Aspart

Lispro

Rapid acting Analogs

onset       - 0-0.2 hrs

Peak        - 1 hr

Duration   - 3-4 hrs

Clear solution

Rapid Acting

Onset       - 0.5

peak         - 2.5-3.5

duration    - 6-8

Clear

Humulin or

Novolin NPH

Intermediate Acting

onset     - 1.5

peak      - 4-12

duration - 22

cloudy

Intermediate

onset       - 2.5

peak        - 7-15

Duratuion - 22

Turbid

Long Acting

onset     - 1-2

peak      - none

duration - 24+

Clear 

Long Acting

onset     - 4

peak      - none

duration - 28

Turbid

50% regular / 50% NPH

onset     - 0.5

peak      - 2-5

duration - 22

Cloudy

Humulin or Novolin 70/30

70% NPH / 30% regular

onset     - 0.5

peak      - 1.5-16

duration - 22

Cloudy

Analog - 75% NPH / 25% Lispro

Onset    - 0-0.2

peak      - 1-6.5

duration - 22

Cloudy

Analog 70% NPH/30% Aspart

onset     - 0-0.2

peak      - 1-4

duration - 22

Cloudy

Trends in types of insulin:

Combinations

Have NPH

Duration 22 hrs

Onset .5 hrs or less

Cloudy

Trends in insulin types:

Long Acting

No peak

Duration > 24 hrs

Sample algorithm

for hyperglycemia

premeal

every 50 above 120 = add 1 unit of regular insulin

Sample Algorithm

for hyperglycemia

bedtime

for every 50 above 150 = add 1 unit regular insulin

Sample Sliding Scale

>200 = 2 units

>250 = 6 units

>300 = 10 units

DM diagnostic testing

fasting (define)

Fasting - 8 hrs no caloric intake

CBG = 126

DM diagnostic

symtoms (listed) + Casual CBG (defined)

symptoms: polyuria, polydipsia, weight loss

Casual: anytime of day, regardless of meals

CBG = 200

DM diagnostic

CBG level 2 hr after glucose tolerance test

Describe test and resultant CBG

Dose pt with 75 g of oral glucose

Wait 2 hrs

CBG = 200

Impaired Glucose Tolerance

Postprandial CBG levels

Dose with 75 g glucose

wait 2 hours

CBG = 140-200

Impaired Fasting Glucose

Fasting CBG = 100-126

Load oral 100g glucose

2 CBG as follows:

Fasting   95

1 hr     180

2 hr 155

3 hr 140

DM diagnostic in general

(1)Without unequivocal hyperglycemia with acute metabolic Decompensation; confirm with 2nd test

(2)glucose tolerance test not routine clinical use

(3)norm HbA1c doesn't rule out DM

Metaformin

(Glucophage)

↓ hepatic glucose prod., ↑ periphreal use

can't cause hypoglycemia

CONTRAINDICATED: renal insuff., liver disease, -OH excess, hypoxic state: CHF, COPD, ASTHMA

D/C: general anesthesia and contrast dyes

Wait 48 hrs or til creatinine norm levels

Thiazolinedines

glitazones

Actos & Avandia

amplify insulin signal, ↑ muscles intake, ↓ free fatty acids

safe with renal insufficiency;

CONTRAIDICATED: liver disease or elevates hepatic transamines (norms: AST 13-40 & ALT 7-40)

8-12 wks to reach max effect

Alpha-glucosidase inhibitors

acarbose (Precose)

miglitol (Glyset)

interferes with postprandial absorption of carbs

take with first bite of meal; used conjunctively with other meds

Cause gas; but get better after continued use

Sulfonylureas

1st gen: chlorpromide, tolazamide, tolbutamide

3rd gen: glimepiride

Enhance Insulin production and action

1st gen: risks-hypoglycemia, Antabuse-like effects (HA, SOB, palpations, N/V)

2nd & 3rd: ↓ side effects, ↑ potency

 Meglitinides

repaglinide (prandin)

nateglinide (starlix)

Enhance insulin secretion

Take right before meals and only with meals

Good for pts with sulfur allergies and hypoglycemia tendencies