Insulin Types for Type 1 Diabetes

Questions and Answers

What type of diabetes is Rapid Acting insulin used for?

Juvenile diabetes

Type 1 (correct)

Type 2

Gestational diabetes

What is the peak time for Intermediate acting insulin?

1 hour

12 hours

24 hours

8 hours (correct)

What is the main consideration for patients using insulin pumps?

Monitoring blood glucose levels hourly (correct)

Checking for low blood pressure

Confirming insulin doses with a healthcare provider

All of the above

What is the correct order for mixing insulin?

Clear then cloudy Signup and view all the answers

What is the normal range for fasting blood glucose?

80-100 mg/dL Signup and view all the answers

What type of insulin is used as a basal insulin?

Long Duration Signup and view all the answers

What is the purpose of sliding scale insulin monitoring?

To adjust insulin doses based on blood glucose levels Signup and view all the answers

What is the effect of insulin on potassium levels?

Insulin stores potassium in cells Signup and view all the answers

What is the MOA of Biguanide?

Increases insulin sensitivity Signup and view all the answers

What is a common side effect of Metformin?

All of the above Signup and view all the answers

What is a rare but dangerous side effect of this medication?

Lactic acidosis Signup and view all the answers

Why is it important to monitor kidney function during treatment?

Because the medication can affect kidney function Signup and view all the answers

What is a common side effect of this medication that can be uncomfortable but is not serious?

Flatulence Signup and view all the answers

Why is it important to stop taking this medication 48 hours before a CT scan?

To allow the contrast dye to work effectively Signup and view all the answers

What is a benefit of this medication for people with polycystic ovary syndrome (PCOS)?

It reduces androgen levels Signup and view all the answers

Why is it important for people with kidney disease to use caution when taking this medication?

Because it can worsen existing kidney disease Signup and view all the answers

What is a potential interaction to be aware of when taking this medication?

It can interact with alcohol Signup and view all the answers

What is a severe side effect of this medication that requires immediate medical attention?

All of the above Signup and view all the answers

Why is this medication used to treat people with pre-diabetes?

It increases insulin sensitivity Signup and view all the answers

What is a contraindication for this medication?

Severe infections Signup and view all the answers

What is the mechanism of action of Sulfonylureas?

Increased insulin secretion by stimulating pancreatic B cells Signup and view all the answers

What is a common side effect of Thiazolidinediones?

Weight gain Signup and view all the answers

What is the mechanism of action of GLP-1 Agonists?

Mimicking the action of incretin hormones Signup and view all the answers

What is a common side effect of DPP-4 Inhibitors?

Headache Signup and view all the answers

What is the mechanism of action of SGLT-2 Inhibitors?

Inhibition of sodium-glucose cotransporters in the kidney Signup and view all the answers

What is a rare but serious side effect of GLP-1 Agonists?

Pancreatitis Signup and view all the answers

What laboratory values would be elevated if the liver is not functioning well?

AST and ALT Signup and view all the answers

What is the effect of Meglitinides on the body?

Increased insulin secretion by stimulating pancreatic B cells Signup and view all the answers

What is a common side effect of Thiazolidinediones in patients with heart failure?

Increased risk of heart failure Signup and view all the answers

What is the mechanism of action of Empagliflozin?

Inhibition of sodium-glucose cotransporters in the kidney Signup and view all the answers

What is the primary characteristic that distinguishes Rapid Acting insulin from other types of insulin?

Onset Signup and view all the answers

Which type of insulin is typically used as a basel insulin?

Long Duration Signup and view all the answers

What is the significance of the cloudy appearance of Intermediate Acting insulin?

It requires agitation before administration Signup and view all the answers

What is the primary purpose of sliding scale insulin monitoring?

To adjust insulin doses based on blood glucose levels Signup and view all the answers

What is the relationship between insulin and potassium levels?

Insulin stores potassium in cells Signup and view all the answers

What is the primary action of Biguanides, such as Metformin?

Decreasing insulin resistance Signup and view all the answers

What is the significance of the SQ route of administration for insulin?

It is a subcutaneous route of administration Signup and view all the answers

What is the primary consideration for patients using insulin pumps?

Monitoring blood glucose levels hourly Signup and view all the answers

What is the primary benefit of using insulin pumps?

Improved glycemic control Signup and view all the answers

What is the primary storage requirement for insulin?

Refrigeration at 2-8°C Signup and view all the answers

What is the primary reason to monitor kidney function during treatment with Metformin?

To prevent lactic acidosis Signup and view all the answers

What is a common side effect of Metformin that can be uncomfortable but is not serious?

Flatulence Signup and view all the answers

Why is it important to stop taking Metformin 48 hours before a CT scan?

To prevent the CT dye from interacting with the medication Signup and view all the answers

What is a rare but dangerous side effect of Metformin?

Lactic acidosis Signup and view all the answers

What is a benefit of Metformin for people with polycystic ovary syndrome (PCOS)?

Improving insulin sensitivity Signup and view all the answers

Why is it important for people with kidney disease to use caution when taking Metformin?

Because it can worsen kidney disease Signup and view all the answers

What is a contraindication for Metformin?

All of the above Signup and view all the answers

What is the primary mechanism of action of Metformin?

Improving insulin sensitivity Signup and view all the answers

Why is Metformin used to treat people with pre-diabetes?

To prevent type 2 diabetes Signup and view all the answers

What is a severe side effect of Metformin that requires immediate medical attention?

Lactic acidosis Signup and view all the answers

Which of the following medications increases insulin responsiveness by stimulating PPAR?

Pioglitazone Signup and view all the answers

What is a common side effect of GLP-1 Agonists that can be uncomfortable but is not serious?

Gastrointestinal upset Signup and view all the answers

Which of the following laboratory values would be elevated if the liver is not functioning well?

AST and ALT Signup and view all the answers

What is the mechanism of action of Sulfonylureas?

Stimulating pancreatic beta cells to release more insulin Signup and view all the answers

What is a rare but serious side effect of GLP-1 Agonists?

Thyroid tumors Signup and view all the answers

What is the mechanism of action of SGLT-2 Inhibitors?

Blocking the reabsorption of glucose in the kidneys Signup and view all the answers

What is a common side effect of Thiazolidinediones in patients with heart failure?

Fluid retention Signup and view all the answers

What is the effect of Meglitinides on the body?

Increases insulin secretion Signup and view all the answers

What is the mechanism of action of DPP-4 Inhibitors?

Inhibiting DPP-4 to increase insulin secretion Signup and view all the answers

What is a common side effect of Empagliflozin?

Genital mycotic infections Signup and view all the answers

Study Notes

Insulin Types and Characteristics

Rapid-acting insulin:
- Onset: 15 minutes
- Peak: 1-3 hours
- Duration: 3-5 hours
- Route: SQ
- Side effects: hypoglycemia, weight gain
Short-acting insulin:
- Onset: 30 minutes
- Peak: 1-5 hours
- Duration: 6-10 hours
- Route: SQ, IV
- Side effects: hypoglycemia, weight gain
Intermediate-acting insulin (basal insulin):
- Onset: 60 minutes
- Peak: 8 hours
- Duration: 24 hours
- Route: SQ
- Side effects: hypoglycemia, weight gain
Long-duration insulin (basal insulin):
- Onset: 70 minutes
- Peak: n/a
- Duration: 24 hours
- Route: SQ
- Side effects: hypoglycemia, weight gain

Insulin Storage and Administration

Insulin storage: 2-8°C, do not freeze
Insulin pump: for type 1 diabetes, self-controlled insulin administration, requires hourly blood glucose checks
Mixing insulin: clear insulin should be added to cloudy insulin, and cloudy insulin requires agitation

Oral Diabetes Medications

Biguanides (Metformin):
- Mechanism of action: increases insulin sensitivity, decreases glucose production in liver, increases peripheral glucose uptake
- Side effects: GI upset, anorexia, flatulence, B12 deficiency
- Contraindications: severe infections, sepsis, shock, kidney disease
Sulfonylureas:
- Mechanism of action: stimulate pancreatic beta cells to release insulin
- Side effects: hypoglycemia, weight gain
- Contraindications: type 1 diabetes, pregnancy, breastfeeding
Meglitinides:
- Mechanism of action: stimulate pancreatic beta cells to release insulin
- Side effects: hypoglycemia, weight gain
- Contraindications: type 1 diabetes
Thiazolidinediones (TZDs):
- Mechanism of action: increase insulin sensitivity, decrease insulin resistance
- Side effects: weight gain, edema, heart failure
- Contraindications: heart failure, liver disease
GLP-1 Agonists (Incretin Mimetics):
- Mechanism of action: mimic incretin action, stimulate pancreatic beta cells to release insulin
- Side effects: GI upset, pancreatitis, thyroid tumors
- Contraindications: type 1 diabetes, severe gastrointestinal disease
DPP-4 Inhibitors:
- Mechanism of action: inhibit DPP-4 enzyme, increase GLP-1 levels
- Side effects: headache, pancreatitis, joint pain
SGLT-2 Inhibitors:
- Mechanism of action: inhibit sodium-glucose contransporters, increase glucose excretion in urine
- Side effects: genital mycotic infections, urinary tract infections, Fournier's gangrene

Monitoring and Contraindications

Liver function tests: AST and ALT levels increase with liver damage
Renal function tests: BUN and creatinine levels increase with renal damage
Contraindications: type 1 diabetes, pregnancy, breastfeeding, severe infections, sepsis, shock, kidney disease, liver disease, heart failure

Insulin Types

Rapid-Acting Insulin: Onset in 15 minutes, peak in 1-3 hours, and duration of 3-5 hours; administered through subcutaneous (SQ) injection; may cause hypoglycemia and weight gain.
Short-Acting Insulin: Onset in 30 minutes, peak in 1-5 hours, and duration of 6-10 hours; administered through SQ or IV injection; may cause hypoglycemia and weight gain.
Intermediate-Acting Insulin: Onset in 60 minutes, peak in 8 hours, and duration of 24 hours; administered through SQ injection; may cause hypoglycemia and weight gain.
Long-Acting Insulin: Onset in 70 minutes, with no peak and a duration of 24 hours; administered through SQ injection; may cause hypoglycemia and weight gain.

Insulin Administration and Precautions

Insulin should be stored at 2-8°C and should not be frozen or exposed to extreme temperatures.
Insulin pumps are only for type 1 diabetes and require self-monitoring of blood glucose levels every 2-3 hours.
Mix insulin should be injected with clear insulin first, followed by cloudy insulin, and cloudy insulin should be agitated before injection.

Oral Diabetes Medications

Biguanide - Metformin

Mechanism of action: decreases glucose production, increases insulin sensitivity, and decreases glucose absorption.
Metabolism: excreted by the kidneys.
Side effects: GI upset, anorexia, flatulence, abdominal cramps, lactic acidosis (rare), and vitamin B12 deficiency.
Nursing considerations: monitor renal function, start with a small dose and gradually increase, and avoid taking with alcohol.

Sulfonylureas - Glyburide and Glipizide

Mechanism of action: stimulates pancreatic beta cells to release insulin.
Side effects: weight gain, hypoglycemia, and disulfiram-like reaction with alcohol.
Nursing considerations: monitor hepatic laboratory tests, avoid taking with alcohol, and skip meals may cause hypoglycemia.

Meglitinides - Repaglinide and Nateglinide

Mechanism of action: stimulates pancreatic beta cells to release insulin.
Side effects: weight gain, hypoglycemia, and GI upset.
Nursing considerations: primarily used for type 2 diabetes, cannot skip meals, and may cause hypoglycemia.

Thiazolidinediones - Rosiglitazone and Pioglitazone

Mechanism of action: increases insulin sensitivity through PPAR-gamma.
Side effects: weight gain, edema, and increased risk of heart failure.
Nursing considerations: monitor for heart failure, cannot be used in patients with heart failure, and primarily used for type 2 diabetes.

GLP-1 Agonists - Semaglutide and Incretin Mimetics

Mechanism of action: mimics incretin.
Side effects: GI upset, severe abdominal pain, and rare cases of thyroid tumors.
Nursing considerations: primarily used for type 2 diabetes, cannot skip meals, and may cause hypoglycemia.

DPP-4 Inhibitors - Sitagliptin and Januvia

Mechanism of action: blocks DPP-4 to stimulate insulin release and suppress glucagon release.
Side effects: headache, joint pain, and rare cases of pancreatitis.
Nursing considerations: primarily used for type 2 diabetes, monitor for pancreatitis, and may cause hypoglycemia.

SGLT-2 Inhibitors - Empagliflozin and Januvia

Mechanism of action: blocks SGLT-2 to increase glucose excretion in urine.
Side effects: genital mycotic infections, urinary tract infections, and hypotension.
Nursing considerations: primarily used for type 2 diabetes, monitor for genital infections, and may cause hypotension.

Laboratory Tests

Liver function tests: AST and ALT elevate if liver function is impaired.
Renal function tests: BUN and creatinine elevate if renal function is impaired.

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Description

This quiz covers the characteristics of different insulin types, including rapid acting, short acting, and intermediate acting insulin, used to manage type 1 diabetes. It includes information on onset, peak, duration, and potential side effects.