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Chapter 44 Injectable Diabetes Drugs

Terms in this set (75)

Short acting insulin
Regular Insulin (Novolin R, Humulin R)
Rapid Insulin
lispro, aspart, glulisine
What drugs are in the GLP-1 agonist class?
Exenatide (Byetta, Bydureon)
Liraglutide (Victoza)
Dulaglutide (Trulicity)
Albiglutide (Tanzeum)
Lizisenatide (Adlyxin)
Semaglutide (Ozempic)
What is the MOA of GLP-1 agonists (glucagon-like peptide 1 agonist)?
increase glucose dependent insulin section, decrease glucagon secretion, slows gastric emptying, increase saity and can cause decrease in weight
BBW for GLP receptor agonist
all except Byetta and Adlyxin have risk of thyroid cell carcinomas
Contraindications for GLP Receptor agonist
Family history of MIC or MEN 2
Side effects of GLP agonist
pancreatitis, nausea, V/D, constipation, weight loss, injection site reactions
How much do GLP-1 agonists lower A1C?
0.5-1.1%
How is Byetta dosed?
BID
How is Bydureon dosed?
2 mg once weekly
Bydureon is contraindicated when CrCl is
<30
or ESRD
Dosing of Victoza
once weekly
Dosing of Trulicity
Once weekly
Trulicity has _______ effects
cardiovascular
Albiglutide Dosing
weekly
Adlyxin Dosing
Daily
Semaglutide dosing
once weekly
Semaglutide
Ozempic
Exenatide
Byetta, Bydureon
Liraglutide
Victoza, Saxenda (weight loss only)
Pramlintide
Symlin
Who can use Pramlinitide?
Type 1 and Type 2 Diabetics if they are receiving insulin shots
How many carbs must you consume on Pramlinitide
> or equal to 30 grams
BBW of symlin
Severe hypoglycemia
Contraindications of symlin
Gastroparesis
SE of Symlin
N/V, anorexia, HA, weight loss
How much does Symlin decrease A1C
0.5-1%
How much do you decrease insulin dose at meal times when starting pramlintide?
decrease insulin dose 50% at mealtimes when starting
MOA of insulin
converts glucose to glycogen
Glucose uptake into muscles
Fat storage
Rapid Acting Insulin
Lispro (Humalog)
Aspart (Novolog)
Glulisine (Apidra)
When should rapid insulin be taken?
15 minutes before meal
SE of insulin
Hypoglycemia, weight gain
Short Acting Insulin
Regular insulin (Humulin R, Novolin R)
Which insulins do not require a prescription
Humulin R
Novolin R
Humulin N
Novolin N
Humulin 70/30
Humulin 70/30 KwikPen
Novolin 70/30
Intermediate acting insulin
NPH (Humulin N, Novolin N)
How do you mix insulin?
Clear before Cloudy (NPH)!!!
1. draw up air to equal total insulin
2. wipe vial runner with alcohol
3. inject the amount of air to equal the amount of cloudy insulin into the cloudy vial. BE CAREFUL NOT TO INJECT INTO THE SOLUTION
4. Inject the remaining air into clear vial and draw up the clear insulin
5. reinsert the needle into the cloudy vial and withdraw the desired amount
When do you take Short Acting insulin?
30 minutes before meals
When is concentrated regular insulin needed?
Humulin R U-500 needed when patient needs >200 units per day
Long Acting Insulin
Glargine (Lantus, Basaglar, Toujeo)
Detemir (Levemir)
Degludec (Tresiba)
ultra long acting insulin
degludec (Tresiba)

ONSET: 30-90 mins
PEAK: none
DURATION: 24 hours +
Toujeo concentrations
300 units/mL
100 units/ml
Treshiba concentrations
200 units per milliliters
100 U/mL
glulisine
Apidra
Aspart
Novolog
Lispro
Humalog
Determir
Levemir
Glargine
Lantus
Basaglar
Toujeo
Degludec
Treshiba
Onset of rapid acting insulin
5-15 minutes
Onset of short acting insulin
0.5-1 hour
Onset of intermediate acting insulin
2-4 hours
Onset of Levemir
2 hours
Onset of Basglar
2-3 hours
Onset of Lantus
3-4 Hours
Onset of Toujeo
6 hours
Onset of Tresiba
2 hours
Which insulin does not have a peak?
Lantus
What is Afrezza?
inhaled rapid acting insulin
Contraindication for Afreeza
COPD, Asthma patients
Most insulins have pen cartridges that are 3 mL except
Toujeo Solostar 1.5 mL pen
Most insulins have 10 mL vials except
Humulin R U-500 which has 20 mL
_________ increases risk of heart failure if taken with insulin
TZDs
How to you calculate insulin to carbohydrate ratio for rapid acting insulin?
Rule of 500

500/TDD = grams of carbohydrate covered by 1 unit of rapid-acting insulin
How do you calculate insulin to carbohydrate ratio for regular insulin?
Rule of 450

450/ TDD= grams of carbohydrate covered by 1 unit of regular acting insulin
How do you calculate the correction factor for rapid acting insulin?
Rule of 1,800

1,800/TDD = correction factor for 1 unit of rapid-acting insulin
How do you calculate the correction factor for regular acting insulin?
Rule of 1,500

1,500/TDD = correction factor for 1 unit of regular acting insulin
How do you calculate the correction dose?
[BG now - target BG]/ correction factor = correction dose

add correction dose to patients regular dose in order to achieve target glucose
What is the units/kg/day that you should start a T1DM patient on insulin with?
0.5units/kg/day using TBW to calculate

Divide this dose into two (basal and prandial)
NPH dosed BID ---> lantus or basaglar
80% of NPH dose
Toujeo ---> lantus or Basaglar
80% of the Toujeo dose
How many units are used to prime the insulin needle?
2 units
In injecting < 30 units of insulin, the patient should use a _____ syringe
0.3 mL
If injecting 30-50 units of insulin, the patient should use a ______ syringe
0.5 mL
If a patient is injecting >51 units, they should use a __________ syringe
1 mL
If using Humulin R U-500 insulin vials, use the ________ syringe
U-500 syringe
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