insulin

insulin lispro

• onset

• peak

• duration

• route

• onset: 10-15 min

• peak: 30-60 min

• duration: 5 hours or less (gone before next meal)

• SQ

regular insulin

• onset

• peak

• duration

• route

• onset: 30-60 min

• peak: 2-4 hours

• duration: 5-7 hours

• SQ, IV

insulin isophane

• onset

• peak

• duration

• route

• onset: 1-2 hours

• peak: 6-12 hours

• duration: up to 24 hours

• SQ

insulin glargine

• onset

• peak

• duration

• onset: 1-2 hours

• peak less action

• duration: up to 36 hours

long acting insulin

nursing considerations

• administered usually once a day, in the evening

• does not mix with other insulins

rapid acting insulin

nursing consideration

administer when food tray comes (15 min AC)

• “give the shot while the tray is hot”

short acting insulin

nursing consideration

administer 30 min before the meal (AC)

intermediate acting insulin

nursing considerations

• give 30 min before meals

• once or twice daily

• usually mixed with regular insulin » to cover rapid and long term needs (basal and prandial insulin)

biguanide

• uses

• side effects

• nursing considerations

uses

• decreases hepatic formation of glucose

• lowers how much sugar your body takes from food

• helps your body use insulin more » does not increase production of insulin

side effects

• GI distress

• lactic acidosis

• hypoglycemia is NOT common

nursing considerations

• take with meals to reduce GI upset

• can accumulate in body with renal dysfunction » monitor kidney function (creatinine >1.2)

• caution in pt with: liver disease, ETOH, lactic acidosis

• avoid IV contrast dye within 48 hrs

• long term therapy » B12 deficiency

• contraindicated GFR <30mL/min

sulfonylureas

• uses

• side effects

• nursing considerations

uses

• stimulates release of insulin from islet cells

side effects

• weight gain

• headache

• skin reactions

• GI distress

nursing considerations

• taken within 30 min prior to meal

• PO intake » hold for skipped meals

• monitor hypoglycemia, liver/renal function

meglitinides

• uses

• side effects

• nursing considerations

uses

• stimulates release of insulin from pancreas

• rapidly absorbed and eliminated » half life is 1hr

side effects

• weight gain

• headache

• skin reactions

• GI distress

nursing considerations

• taken within 30 min prior to meal

• PO intake » hold for skipped meals

• monitor hypoglycemia, liver/renal function

alpha-glucosidase inhibitors

• uses

• side effects

• nursing considerations

uses

• slows digestions and absorption of sugars and starches in small intestine

• “starch blockers”

side effects

• GI distress » abd pain, flatulence, diarrhea

• very small risk of hypoglycemia » unless taken with sulfonylureas

• liver toxicity RARE

nursing considerations

• take with first bite of meal

thiazolidinediones

• uses

• side effects

• nursing considerations

uses

• works to improve body’s ability to use insulin by “opening up” insulin receptors in skeletal tissues » increase insulin sensitivity

• decrease production and release of glucose from liver

side effects

• fluid retention/edema

• headache

• dizziness

• liver toxicity

nursing considerations

• liver function tests

• generally well tolerated

• very low incidence of hypoglycemia

mimetics GLP-1 agonist

• uses

• side effects

• nursing considerations

uses

• incretins (hormones) secreted by intestine following a meal when blood glucose is elevated » incretions signal pancreas to increase insulin secretion and to stop producing glucagon

• slow gastric emptying

side effects

• GI disturbances » N/V, diarrhea

nursing considerations

• MUST be given 1hr before meals

• SQ ONLY

DPP-4 inhibitors

• uses

• side effects

• nursing considerations

uses

• slow breakdown of incretin » incretin increases

• natural way to increase insulin secretion

side effects

• flu/cold like symptoms

nursing considerations

• daily PO administration

• does NOT cause hypoglycemia

• can be combined with sulfonylureas

insulin nursing considerations

• check for BS before meals and insulin administration

• know onset, peak, duration

• assess for hypoglycemia » peak

• don’t give if pt is NPO, vomiting, skipping meals, BS<100

• rotate injection sites » prevent lipodystrophy

• proper storage of insulin

  • open vials/pen stored at room temp, out of direct sunlight

  • closed vials stored in fridge, unless ordered otherwise

  • label opened bottle with new expiration date from date it was opened » less potent after 28 days