FYI: (Acceptable range for blood glucose usually mg/dl. know your institutions policy.)

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1 How Insulin Works: Each type of insulin has an onset, a peak, and a duration time. Onset is the length of time before insulin reaches the bloodstream and begins lowering blood Peak is the time during which insulin is at maximum strength in terms of lowering blood Duration is how long insulin continues to lower blood glucose, how long it lasts. Summary on Types of Insulin: Rapid-acting insulin, begins to work about 5 minutes after injection, peaks in about 1 hour, and continues to work for 2 to 4. Types: Insulin glulisine (Apidra), insulin lispro (Humalog), and insulin aspart (NovoLog) Regular or Short-acting insulin usually reaches the bloodstream within 30 minutes after injection, peaks anywhere from 2 to 3 after injection, and is effective for approximately 3 to 6. Types: Humulin R, Novolin R Intermediate-acting insulin generally reaches the bloodstream about 2 to 4 after injection, peaks 4 to 12 later, and is effective for about 12 to 18. Types: NPH (Humulin N, Novolin N) Long-acting insulin reaches the bloodstream several after injection and tends to lower glucose levels fairly evenly over a 24-hour period. Types: Insulin detemir (Levemir) and insulin glargine (Lantus) Long acting and Pre-mixed insulin s should never be mixed or diluted with any other insulin or solutions. Fun ways to learn about insulin and diabetes: quizlet.com/ /mnse-nclex-pn-review-insulin-flash-cards/ quizlet.com/ / l s dex n e m insulin flashcarddb.com/cardset/50409-insulin-flashcards FYI: (Acceptable range for blood glucose usually mg/dl. know your institutions policy.) HYPOglycemia: can occur during peak time. Sweating, weakness, dizziness, chills, confusion, headache, nausea, rapid/weak pulse, fatigue, tachycardia, change in LOC, slurred speech, staggering gait, anxiety, tremors, hunger, Unconsciousness, insulin shock DEATH HYPERglycemia: fatigue, polyuria, polydipsia, flushed dry skin, change in LOC acetone breath (fruity breath) DKA Diabetic coma & death

2 The onset, peak and duration times shown in the chart are estimates based on ADA and pharmaceutical inserts. Patient onset, peak, and duration times may vary slightly per patient. Type of Insulin & Brand Names Rapid-Acting Humalog or lispro Novolog or aspart Apidra or glulisine Short-Acting Onset Peak Duration Role in Blood Sugar Management min ½ Rapid-acting insulin covers insulin needs for meals eaten within 10 minutes or at the same time as the injection. This type of insulin is used with scheduled longer-acting insulin. If mixing with NPH, rapid acting insulin, clear, should be drawn into syringe first. Mixture should be given immediately to avoid effects on peak action. Regular (R) Humulin or Novolin 30-1 hour Intermediate-Acting NPH (N) Long-Acting Lantus Levemir or detemir Pre-Mixed* Humulin 70/ ½ hour No peak time; insulin is delivered at a steady level Novolin 70/ Short-acting insulin covers insulin needs for meals eaten within minutes of injection. May be mixed with NPH in same syringe. Mixing order should be e le e ul d n up i s, en e l udy NPH (ie le l udy ) Intermediate-acting insulin covers insulin needs for about half the day or overnight. This type of insulin is often combined with rapidor short-acting insulin. NPH by itself should be given regardless of meal time. Available as pen or in vial to be used with syringe. Injections of long-acting insulin are not "timed" to mealtime because of their long duration of action Levemir is taken once or twice a day irrespective of mealtime. Lantus is only administered once a day (and should be administered at the same time each day). Keep in mind that these long-acting insulins may need to be given with shorter-acting insulin products --depending on patient situation. These products are generally taken twice a day before mealtime. 70% NPH +30% regular insulin. Novolog Mix: aspart protamine 70% + aspart 30% Novolog 70/30 Humalog 50/50 Humalog mix 75/ ½ Humalog 50/50: 50% lispro protamine suspension + 50% lispro protamine injection rdna origin Humalog mix 75/25: 75% lispro protamine suspension + 25% lispro protamine injection rdna origin *Premixed insulins are a combination of specific proportions of intermediate-acting and a rapid or short-acting insulin in one bottle or insulin pen (the numbers following the brand name indicate the percentage of each type of insulin). Insulin action includes 2 peaks (1 from each formulation). Depending on mixture they should be given between minutes before the meal. = may be infused subcutaneously by external insulin infusion pumps.

3 Oral Hyperglycemic Pills How to Take How They Work Side Effects Of Note Biguanides Metformin (Glucophage) Metformin liquid ( Riomet) Metformin extended release (Glucophage XR, Fortamet, Glumetza) Sulfonylureas Glimepiride (Amaryl) Glyburide (Diabeta, Micronase) Glipizide (Glucotrol, Glucotrol XL) Micronized glyburide (Glynase) Meglitinides Repaglinide (Prandin) D-Phenylalanine Derivatives Nateglinide (Starlix) Thiazolidinediones Pioglitazone (TZDs) Pioglitazonen (Actos) DPP-4 Inhibitors Sitagliptin (Januvia) Saxagliptin (Onglyza) Linagliptin ( Tradjenta) Alpha-glucosidase Inhibitors Acarbose (Precose) Miglitol (Glyset) Metformin: usually taken twice a day with breakfast and evening meal. Metformin extended release: usually taken once a day in the morning. Decreases amount of glucose released from liver. Bloating, gas, diarrhea, upset stomach, loss of appetite (usually within the first few weeks of starting). Take with food to minimize symptoms. Metformin is not likely to cause low blood In rare cases, lactic acidosis may occur in people with abnormal kidney or liver function. Take within Stimulates the pancreas to minutes of a meal or with release more insulin, both right Low blood glucose, occasional skin rash, meals once or twice a day. after a meal and then over several irritability, upset stomach Both of these medications should be taken with meals. If you skip a meal, skip the dose. Usually taken once a day; take at the same time each day. Take once a day at the same time each day. Stimulate the pancreas to release more insulin right after a meal. Makes the body more sensitive to the effects of insulin. Improves insulin level after a meal and lowers the amount of glucose made by your body. Take with first bite of the Slows the absorption of meal; if not eating, do not carbohydrate into your take. bloodstream after eating. Effects diminish quickly and they must be taken with each meal; may cause low blood May cause side effects such as swelling (edema) or fluid retention. Does not cause low blood sugar when used alone. Increased risk of congestive heart failure in those at risk. Stomach discomfort, diarrhea, sore throat, stuffy nose, upper respiratory infection. Does not cause low blood Gas, diarrhea, upset stomach, abdominal pain Always tell healthcare providers that it may need to be stopped when you are having a dye study or surgical procedure. Because these medicines can cause low blood glucose, always carry a source of carbohydrate with you. Follow your meal plan and activity program. Call your healthcare provider if your blood glucose levels are consistently low. If there is an increase in your activity level or reduction in your weight or calorie intake, the dose may need to be lowered. These work quickly when taken with meals to reduce high blood glucose levels. However, they are less likely than sulfonylureas to cause low blood Increases the amount of glucose taken up by muscle cells and keeps the liver from overproducing glucose; may improve blood fat levels. Talk with your healthcare provider if you have the following symptoms: nausea, vomiting, fatigue, loss of appetite, shortness of breath, severe edema or dark urine. Can be taken alone or with metformin, a sulfonylurea or Actos. Tell your healthcare provider if you have any side effects that bother you or that don t go away. Take with meals, to limit the rise of blood glucose that can occur after meals; these do not cause low blood Bile Acid Sequestrants Colesevelam (Welchol) Take once or twice a day with a meal and liquid. Works with other diabetes medications to lower blood Constipation, nausea, diarrhea, gas, heartburn, headache (may interact with glyburide, levothyroxine and contraceptives) Primary effect, when used either alone or with a statin, is to lower LDL cholesterol; has blood glucose-lowering effect when taken in combination with certain diabetes medications. Before taking this medication, tell healthcare

4 Combination Pills Pioglitazone & metformin) (Actoplus Met) provider if pt. has high triglycerides (blood fats) or stomach problems, takes thyroid medication or glyburide (take them 4 before taking Welchol.) Glyburide & metformin (Glucovance) Glipizide & metformin (Metaglip) Sitagliptin & metformin (Janumet) Saxagliptin & metformin (kombiglyze ) Check with your provider; usually taken once a day. Combines the actions of each pill used in the combination. Side effects are the same as those of each pill used in the combination. Some combination pills may lead to low blood glucose levels if one of the medications contained in the combination has this effect. May decrease the number of pills you need to take. Repaglinide & metformin (Prandimet) Pioglitazone & glimepiride (Duetact)

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