Insulin

Insulin- increases glucose transport into cells and promotes conversion of glucose to glycogen, decreasing serum glucose levels **for people who do not produce insulin Oral Hypoglycemic- stimulate the pancreas to produce more insulin and increase the sensitivity of peripheral receptors to insulin, thereby decreasing serum glucose levels ** for type 2 diabetes ** for those who do produce insulin, just not enough *Sulfonylureas: stimulate beta cells to produce more insulin *Nonsulfonylureas: affect the hepatic & GI production of glucose (so they wont produce as much) Aspart (Novolog) -Rapid- acting -Onset: 10-20 min -Peak: 1-3 h -Duration: 3-5 h *SubQ 5-10 before meals *Can give w/ NPH, draw up aspart first Glulisine (Novolog) -Rapid-acting -Onset: 15-30 min -Peak: 1h -Duration: 3-4 h *SubQ 15 min before meals Regular Insulin (Humulin R, Novolin R) -Short-acting -Onset: 30-60 min -Peak: 1-5 h -Duration: 6-10 h * SubQ 30-60 min before meals Humulin NPH & Humulin Lente -Intermediate-acting -Onset: 1-2 h -Peak: 6-14 h -Duration: 16-24 h *SubQ mix (cloudy) Detemir (Levemir) -Long-acting -Onset: gradual Lispro (Humalog) -Rapid-acting - Onset: 5-15 min -Peak: 1-1.5 h -Duration: 3-4 h * SubQ 5-10 min before meals

-Peak: 6-8 h -Duration: 24 h *SubQ 1/day or 2/day

Glargine (Lantus) -Long-acting -Onset: 1 h -Peak: no peak -Duration: 24 h *SubQ 1/day, same time each day

MOA:: promotes cellular up take of glucose (decrease glucose levels) - Converts glucose to glycogen - Moves potassium into cells (along w/ glucose) Therapeutic use:: Insulin is used for glycemic control of DM AE:: Hypoglycemia - Lipohypertrophy (scar tissue build up) - Sulfonylureas, meglitinides, beta blockers & alcohol have additive hypoglycemic effects - Thiazide diuretics & glucocorticoids may raise blood glucose levels (counter act w/ insulin) - Beta blockers may mack SNS response to hypoglycemia (tachycardia, trmors) making it difficult for clients to identify hypoglycemia Nursing Interventions:: - Abrupt onset for hyperglycemia pt may experience SNS symptoms (tachycardia, palpations, diaphoresis, shakiness) -Gradual onset pt may experience PNS symptoms (headache, tremors, weakness) **Clients dosage may need to be increased in response to : increase in caloric intake, infection, stress, growth spurts & in second or third trimester. **Clients dosage may need to be decreased in response to : level of exercise or first trimester Insulin Glargine & Insulin Detemir are both clear in color, not administered IV, & should not be mixed in a syringe w/ any other insulin. **Absorption rates from SubQ tissue increase from thigh to upper arm to abdomen.