Diabetes Medications Notes (Week 5)

What is the goal of diabetes treatment?

Maintain glucose control and prevent complications

What lifestyle modifications are important in diabetes management?

Healthy diet, exercise, blood pressure control, and lipid control

What type of diabetes always requires insulin replacement?

Type 1 Diabetes

What type of diabetes usually starts with oral medications?

Type 2 Diabetes

What does HbA1C measure?

Average blood glucose over the previous 3 months

What is the goal HbA1C for most diabetic patients?

Less than 7%

What HbA1C goal may be appropriate for patients with frequent hypoglycemia or limited life expectancy?

Less than 8%

An HbA1C of 7% corresponds to an average blood glucose of approximately what value?

150 mg/dL

An HbA1C of 12% corresponds to an average blood glucose of approximately what value?

300 mg/dL

What does CGM stand for?

Continuous Glucose Monitoring

What does TIR stand for?

Time in Range

What is the goal TIR for most diabetic patients?

Greater than 70%

What are the five insulin categories?

Rapid-acting, Short-acting, Intermediate-acting, Long-acting, and Ultra-long-acting

What unit is used to measure insulin doses?

Units

Why is insulin considered a high-alert medication?

Risk of serious harm from dosing errors

What safety measure may be required before administering insulin?

Two RN verification/signatures

What is the most common adverse effect of all insulins?

Hypoglycemia

What is the prototype rapid-acting insulin?

Insulin lispro

What is the onset of insulin lispro?

About 15 minutes

What is the peak of insulin lispro?

30 minutes to 2 hours

What is the duration of insulin lispro?

Up to 5 hours

When is insulin lispro commonly administered?

Before meals

What appearance does insulin lispro have?

Clear

Can insulin lispro be given IV?

No

What concentrations are available for insulin lispro?

U-100 and U-200

What is the prototype short-acting insulin?

Regular insulin

What is the onset of regular insulin?

Less than 60 minutes

What is the peak of regular insulin?

1 to 5 hours

What is the duration of regular insulin?

Up to 10 hours

What appearance does regular insulin have?

Clear

Can regular insulin be given IV?

Yes

Which insulin is the only insulin that can be given IV?

Regular insulin

What concentration of regular insulin may be given IV?

U-100

Is regular insulin available without a prescription?

Yes

What is the prototype intermediate-acting insulin?

NPH insulin

What is the onset of NPH insulin?

1 to 2 hours

What is the peak of NPH insulin?

6 to 8 hours

What is the duration of NPH insulin?

Up to 24 hours

What appearance does NPH insulin have?

Cloudy

Why should NPH insulin be gently mixed before administration?

It is a suspension

Can NPH insulin be given IV?

No

Can NPH insulin be mixed with short-acting insulin?

Yes

When mixing NPH and regular insulin, what is drawn up first?

Clear before cloudy

Is NPH insulin available without a prescription?

Yes

What is the prototype long-acting insulin?

Insulin glargine (Lantus)

What is the onset of insulin glargine (Lantus)?

About 1 hour

What is the peak of insulin glargine (Lantus)?

No significant peak

What is the duration of insulin glargine (Lantus)?

About 24 hours

What type of glucose control does insulin glargine mimic?

Basal control

How often is insulin glargine usually administered?

Once daily

Can insulin glargine be given IV?

No

What concentration is insulin glargine (Lantus)?

U-100

What are the ultra-long-acting insulins discussed in lecture?

Insulin glargine (Toujeo) and insulin degludec (Tresiba)

What is the onset of insulin glargine (Toujeo)?

Within 6 hours

What is the peak of insulin glargine (Toujeo)?

No significant peak

What is the duration of insulin glargine (Toujeo)?

Greater than 24 hours

What concentration is insulin glargine (Toujeo)?

U-300

How many times more concentrated is Toujeo than U-100 insulin?

Three times

What is the onset of insulin degludec (Tresiba)?

Less than 90 minutes

What is the peak of insulin degludec (Tresiba)?

No significant peak

What is the duration of insulin degludec (Tresiba)?

Greater than 24 hours

What concentrations are available for Tresiba?

U-100 and U-200

Which insulin has the fastest onset?

Insulin lispro

Which insulin is the only insulin given IV?

Regular insulin

Which insulin is cloudy?

NPH insulin

Which insulin should be drawn up first when mixing?

Regular insulin

Which insulin should be drawn up second when mixing?

NPH insulin

Which insulin best mimics natural basal insulin secretion?

Insulin glargine

Which insulin category has the highest risk of hypoglycemia?

Shorter-acting insulins

Why is knowing insulin onset important?

To anticipate when glucose lowering begins

Why is knowing insulin peak important?

To anticipate highest risk for hypoglycemia

Why should rapid-acting insulin generally not be administered until the meal tray arrives?

To prevent hypoglycemia if the patient does not eat

What insulin mnemonic helps remember mixing order?

Clear before cloudy

What is the fastest subcutaneous insulin injection site?

Abdomen

What is the slowest subcutaneous insulin injection site?

Thigh

What are common sites for subcutaneous insulin injections?

Abdomen, upper arm, and thigh

Why should insulin injection sites be rotated?

To prevent lipohypertrophy

What is lipohypertrophy?

Fatty tissue buildup at injection sites that alters insulin absorption

What insulin administration route is most commonly used?

Subcutaneous injection

What insulin delivery devices are available?

Syringes, insulin pens, and insulin pumps

What is the advantage of insulin pumps?

Continuous insulin delivery and improved glucose control

What is the most common complication of insulin therapy?

Hypoglycemia

What causes hypoglycemia in diabetic patients?

Insulin levels exceed the body's glucose needs

What are the early signs of a rapid drop in blood glucose?

Tachycardia, sweating, and shakiness

What are the signs of a slower decline in blood glucose?

Headache, confusion, fatigue, and drowsiness

Which patients are at highest risk for hypoglycemia?

Patients with decreased food intake, vomiting, diarrhea, alcohol intake, increased activity, or excessive insulin administration

Why does exercise increase hypoglycemia risk?

Exercise increases glucose utilization

Why does alcohol increase hypoglycemia risk?

It interferes with glucose production by the liver

What is the first nursing assessment when treating hypoglycemia?

Level of consciousness (LOC)

Why is LOC important in hypoglycemia?

It determines the appropriate treatment

How should hypoglycemia be treated in a conscious patient?

Fast-acting oral carbohydrates

What are examples of fast-acting oral carbohydrates?

Glucose tablets, orange juice, regular soda, or candy

What is the 15-15 Rule?

Give 15 grams of carbohydrates, wait 15 minutes, and recheck blood glucose

How many grams of carbohydrates are given in the 15-15 Rule?

15 grams

When should blood glucose be rechecked after treatment?

15 minutes later

What should be done if blood glucose remains low after the 15-15 Rule?

Repeat the process

How should hypoglycemia be treated in an unconscious patient?

Glucagon or D50

What is glucagon?

A hormone that raises blood glucose by stimulating glycogen breakdown

What is the natural action of glucagon?

Raises blood glucose

What routes can glucagon be administered?

IV, IM, or subcutaneous