INSULIN THERAPY
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- 3 types of rapid acting insulin.
-
Humalog (lispro)
Novolog (aspart)
Apidra (glulisine) - Humalog (lispro) onset
- 10-15 minutes
- Humalog (lispro) peak
- 30 min - 1.5 hours
- Humalog (lispro) duration
- 3-5 hours
- Novolog (aspart) onset
- 10-15 minutes
- Novolog (aspart) peak
- 1-3 hours
- Novolog (aspart) duration
- 3-5 hours
- Apidra (glulisine) onset
- 20 minutes
- Apidra (glulisine) peak
- 30 minutes- 1.5 hours
- Apidra (glulisine) duration
- 5 hours
- What are the 3 short acting insulins?
-
Humulin R
Novolin R
Velosulin BR - Humulin R onset? (after SQ)
- 0.5-1 hour
- Humulin R peak? (after SQ)
- 2-4 hours
- Humulin R duration? (after SQ)
- 5-7 hours
- Novolin R onset (IV)
- 10-30 minutes
- Novolin R peak (IV)
- 15-30 minutes
- Novolin R duration (IV)
- 30-60 minutes
- Velosulin BR onset
- 30 minutes
- Velosulin BR peak
- 1-3 hours
- Velosulin duration?
- 8 hours
- Which class of insulins most closely mimics teh body's own insulin response?
- Rapid-Acting insulins...which are???
- When should you give an injection of rapid acting insulin? (how many minutes before a meal?)
- 5-15 minutes before
- What does the administration of insulin control when given before meals?
- post prandial hyperglycemia
- Is rapid acting insulin clear or cloudy?
- clear
- What 3 other insulins can rapid acting insulins be mixed with?
-
NPH
Lente
Ultralente - When are short acting insulins given? how many minutes before a meal?
- 30 minutes before a meal to control post prandial hyperglycemia
- What is very necessary with the administration of short acting insulins as far as meals are concerned?
- a rigid meal schedule is necessary...the patient must estimate a meal will occur within 45 minutes of the injection.
- What is the only insulin that can be given IV? What is the normal dose and how is it administered?
- Regular 0.1 unit/kg/hr per continuous infusion
- What are the 2 main types of intermediate acting insulins?
-
NPH
Lente - What are the 2 types of NPH insulins?
-
Humulin N (NPH)
Novolin N (NPH) - What are the 2 types of Lente insulins? What is the insulin suspended in?
-
Humulin L (Lente)
Novolin L (Lente)
they are suspended in Zinc - What type of suspension are the NPH insulins in?
- Isophane
- Humulin N (NPH) onset?
- 3-4 hours
- Humulin N (NPH) peak?
- 6-12 hours
- Humulin N (NPH) duration?
- 18-24 hours
- Novolin N (NPH) onset?
- 3-4 hours
- Novolin N (NPH) peak?
- 6-12 hours
- Novolin N (NPH) duration?
- 18-24 hours
- Humulin L (Lente) onset?
- 1-3 hours
- Humulin L (Lente) peak?
- 8-12 hours
- Humulin L (Lente) duration?
- 18-28 hours
- Novolin L (Lente) onset?
- 1-3 hours
- Novolin L (lente) peak?
- 8-12 hours
- Novolin L (lente) duration?
- 18-28 hours
- What purpose is intermediate acting (NPH) insulin given?
- to control blood glucose levels when patient is not eating.
- What substance is added to insluin to form a suspension that is more slowly absorbed with different time/action profile?
- Protamine
- What causes the cloudy appearance of NPH?
- protamine
- What special thing should you do before drawing up NPH?
- roll the vial to mix up solution
- What 2 other insulin classes can NPH be mixed with?
- short and rapid acting insulin
- What does NPH stand for?
- Neutral protamine Hagedorn
- what should you NOT mix with short acting insulin unless the patient already controlled on this mixture?
- should not mix lente plus short acting (not reccommended)
- Long acting insulins: (name the most commonly used now, and the 4 other not common)
-
Lantus (glargine)
Humulin U (ultralente)
Novolin U (ultralente)
Ultralente U (ultralente)
Levemir (insulin detemir) - What is the onset of Lantus (glargine)?
- 1.1 hours
- Lantus (glargine) peak?
- NO PEAK
- Lantus (glargine) duration?
- 24 hours
-
Humulin U-onset, peak, duration?
Novolin U- " "
Ultralente U- " " -
4-6 hours onset
18-24 hours peak
36 hours duration - Levemir (insulin detemir) onset, peak, duration
-
onset: .8-2 hours
peak: 3.2-9.3 hours
duration: 24 hours - What color is glargine (Lantus?)
- clear
- can lantus be mixed with any other insulin?
- HELL NO.
- Why can't lantus be mixed?
-
because stupid...
it can unpredictably alter the onset of actoin and time of peak effect. DUH. - 3 weird lente insulins not used much any more...what are they used for.
- used for basal injection
- what should you be careful of when using both lantus and lente?
- DON'T CONFUSE THE MOTHERFUCKERS. lantus is different than lente.
- should you mix levemir (insulin detemir) with any other insulin?
- HELL NO.
- Normal RBC level for males
- 4.7 - 6.1
- Normal RBC level for females
- 4.2 - 5.4
- Normal Hgb for males
- 14 - 18
- Normal Hgb for females
- 12 - 16
- Normal Hct for males
- 45%
- Normal Hct for females
- 40%
- Normal WBC range
- 4,500 - 10,000
- Normal platelet range
- 150,000 - 400,000
- Normal serum sodium range
- 135 - 145
- Normal serum potassium range
- 3.5 - 5
- Normal serum calcium range
- 4.5 - 5.5
- Normal serum magnesium range
- 1.5 - 2.5
- Normal serum cloride range
- 96 - 106
- Normal serum phosphate range
- 2.5 - 4.5
- Osmolarity of a hypotonic solution
- < 275
- Osmolarity of an isotonic solution
- 275 - 295
- Osmolarity of a hypertonic solution
- > 295
- What is the percentage of RBC's, buffy coat, and platelets in total blood volume?
- 45%
- What is the percentage of plasma in total blood volume?
- 55%
- What 3 major constituants can plasma be broken down into?
-
Albumin
fibrinogen
globulin - What is the normal ph range of blood in an ABG?
- 7.35 - 7.45
- What is the normal PCO2 range of blood in an ABG?
- 35 - 45
- What is the normal bicarbonate range of blood in an ABG?
- 22 - 26
- What is the IVPB infusion time?
- 20 - 60 minutes (NO LONGER THAN 60 MINUTES)
- IVPB are usually what volumes?
- 25 - 250 mL
- The infusion volume and time of Whole Blood
- 300 - 350 mLs over 2 - 4 hours
- The infusion volume and time of PRBC's?
- 200 - 250 mL's over 2 - 4 hours
- The infusion volume and time of Leukocyte filtered RBC's?
- 200 mLs over 2 - 4 hours
- The infusion volume and time for platelets?
- 200 - 300 mLs over 15 - 30 minutes
- The infusion volume and time for FFP?
- 200 mLs over 30 - 60 minutes
- The infusion volume and time of cryoprecipitate
- 10 - 20 mLs over 3 minutes (infused or IV push)
- The infusion volume and time for WBC's
- 400 mL over 60 minutes
- The infusion volume and time for albumin
-
2 - 4 minutes for 5%
slower for 25% - 1 unit of RBC's increases HgB how many grams? increases Hct what percentage?
-
Hgb: 1 gram
Hct: 3% - 3 types of combination NPH/Regular mixture?
-
Humulin 70/30
Humulin 50/50
Novolin 70/30 - Onset of Humulin 70/30 and Novolin 70/30
- 30 minutes
- peak of humulin 70/30 and Novolin 70/30
- 2-12 hours
- duration of humulin 70/30 and novolin 70/30
- 2-12 hours
- Onset of Humulin 50/50
- 30 minutes
- Peak of Humulin 50/50
- 3-5 hours
- Duration of Humulin 50/50
- 24 hours
- 2 types of combination NPH/Lispro mixtures?
-
Humalog mix 75/25
Humalog 50/50 - onset of humalog 75/25
- 15 minutes
- peak of humalog 75/25
- 1-2 hours
- duration of humalog 75/25
- 24 hours
- onset humalog 50/50
- 15 minutes
- peak humalog 50/50
- 1-4 hours
- duration humalog 50/50
- 24 hours
- NPH/Aspart mixture?
- Novolog mix 70/30
- Concentrated regular insulin U-500 used for whom?
- only for use in patients with insulin >200 u/day
- What 2 factors determine if the insulin therapy is effective?
-
blood glucose is controlled without appearance of hyper/hypoglycemic episodes and
glycosylated hemoglobin < 7% - What are the contents of the formed elements in the blood and the percentages of each?
-
RBC's-95.1
buffy coat-.1
platelets-4.8 - what percentage of the blood is formed elements?
- 45%
- what factors can make the onset/peak/duration of insulin vary?
-
injection site
blood supply
concurrent illness
lifestyle
exercise level - NORMAL BUN LEVELS
- 10-20
- NORMAL CREATININE LEVELS
- 0.7-1.4