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What 4 things do Oral Hypoglycemic agents do?

-slow intestinal absoprtion of carbs
-stimulate insulin secretion
-decrease cellular insulin resistant
-enhance insulin action
** can be from multiple categories but not 2 from the same category. if you see that question the patient

What does insulin therapy do?

Mimics normal body insulin
-daily dosing and intenstive therapy

What are 2 Oral Hypoglycemic Agents that ⬇ insulin resistance

1. Biguanides = anti-hyperglycemic agents & insulin sensitizers
2.Thiazolidinediones

What are 3 Oral Hypoglycemic Agents that ⬆ insulin secretion

1. Sulfonylureas
2. DPP-4 Inhibitors (new)
3. Incretin Mimetic Agents (new)

What is an example of a Biguanides & what are the characteristics?

Metformin (Glucophage)

- ⬇ insulin resistance
- can cause kidney damage
- may be discontinued while in hospital
- don't give if having a test containing dye - hold 48 hrs before & 48 hrs after test with dye. If ER then flush kidneys & then stop for 2 days afterwards
- if dehydrated DON'T take → acute renal failure

- lowers basal & post meal glucose levels in pts w/ type 2 diabetes by reducing hepatic glucose production & tissue sensitivity to insulin

What is an example of a Thiazolidinediones (TDZ) & what are the characteristics?

- Pioglitazone "pi-o-glit-azone" (Actos)
- ↓ insulin resistance

- improves tissue sensitivity to insulin in treatment of diabetes

What are 3 examples of Sulfonylureas & what are the characteristics?

- Glyburide (Micronase), glimepiride (Amaryl), glipizide (Glucotrol)

- don't give more than 1 from this category
- ⬆ insulin secretion from pancreatic beta cells & ⬆ the number or the sensitivity of cell receptor sites for interaction w/insulin (type 2)

What is the trade name & category of Glyburide?

Trade name: Micronase
Category: sulfonylureas

What is the trade name & category of Glimepiride?

Trade name: Amaryl
Category: sulfonylureas

What is the trade name & category of Glipizide?

Trade name: Glucotrol
Category: sulfonylureas

What is an example of DPP-4 inhibitors & what are the characteristics?

- Sitagliptin (Januvia)

- ⬆ insulin secretion
- works when glucose is elevated
- ⬆ bodys active incretin hormone levels
- side effects also help BG levels

What is an example of Incretin Mimetic Agents & what are the characteristics?

- Exenatide "ex-en-a-tide" (Byetta)

- ⬆ insulin secretion
- side effects also help BG levels

What is insulin therapy?

- an attempt to duplicate the normal release of insulin by the pancreas

What are the three actions of insulin?

- move glucose into cells
- stores glucose in the liver & muscles
- enhances fat storage

what are insulin side effects?

Hypoglycemia → HA, hunger, nausea, delirium, tremors, sweating, tachycardia
- the highest risk for hypoglycemia is during peak
- everyones side effects are different, so listen to the patient

What are the 3 Insulin Actions (OPD)?

Onset = when you start to see a decreased BS, when it starts working
Peak = highest plasma concentration of insulin, anticipate the lowest BS level
Duration = length of time drug elicits effects

What insulins ARE given when a patient is on a sliding scale?

Rapid or Short Acting

What are two RAPID ACTING INSULINS (generic & trade names) & general information (2)?

1. Insulin Lispro (Humalog)
2. Insulin Aspart (Novolog)
- only SQ
- tray should be in room

What is the ONSET of RAPID ACTING INSULINS?

within 15 minutes

What is the PEAK of RAPID ACTING INSULINS?

1-1.5 hours

What is the DURATION of RAPID ACTING INSULINS?

2-4 hours

What is the APPEARANCE of RAPID ACTING INSULIN?

Clear

What are two SHORT ACTING INSULINS & general information (2)?

Regular (Humulin R / Novolin R)

- Has an R after the name for Regular
- most common insulin to be given IV (ex. someone comes into ER with a BG of 800)

What is the ONSET of SHORT ACTING INSULINS?

30-60 minutes (SubQ)

What is the PEAK of SHORT ACTING INSULINS?

2-4 hours

What is the DURATION of SHORT ACTING INSULINS?

5-7 hours

What is the APPEARANCE of SHORT ACTING INSULINS?

Clear

What are the INTERMEDIATE ACTING INSULINS & general information (5)?

NPH (Humulin N, Novolin N)

- Don't see these much anymore
- can be mixed w/short & rapid acting
- draw up Long, short, short, long
- if contaminated then short will be contaminated
- if you combine, expect 2 peaks

What is the ONSET of INTERMEDIATE ACTING INSULINS?

1-2 hours

What is the PEAK of INTERMEDIATE ACTING INSULINS?

4-12 hours, typically 6-8 hours

What is the DURATION of INTERMEDIATE ACTING INSULINS?

12-18 hours

What is the APPEARANCE of INTERMEDIATE ACTING INSULINS?

Cloudy

What are three LONG ACTING INSULINS & general information?

1. Insulin determir (Levemir)
2. Insulin Glargine (Lantus)
3. Ultralente (Humulin U) - very rare to see, usually only seen on someone who has been taking for a long time

- given am or evening
- sometime you see given bid
- DO NOT MIX*** with other insulins, if you need to give other insulin use a another syringe, Also use separate sites for both injections

What is the ONSET of LONG ACTING INSULINS (levemir & lantus)?

Determir (Levemir) = 3-4 hours
Glargine (Lantus) = 3-4 hours

What is the PEAK of LONG ACTING INSULINS (levemir & lantus)?

Determir (Levemir) = 3-14 hours (usually around 12)
Glargine (Lantus) = No Peak

What is the DURATION of LONG ACTING INSULINS (levemir & lantus)?

Determir (Levemir) = 24 hours
Glargine (Lantus) = 24 hours

(usually get once a day but sometimes get twice)

What is the APPEARANCE of LONG ACTING INSULINS?

Clear

What are two COMBINATION INSULINS & general information?

1. Humulin 70/30 (70=NPH, 30=Regular/short)
2. Novolin (70/30)

- Pre-mixed with different combinations
- 2 different onsets/peaks/durations based on the combination

What is the APPEARANCE of COMBINATION INSULINS?

Cloudy

What insulins can you NOT mix with any other insulins?

1. Determir (Levemir) = long acting
2. Glargine (Lantus) = long acting

- not in the same syringe (use separate syringe if you have to give another insulin) & not in the same site

How do you mix insulins?

- Draw up Clear to Cloudy

- Long-Short (With Air)
- Short-Long (With Insulin)

What are 5 Nursing Implications for Insulin administration?

1. adjust dose on BS, carb (CHO) intake, illness, level of activity (patient usually aware of their carb intake)
2. absorption varies by site and activity of site (rotate sites → thighs, back of arms & abdomen)
3. hypoglycemia risk varies w/ type of insulin- must know OPD of each type
4. Mixing; clear-> cloudy. Do not mix glargine, detemir (long acting insulins)
5. usually held if pt. is NPO

What is Intensive Insulin Therapy/sliding scale insulin (2)?

1. Several doses of regular insulin given during the day based on BS levels - before meals & at bedtime
(IV and injection in hospital, injections at home)
2. Insulin pump therapy

What is Insulin Sliding Scale (5)?

1. Insulin dose is adjusted to blood glucose levels
2. almost all hospitalized its (b/c stress of trauma)
- Ex. infection, surgery, steroids → may cause patient to have to get insulin while hospitalized
3. usually before meals and HS when sleeping (ACHS bs)
4. scheduled (q6 hrs) when NPO
5. type of insulin specified- rapid or short acting NEVER intermediate or long acting

When is insulin usually checked when a patient is on a sliding scale (3)?

- before meals
- at bedtime
- q6 hours when NPO

What insulin's are NEVER given when a patient is on a sliding scale (2)?

Intermediate and Long Acting

What is Insulin Pump Therapy (8) & complications (3)?

1. continuous insulin
2. rapid/short acting insulin
3. catheter in abd.
4. basal rate (continuous/regular rate) and bolus - depending upon BS & what they ate
5. frequently check BS (4x per day)
6. change needle & site every 2-3 days
7. always worn
8. Most common w/Type 1

Complications: infection in site, hypoglycemia, hyperglycemia

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