Term
| Humalog (Lispro), Novalog (Aspart), Glulisine (Aprida) |
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Definition
Rapid acting insulin. Onset of 5-15 min. Peak: 30 min - 1 hr. Duration 2-4 hrs.
Rapid acting insulins are clear. They are Rx only. They have a very quick onset and therefore SHOULD NOT be given more than 5 minutes before a meal; they can be given with meals or right after eating. Is given SQ or via an insulin pump. |
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Term
| Regular insulin (Novilin R, Humulin R) |
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Definition
| Short acting insulin. Onset 30 min. Peak 2-3 hrs. Duration 3-4 hrs. Short acting insulin is clear. ONLY REGULAR insulin can be given IV. It can also be given SQ or via an insulin pump. It is generally given approximately 30 minutes before meals. Again, regular insulin is the only insulin that can be given IV! |
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Term
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Definition
Intermediate acting
Onset of action (2 to 4 hours)
Peak (4 to 12 hours)
Duration (18 to 24 hours)
Intermediate-acting insulin contains the protein protamine which prolongs the insulin action time.
Intermediate-acting insulin is cloudy. DO NOT SHAKE THE VIAL. However, it is imperative that the solution is mixed. You mix the solution by gently rolling or swirling the vial. |
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Term
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Definition
Composed of short- and intermediate-acting or rapid- and intermediate-acting
Usually humilin (30) and NPH (70) |
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Term
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Definition
Long acting insulin
Onset of action (4 to 8 hours)
Peak (14 to 20 hours)
Duration (24 to 36 hours) |
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Term
| Insulin glargine (Lantus) |
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Definition
Of the long-acting insulins, does not PEAK. Duration is 24 hrs. It is evenly absorbed at a slow evenly distributed rate.
It is administered once a day, usually at bedtime. |
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Term
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Definition
Action
Promote use of glucose by body cells, store glucose as glycogen in muscles
Use
Reduce blood glucose |
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Term
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Definition
Increased hypoglycemia with aspirin, oral anticoagulants, alcohol, oral hypoglycemics, BBs, TCAs, MAOIs, tetracyclines
Decreased hypoglycemia with thiazides, glucocorticoids, oral contraceptives, thyroid drugs, smoking |
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Term
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Definition
Hypoglycemia
Headache, dizziness, confusion, slurred speech
Nervousness, anxiety, agitation
Tremors, uncoordination, sweating, tachycardia, seizures
Hyperglycemia
Extreme thirst, dry mucous membranes
Poor skin turgor, polyuria, fruity breath
Fatigue, tachycardia, Kussmaul respirations |
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Term
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Definition
| tissue atrophy, or a depression under the skin surface that primarily occurs, or is more common, in women and children. |
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Term
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Definition
| (tissue hypertrophy) is a raised lump or know on the skin surface and is more common in men. |
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Term
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Definition
| hypoglycemic condition that usually occurs in the predawn hours of 2:00 – 4:00 am. A rapid decrease in blood glucose during the nighttime hours stimulates a release of hormones (ie. Cortisol, glucagon, epinephrine) to increase blood glucose by lipolysis, glucogeogenesis, and glycogenolysis Management involves monitoring blood glucose between 2:00 and 4:00 AM and reducing the bedtime insulin dosage. |
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Term
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Definition
| Hyperglycemia on awakening.client usually awakens with a headache and reports night sweats and nightmares. Management involves increasing the bedtime dose of insulin |
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Term
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Definition
| A hypoglycemic reaction occurs when more insulin is administered than needed for glucose metabolism. The person may exhibit nervousness, trembling, and lack of coordination; have cold and clammy skin; and complain of a headache. Some clients become combative and incoherent. Giving sugar orally or IV increases the use of insulin, and the symptoms disappear immediately. |
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Term
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Definition
| When there is not enough insulin, sugar cannot be metabolized, and fat catabolism occurs. The use of fatty acids (ketones) for energy causes ketoacidosis. Signs are fruity breath, altered LOC, tachycardia, Kussmaul respirations, BS of >300 |
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Term
| Oral hypoglycemic drugs uses and requirements |
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Definition
| appropriate for certain clients whose pancreases are still producing some insulin. The general guidelines for their use are as follows: onset of diabetes at age 40 years or older; diagnosis of diabetes for less than 5 years; not underweight; fasting blood glucose of less than 200 mg/dL; greater than 40 units of insulin required per day; and normal renal and hepatic function. |
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Term
| Different types of insulin delivery |
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Definition
| Syringe (in units, 100 units per ml), insulin pen injectors, insulin jet, pumps (implantable and portable) |
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Term
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Definition
| headache, nervousness, sweating, tremors, rapid pulse, lightheadedness, tremor, cold clammy skin, slurred speech, tachycardia, confusion, BS <60 mg/dl |
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Term
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Definition
| fruity breath, kussmaul resp., rapid thready pulse, dry mucous membranes, poor skin turgor, BS >250 |
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Term
| Insulin Administration: Nursing Interventions |
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Definition
Monitor vital signs and glucose levels.
Instruct client to report hypoglycemia and hyperglycemia.
Encourage compliance with diet, insulin, exercise.
Advise client to wear medical alert tag.
Teach client how to check blood glucose.
Teach client how to administer insulin |
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Term
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Definition
Glipizide (Glucotrol), glyburide (Diabeta)
Stimulates beta cells to secrete insulin, alters sensitivity of peripheral insulin receptors
Cautions
Liver or kidney dysfunction, elderly, malnourished, adrenal or pituitary insufficiency |
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Term
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Definition
Interactions
Alcohol may cause disulfiram-like reaction; hypoglycemia with anticoagulants, cimetidine, anticonvulsants, aspirin, NSAIDs, sulfonamides
Increases action of thiazide diuretics, barbiturates, phenothiazines; decreases action of thyroid drugs
Side effects
Drowsiness, headache, confusion, visual disturbances, anxiety, hunger, hypoglycemia, tachycardia, seizures, respiratory depression, coma |
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Term
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Definition
Biguanides
Metformin (Glucophage)
Action: increases binding of insulin to receptors |
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Term
| Alpha-glucosidase inhibitors |
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Definition
Acarbose (Precose)
Action: inhibits absorption of sugars from GI tract |
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Term
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Definition
Pioglitazone (Actos), rosiglitazone (Avandia)
Action: affects insulin receptors by enhancing insulin sensitivity of cells |
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Term
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Definition
Repaglinide (Prandin), neteglinide (Starlix)
Action: stimulates release of insulin from pancreatic islets |
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Term
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Definition
Action
Increases binding of insulin to receptors
Improves tissue sensitivity to insulin
Increases glucose transport into skeletal muscles and fatty tissues
Use
Control hyperglycemia in type 2 diabetes mellitus |
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Term
Metformin (Glucophage)
Interactions |
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Definition
Hypoglycemia potentiated by captopril, nifedipine, procainamide, quinidine, digoxin, furosemide, cimetidine, ranitidine, azole antifungals, vancomycin
Iodinated contrast dyes may lead to lactic acidosis or acute kidney failure
Side effects
Dizziness, fatigue, headache, agitation, metallic taste, GI distress, lactic acidosis |
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Term
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Definition
Sitagliptin (Januvia)
Action
Increases insulin secretion
Decreases glucagon secretion to reduce glucose production |
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Term
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Definition
Exenatide (Byetta)
Injectable
Action: improves beta-cell responsiveness and enhances insulin secretion in proper amounts
Prevents the liver from making excess glucose when not needed
Delays gastric emptying
Reduces appetite |
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Term
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Definition
Pramlintide (Symlin)
Injectable
Suppresses glucagon secretion
Delays gastric emptying
Reduces appetite |
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Term
| Nursing interventions for Oral Antidiabetics |
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Definition
Monitor vital signs, glucose levels.
Administer with food to minimize GI distress.
Teach client to eat prescribed diet on schedule.
Teach client to recognize symptoms of hyperglycemia and hypoglycemia.
Encourage drug compliance.
Advise client to wear medical alert tag.
Warn client to avoid alcohol.
Teach client the treatment for hypoglycemia and hyperglycemia. |
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Term
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Definition
Hyperglycemic hormone secreted by alpha cells of the islets of Langerhans in the pancreas
Action
Stimulates breakdown of stored glycogen to glucose in liver
Use
Insulin-induced hypoglycemia |
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