Flashcards in Oral Glycemics 2 Deck (18)
Which two types of drugs is hypoglycemia most common in? What are some risk factors for hypoglycemia?
-sulfonylurea drugs and insulin
->60 years old, impaired renal function, poor nutrition, liver disease, increased physical activity
List some of the symptoms of hypoglycemia.
-confusion, slurred speech, dizzy
What are the treatment options for hypoglycemia?
2) Glucagon- prophylactic rx for those at high risk (type 1 and type 2 with previous severe low blood sugar)
When is a glucagon emergency kit used? Whats given if a patient in the hospital has severe hypoglycemia?
-if unconscious or unable to swallow
-after administration turn on side and call 911
-Hospital: IV dextrose
What are some possible causes of oral therapy inadequacy (failure to reach targeted treatment goals)?
-dietary noncompliance and physical activity
-simultaneous use of diabetogenic drugs
-progressive B-cell dysfxn
What is Amylin? Name the Amylin analog that is used in insulin-requiring diabetics.
-peptide released with insulin from B cells that slows gastric emptying, suppresses postprandial glucagon secretion and reduces appetite
-Analog: Pramlintide (injection before meals)
Which patients is insulin used in?
-Type 1 diabetics
- Type 2 when there is glucose toxicity, insufficient endogenous insulin or a contraindication to oral therapy
**DO NOT use Insulin as a threat, last resort or as a reflector of pt compliance failure**
What are some of the reasons patients have for not wanting to use insulin?
-fear of injection
-permanence of having to take insulin
-failure in managing their diabetes
-inconvenience of monitoring
-fear the demands of insulin therapy
What are some indications for using insulin in type 2 diabetics?
-significant hyperglycemia at presentation
-hyperglycemia at max doses of oral
-Decompensation (weight loss, injury, stress, MI)
-renal or hepatic disease
What are the 3 rapid acting insulins?
Onset: 5-30 min, Peak: 0.5-3 hrs, Duration: 3-5 hrs
What is the short acting insulin?
regular insulin-only insulin that can be given IV
Onset: 30-60 min; Peak: 1-5 hrs; Duration: 6-8 hrs
What are the 4 intermediate acting insulins?
Onset: 1-4 hrs, Peak: 4-10 hrs, Duration: 14-24 hrs
Detemir at lower doses Onset: 3-4hrs, Peak: 4-8hrs, Duration: 6-24hrs
What are the 2 long acting insulins?
Detemir- at higher doses
Glargine-can't be mixed in syringe with any other type insulin (Onset: 2-3 hrs; Peak: none, Duration: 24-30 hrs)
**used for basal insulin**
Name the 5 premixed insulins and what their components are.
Humulin/Novolin (70/30) -30% reg and 70% NPH
Novolog Mix (70/30)- 30% aspart and 70% aspart protamine
Humalog Mix 75/25- 25% lispro and 75% lispro protamine
Humulin 50/50- 50% reg and 50% NPH
Humalog Mix 50/50-50%lispro and 50% lispro protamine
What are some advantages to using premixed insulin?
-longer shelf life
-less dosing errors
What are some disadvantages to using premixed insulin?
-Loss of flexibility (matching to carb intake and activity)
-harder to tx short term high or low glucose levels
**rarely used in Type 1**
How is Insulin stored?
-refrigerated, never freeze, avoid direct sunlight