Diabetes Medications: Insulin Types

Medications for Diabetes

• Rapid-acting insulin includes Lispro (Humalog).
  • Onset: 10-30 minutes.
  • Peak: 30 minutes - 3 hours.
  • Duration: Up to 5 hours.
  • It works fast, and patients need to eat within 15 minutes of receiving it.
  • It suits individuals without much mealtime flexibility.
• Short-acting insulin includes Regular Insulin (Humulin R).
  • It is the only type that can be administered intravenously.
  • Onset: 30 minutes - 1 hour.
  • Peak: 2-5 hours.
  • Duration: Up to 8 hours.
  • It can be used for mealtimes but offers less flexibility.
  • Administer 30-45 minutes prior to a meal for best results.
• Intermediate-acting insulin: NPH.
  • Onset: 1.5-4 hours.
  • Peak: 4-12 hours.
  • Duration: Up to 18 hours.
  • Not for mealtime but for daily maintenance.
  • The peak after 4 hours raises concern for hypoglycemia.
• Long-acting insulin includes Glargine (Lantus) and Detemir (Levemir).
  • Onset: 0.8-4 hours.
  • Peak: No peak.
  • Duration: 16-24 hours.
  • Not for mealtime, but to help with daily maintenance of blood glucose (BG).
  • Not used alone; mealtime coverage is still needed.

Oral Agents for Diabetes

• Biguanides, like Metformin, are a first-line treatment for diabetes and pre-diabetes.
  • Metformin reduces glucose production by the liver.
  • Take with meals.
  • Withhold if contrast medium is used.
  • Not for people with kidney and liver diseases or heart failure (HF).
  • Staying hydrated helps prevent lactic acidosis.
• Sulfonylureas, like Glyburide, increase insulin production from the pancreas.
  • Take with meals, 30 minutes prior to eating.
  • Can lead to weight gain (WG).

Other Agents for Diabetes

• Amylin analogs, like Pramlintide (Symlin), slow gastric emptying and reduce postprandial glucagon secretion.
  • Administer subcutaneously in the thigh or abdomen before meals.
  • Oral medications should be taken 1 hour prior to injections.
  • Use concurrently with insulin but do not mix with insulin.
  • Discard opened vials after 4 weeks.
• Beta-blockers can cause hypoglycemia to go undetected.

Type 1 Diabetes

• It involves a pancreas problem.
• Origins are genetic, autoimmune, or viral.
• It features an abrupt onset.
• Characterized by little to no insulin, leading to too much sugar.
• Insulin is the only treatment.
• Assessment findings: weight loss, vision loss/problems, numbness/tingling.
• Manifestations include polyuria, polydipsia, and polyphagia.

Type 2 Diabetes

• It involves a cell problem and/or a pancreas problem.
• The pancreas is overworked and quits.
• Either insulin cannot get glucose into the cell, or not enough insulin is produced.
• Assessment findings: weight, vision loss/problems, numbness/tingling, recurrent infections.
• There can be no manifestations.
• Signs of hyperglycemia: 3 Ps, weakness, fatigue, hot and dry.
  • Polyuria: frequent urination.
  • Polydipsia: excessive thirst.
  • Polyphagia: excessive hunger.
• Patients may feel tired or complain of not being able to heal or being sick more often.

Prediabetes

• Glucose levels aren't high enough to be diagnosed as diabetes.
• There are no symptoms.
• Screenings and lifestyle changes are crucial.
• Impaired Glucose Tolerance (IGT): OGTT - 140 to 199 mg/dL.
• Impaired Fasting Glucose (IFG): 100 to 125 mg/dL.
• Teaching involves undergoing screening for glucose and A1C.
• Manage risk factors, monitor for symptoms of diabetes.
• Maintain a healthy weight, exercise, and make healthy food choices.

Foot Care for Diabetic Patients

• Treatment:
  • Maintain euglycemia.
  • Manage pain.
  • Prevent injury.
  • Skin assessments and foot care are key.
  • Always wear closed-toe shoes.

Glucose Monitoring for Diabetic Patients

• Regular serum glucose testing: normal range is 70-100 mg/dL.
• Give insulin when BG is around 150 mg/dL.
• Regular Hemoglobin A1c (HgA1C) testing should be done every 3-6 months.
• Keep HgA1C less than 7%.
• Glucometer: point of care/at-home self-monitoring.
• Continuous glucose monitoring systems: internal sensor reads every 1-5 minutes; can work for an insulin pump.
• Insulin pump: provides continuous insulin over a 24-hour period and requires frequent monitoring.

Treatment for Hypoglycemia

• Hypoglycemia is defined as glucose levels less than 70mg/dL
• Follow the 15/15 rule from the ADA:
  • Consume 15 grams of fast-acting carbohydrates, such as:
    • 4 glucose tablets (usually 4 grams per tablet).
    • 1/2 cup (4 ounces) of fruit juice.
    • 1 tablespoon of sugar or honey.
    • 1/2 cup of regular soda (not diet).
  • Wait 15 minutes for the sugar to be absorbed.
  • Check blood sugar again; if it is still low, repeat the process.

Diabetic Ketoacidosis (DKA)

• First line of treatment:
  • Airway management with head of bed (HOB) elevated.
  • Assess level of consciousness.
  • Administer IV fluids with an 18-gauge needle, using 1/2 normal saline (NS) at 150/75 mL/hour
  • Administer insulin intravenously.
  • Monitor electrolytes, especially potassium (K), and obtain an EKG if administering K.
  • If IV BG levels go less than 250, give IV dextrose to keep the BG within normal limits (WNL).
  • Administer sodium bicarbonate if acid-base imbalance goes unresolved.
• Pathophysiology: patients stop taking their medications or have more sugar as a result of illness/infection.
• High glucose results in a high osmotic effect, leading to excessive water in the bloodstream and the 3 Ps because cells are dehydrated, which increases blood glucose.
• Signs and symptoms of dehydration: poor skin turgor, sunken eyelids, increased heart rate (HR), decreased blood pressure (BP).
• pH less than 7.30 indicates acidosis.

Cancer Overview

• Lung cancer is the most deadly for both men and women.
• Prostate cancer is second for men and breast cancer is second for women.
• Most diagnoses occur over the age of 55.
• Cancer develops over time, not all at once.
• Proto-oncogenes are involved in normal cellular processes that encourage cell division.
  • When mutated, growth-promoting pathways become overactive.
• Tumor-suppressor genes normally inhibit cell division and promote apoptosis.
  • When mutated, critical tumor-suppressor proteins become inactive, removing the brake on cell division.
• Genetic mutations can be inherited from a parent or acquired from damage to genes over a lifetime.
• It usually takes decades to accumulate enough mutations to reach a malignant state.
• Exposure to carcinogens increases the likelihood that certain harmful changes will occur.

Benign vs. Malignant Tumors

• Benign tumors are non-cancerous.
  • Small and slow-growing.
  • Non-invasive and well-differentiated.
  • Stay in one space and cannot metastasize.
• Malignant tumors are cancerous.
  • Large and fast-growing.
  • Invasive and poorly differentiated.
  • Infiltrate, invade, and destroy surrounding tissue, then metastasize to other parts of the body.

TNM System for Cancer

• The TNM system is a standardized way to describe the extent of cancer in the patient's body.

Purpose of a Biopsy

• A biopsy is the only definitive way to diagnose cancer.

Management During Chemotherapy

• Chemotherapy is administered intravenously; watch for irritants vs. vesicants.
  • Irritants cause damage to direct skin contact.
  • Vesicants cause tissue damage.
• Provide oral care, ensure the patient eats, provide emesis bags, and administer medications for pain management.

Diagnostic Tests

• White Blood Cell (WBC) count normal range: 4,000-11,000.
• Platelet count normal range: 150,000-450,000.
• Hemoglobin normal range: 12.1-17.2.
• Hematocrit normal range: 37-54%.
• Serum Creatinine normal range: 0.6-1.3.

Overview of rapid-acting, short-acting, intermediate-acting, and long-acting insulins used to manage diabetes. Covers onset, peak, and duration for each type including Lispro (Humalog), Regular Insulin (Humulin R), NPH, Glargine (Lantus) and Detemir (Levemir). Highlights administration considerations and potential risks.