WEEK 3+4 PHARMA

Question 1

Insulin is always required for type 2 diabetes. True or false?

Answer 1

False, Always required for type 1 diabetes

Question 2

What is done for people with type 1 diabetes when body does not produce endogenous insulin?

Answer 2

replacement therapy

Question 3

goal of insulin therapy

Answer 3

prevent long term complications of diabetes by keeping BG levels within targeet ranges

Question 4

Are insulin requirements the same throughout for everybody?

Answer 4

No, it varies in response to fluctations of BG that occur with daily activities - excersise, sleeping, eating

Question 5

Insulin: indication, moa, desired effects and adverse effects

Answer 5

Indication: required for those with type 1 diabetes and for those whose BG is uncontrolled in type 2 diabetes
Mechanism of action: replacement for endogenous insulin - literally works like endogenous insulin
Desired effects - restores ability to metabolize carbohydrates, fats and proteins, glucose uptake by cells
Adverse effects: Hypoglycemia (taking too much insulin, not timing insulin right with food intake, skipping a meal)

Question 6

TCSD - Totally Care Seeing you Die

Signs of hypoglycemia

Answer 6

T- Tachycardia
C - confusion
S - sweating
D - drowsiness
If severe - convulsions, coma, death

Question 7

How is hypoglycemia treated

Answer 7

glucagon, D50W or glucose source

Question 8

Are insulin dosages/routes the same for everyone? if so, what does it depend on?

Answer 8

No, doses and route are higly individualized for each client
depends on - how many doses daily, type of insulin (long vs short)

Question 9

Common route for insulin

Answer 9

subcutaneous

Question 10

why is insulin given subcu and not orally or any other way?

Answer 10

if intramuscular - uptake is super fast and can be inconsistent
if oral - goes through digestive enzymes and may not produce action

Question 11

what is an insulin pump?

Answer 11

• to deliver small doses of insulin at predetermined intervals, with large boluses programmed manually at mealtimes
• pump delivers insulin through small pliable catheter that is anchored in SC tissue of abdomen

Question 12

Types of insulin

Answer 12

Rapid - Lispro
Short acting (regular) - Humulin-R
Intermdiate acting - Humulin - N
Long acting - glargine

Question 13

Diabetes checklist

Answer 13

1. USE - basal-bolus injection therapy or continuous subcutaneous insulin injection
2. TAILOR - insulin regimen to treat individual treatment goals lifestyle, diet, age, general health, motivation, hypoglycemia motivation, self management
3. COUNSEL- about the risk, prevention and treatment of insulin-induced hypoglycemia

Question 14

Difference between basal - bolus injection therapy and continuous subcutaneous insulin infusion

Answer 14

• Basal-bolus injection therapy - bolus insulin at mealtime+basal insulin once or twice a day
• continuous subcu insulin infusion - insulin pump therapy with a continuous subcutaneous infusion of insulin via a catheter

Question 15

Rapid:Lispro

Answer 15

• bolus injection
• prandial - 15 minutes before or after a meal
• onset of action - 10-15 minutes
• peak - 30-60 minutes
• duration of action - 5 hours or less
• used in combination with intermediate or long acting insulin - basal

Question 16

short acting - Humulin R

Answer 16

-AKA regular
- bolus injection
- given 30 minutes before meal with one or more meals
- hypoglycemic reactions can occur if regular insulin is not supported by suffiecient food or is given to hypoglycmeic patients
- onset - 30-60 minutes
- peak effect- 2-3 hours
- duration of action - 5-7 hours

Question 17

Intermediate - Humulin N

Answer 17

• basal insulin
• often started once daily at bedtime
• can be given once or twice a day , not specific to meals
• onset - 1-3 hours
• peak effect - 5-8 hours
• duration of action - longer acting source of insulin - upto 18 hours

Question 18

Long acting - Glargine

Answer 18

• basal insulin
• once daily at bedtime
• no specific peak (provides consistent BG levels)
• onset - 90 minutes
• duration - upto 24 hours

Question 19

Role of nurse: insulin therapy

Answer 19

• familiar with onset, peak, duration
• convey info to client
• explain hypoglycemia and DKA and what actions to take
• not all insulin are compatible and may not be mixed together in a single syringe
• provide education bout insulin, potential adverse effects, technique for self administering insulin, diet and lifestyle
• monitor - BG levels, increase frequency of testing if client has fever, vomiting, diarrhea, weight on regular basis, serum K levels, urine for ketones if BG above 14mmol/L, signs of long term complication
• rotate injection sites and monitor for signs of irritation/infection
• have client report adverse effects related to insulin therapy

Question 20

When is hypoglycemia most likely to occur?

Answer 20

• when insulin reaches its peak effect
• during excersise - depletion of glycogen stores needd to compensate for you working out
• acute illness

Question 21

why is insulin used in caution for pregnant clients or those with severe stress/infection

Answer 21

• increased insulin requirements and must be monitored more carefully

Question 22

Client education - insulin therapy

Answer 22

• closely monitor BG before each meal and before insulin adminsitration
• always carry source of simple sugar in case of hypoglycemic reactions

Question 23

what do you do If BG less than 4 mmol/L

Answer 23

take a fast acting carbohydrate (15g glucose tablets, 3tsp sugar or 1/2 cup orange juice)
- repeat in 15 minutes if blood glucose is still less than 4mmol/L
- is there is more than 1 hour until next meal, eat a snack of starch and protein

Question 24

remember hypoglycemia - too much insulin is given

Signs of hypoglycemia

Answer 24

• nervousness
• confusion
• excessive sweating
• rapid pulse
• tremors
• signs of overdose

Question 25

# remember hyperglycemia (too much glucose - insulin is not right) Signs of hyperglycemia

Answer 25

- increased thirst or urine output - decreased appetite - excessive fatigue

Question 26

what to do when youre not sure about whether they are hypo/hyperglycmeic?

Answer 26

treat for hypoglycemia - hypoglycemia progresses rapidly and hyperglycemia progresses slowly

Question 27

why do we need to rotate insulin sites?

Answer 27

to prevent lipodystrophy - person lose fat from parts of body and gains it in organs

Question 28

do I keep insulin vials in the fridge?

Answer 28

No, store at room temp but refrigerate to keep it stable when not needed

Question 29

Pharmacotherapy in type 2 diabetes

Answer 29

1. choose intial therapy based on glycemia 2. start with metformin 3. individualize your therapy choice based on characterists of the person with diabetes and the agent 4. reach target within 3-6 months of diagnosis

Question 30

if glycemic targerts are not achieved in 3 months, what do you do (type 2)

Answer 30

antihyperglycmeic therapy should be added to reduce the risk of microvascular complications

Question 31

why is metformin chosen over other agents

Answer 31

due to its low risk of hypoglycemia and weight gain

Question 32

Choice of therapy? (type 2)

Answer 32

A1C<1.5% over target - initate healthy behavior intervention and start metformin if not at target in 3 months or start metformin with healthy behavior interventions A1C> 1.5% over target - start metformin with healthy behavior interventions or consider second concurrent agent

Question 33

How is type 2 diabetes controlled?

Answer 33

- some clients can achieve target BG levels with nutrition guidance and physical activity alone - but most also need oral antihyperglycemic drugs - insulin only prescribes when BG not controllable by other means

Question 34

So when is insulin used for type 2 diabetes?

Answer 34

- symptomatic hyperglycemia and/or metabolic decompensation - polyuria - polydipsia - weight loss - volume depletio - start insulin with/without metformin

Question 35

Three core mechaninsms contributing to type 2 diabetes?

Answer 35

- decreased insulin stimulated glucose uptake - insulin resistance - impaired insulin secretion - beta cell dysfunction - excessive glucagon secretion and increased hepatic glucose production