset: 5-15 min,
last 3-5 hrs
When should you use rapid acting insulin analogs?
inject subQ just before a meal to prevent postprandial hyperglycemia
(no adv over IV infusion of recombinant hu insulin)
Short acting human insulin
- name
- method
- onset of action
- duration
Regular insulin
(humulin R, Novolin R)
SubQ or IV
Onset: 30-60 min (IV has immediate effect)
Lasts: 6-8 hours
When should you use short acting hu insulin?
use 30 min prior to meals,
IV: DKA, hyperosmolar/hyperglycemic state, perioperatively
- has immediate effect
Long acting insulin analogs
- name
- method
- onset of action
- duration
Glargine
Detemir
Sub Q
Onset: 1.5 hours
Duration: 24 hours
(note: it is injected into the pH neutral SubQ even though it is acidic, bc that is what gives it the slow release)
When should you give long acting insulin?
once a day to provide basal coverage
*note: acid pH, cannot be mixed with other insulins
Intermediate acting insulins
- name
- method
- onset of action
- duration
NPH, Humulin N, Novolin N.
*cloudy
SubQ
Onset: 1-3 Hrs
Duration: 12-16 hoursd
When should you give intermediate acting insulins?
NPH used to treat mid day hyperglycemia associated with lunch, and to act as a basal insulin
- twice daily injxns
Bolus insulin made up of?
Prandial and correctional insulin doses
- pts on this are on the “basal bolus therapy”
Basal insulins you can use
glargine
Detemir
NPH
(without this, pts with T1D can get DKA, and T2D can get severe hyperglycemia)
Prandial insulins you can use
humalog
novolog
apidra
*same same for correctional
Correctional doses of insulin you can use
Humalog
novolog
apidra
*same for prandial insulins
Ratio of number of grams of carbs that 1 unit of insulin is anticipated to cover
C:I
15:1 or 20:1
(insulin R indiv are 10:1)
How many KCal/g is in carbs and fat
Carbs: 4KCal/g
Fat: 9KCal/g
(average expenditure is 30KCal/kg/day)
dawn phenomenon
hyperglycemia in response to surge in growth hormon/cortisol (CRH)
- give them a bit more insulin (0.9 units/hr instead of 0.6 in between 4am-8am)
LDL = ?
TC - HDL - (TG/5)
TG/5 is estimate of VLDL
early morning hyperglycemia can be due to?
Clinical pearls
- inadequate basal insulin dosing
- bedtime hyperglycemia
- waning effect of basal insulin
- somogyi effect
Somogyi effect
nocturnal hypoglycemia causing a surge of CRH –>
morning hyperglycemia
*dawn phenom: surge of GH
preferred method for achieving control of inpatient hyperglycemia
insulin therapy
- discontinue oral agents at time of hospital admission
INsulin secretagogues
- action
sulfonureas
- enhance endogenous insulin by increasing b cell secretion by closing ATP sensitive K channels in membrane . . . yadi yada
side effects of sulfonureas
hypoglycemia
weight gain
Metformin
- action
acts at liver to potentiate effects of insulin on glucose production
(helps insulin)
- does not stimulate insuling secretion (sulfonureas)
Side effects of metformin
GI:
n/v
bloating
diarrhea
-lactic acidosis if they are at higher risk
on plus side, thanx to that, NO weight gain! NO hypoglycemia when used as monotherapy
Contraindications to metformin use
- CHF
- IV iodinated contrast media
- Renal impairment
- met acidosis
