Week 4 Diabetes

what are the brand names for Human Regular Insulin?

Humulin R and Novolin R

What is the prototype for regular insulin?

Human Regular Insulin

True or false: Human Regular Insulin is the only insulin that can be given both IV and SQ.

TRUE - other insulins can only be given SQ

brand names for metformin

Fortamet, Glucophage, Glumetza

what kind of insulin is metformin?

oral hypoglycemic

Type I diabetes

pancreas is functionally impaired - autoimmune disease that destroys beta cells of pancreas (islets of Langerhans)

What is released from pancreas when blood glucose is high?

insulin - carries glucose to cells to use for energy

What is released from pancresas when blood glucose is low?

glucagon

Which is more common, type I or type II diabetes?

type II - 95% of patients with diabetes have type II

Type II diabetes

insulin resistance - defective insulin receptor function

Characteristics of type II diabetes

1. target cells become unresponsive to insulin (defective receptor function)

2. blood glucose levels rise

3. pancreas secretes more insulin, beta cells get exhausted and die

4. deficiency in insulin secretion and resistance develops

Ideal level for HbA1C in adults

less than 6.5 or 7%

A1C

percentage of glucose adhering to hemoglobin

Fasting blood glucose indicative of diabetes

greater than 126 mg/dL TWICE

What is exogenous insulin and which type of diabetes is it most commonly used for?

insulin that is made from an outside source (not in body) - always used for type I but can be used for type II if needed

Rapid acting insulin

LOGS - Humalog, Novolog

Rapid acting insulin onset

15 minutes

Rapid acting insulin peak

about an hour

Rapid acting insulin duration

2-4 hours - usually taken right before meal with tray in front of patient to prevent hypoglycemia if don’t actually eat

Short acting insulin

prototype - Humulin R, only insulin given IV

Short acting insulin onset

30 minutes

Short acting insulin peak

2-3 hours

Short acting insulin duration

3-6 hours

Intermediate acting insulin

Novolin N and Humulin N - clear before cloudy

Intermediate acting insulin onset

2-4 hours

Intermediate acting insulin peak

4-12 hours

Intermediate acting insulin duration

12-18 hours

Long acting insulin

NEVER hold - Lantus or Basaglar/glargine

Long acting insulin onset

1-3 hours

Long acting insulin peak

no real peak - base level

Long acting insulin duration

18-24 hours

Modern human insulin characteristics

-made by recombinant DNA

-more effective, fewer allergies, less resistance

-modified (analog) to be more rapid like Humalog or have prolonged action (Lantus)

Adverse effects of insulin therapy

hypoglycemia - too much insulin, not timing injection with food intake, skipping meal

Symptoms of hypoglycemia

tachycardia, confusion, sweating, drowsiness, possible weight gain - COLD AND CLAMMY NEED SOME CANDY

Symptoms of hyperglycemia

HOT AND DRY SUGARS HIGH

Rule of 15 - for hypoglycemia

if blood glucose level lower than 70 and you have symptoms, take 15 grams of rapid acting carbs ( ½ cup of juice, ½ cup of soda, glucose, or gel, 4 glucose tablets, 1 tablespoon of sugar/honey), wait 15 minutes then re-check, if still low repeat, if gone up eat meal within 30 minutes

Insulin needles

only use calibrated insulin syringes for insulin administration - other wise can cause overdose

3 main physiological defects of type II diabetes

1. increase hepatic glucose production/glycogen

2. abnormal insulin secretion

3. resistance to insulin

Treatment goals for people with type II diabetes

1. pre-prandial (before meals) blood sugar below 110 mg/dL

2. HbA1C of 6.5% or less

Type of oral hypoglycemic

Biguanides (Metformin)

Biguandies - Metformin

-decreases production of glucose from liver (blocks gluconeogensis)

-reduces insulin resistance

-minor side effects - only GI

-first-line of defense (pre-diabetics can use)

-have to make sure kidney function is good or lactic acidosis can occur (FATAL)

-avoid if CAT scan or IV contrast to protect kidneys

-does not cause hypoglycemia