Antidiuretic Hormone and its Medications

Premixed Insulins

• 70% NPH and 30% regular: mixture of intermediate- and short-acting insulin
• 75% insulin lispro protamine and 25% insulin lispro: mixture of intermediate- and rapid-acting insulin

Pharmacological Action

• Promotes cellular uptake of glucose (decreases glucose levels)
• Converts glucose into glycogen and promotes energy storage
• Moves potassium into cells (along with glucose)

Therapeutic Uses

• Used for glycemic control of diabetes mellitus (type 1, type 2, gestational) to prevent complications
• Clients with type 2 diabetes mellitus may require insulin when:
  • Oral antidiabetic medications, diet, and exercise are unable to control blood glucose levels
  • Severe renal or liver disease is present
  • Painful neuropathy is present
  • Undergoing surgery or diagnostic tests
  • Experiencing severe stress (infection and trauma)
  • Undergoing emergency treatment of diabetes ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic syndrome
  • Requiring treatment of hyperkalemia

Complications

• Hypoglycemia: occurs when blood glucose is less than 70 mg/dL
• Causes of hypoglycemia:
  • Toxic dose of insulin
  • Too little food
  • Vomiting and diarrhea
  • Alcohol intake
  • Strenuous exercise
  • Childbirth

Diabetes Mellitus

• Chronic illness resulting from an absolute or relative deficiency of insulin, often combined with a cellular resistance to insulin’s actions

Insulin Types

• Rapid-acting:
  • Lispro insulin
  • Onset: 15 to 30 min
  • Peak: 0.5 to 3 hr
  • Duration: 3 to 5 hr
• Short-acting:
  • Regular insulin
  • Onset: 0.5 to 1 hr
  • Peak: 1 to 5 hr
  • Duration: 6 to 10 hr
• Intermediate-acting:
  • NPH insulin
  • Onset: 1 to 2 hr
  • Peak: 4 to 14 hr
  • Duration: 14 to 24 hr
• Long-acting:
  • Insulin glargine U-100
  • Onset: 1 to 4 hr
  • Peak: None
  • Duration: 24 hr

Antidiuretic Hormone

• Promotion of reabsorption of water within the kidney through vasoconstriction
• Therapeutic uses:
  • Diabetes insipidus (DI)
  • Nocturnal enuresis (decreases the production of urine)
  • Hemophilia (promote release of certain clotting factors)
• Route of administration:
  • Desmopressin: oral, intranasal, subcutaneous, IV
  • Vasopressin: subcutaneous, IM, IV
• Complications:
  • Water intoxication (retention of too much water)
  • Myocardial ischemia from excessive vasoconstriction (vasopressin) of coronary arteries