Pharmacology Insulin Drugs

Insulin drugs
insulin lispro (Humalog) – rapid
regular insulin (Humulin) – short, subQ, IV
insulin isophane (NPH) – intermediate
insulin glargine or detemir (Lantus, Levimer) – long

Insulin definition
Synthesized pancreatic hormone

Caution of Insulin & Routes of Administration
Hypoglycemia
IV, SQ, Nasal spray

insulin lispro (Humalog) – time to administer, onset, peak, duration
15 min before eating, 15 min, 30-90 min, 6-8 hrs

regular insulin (Humulin) – time to administer, onset, peak, duration
30 min before eating, 30-60 min, 2-3 hrs, 5-7 hrs

insulin isophane (NPH) – time to administer, onset, peak, duration
30-45 min before eating, 60-90 min, 8-12 hrs, 18-24 hrs

insulin glargine or detemir (Lantus, Levimer) – time to administer, onset, peak, duration
Given at bedtime, 1 hr, none, 24 hrs

Which is the basal insulin? What does it do?
-Lantus; mimics effects of basal insulin being secreted by pancreas
-Has no issues with hypoglycemia, has no peak

Mixed combination Insulins
Humulin 70/30 (NPH 70%, Regular 30%)
Humalog 75/25 (NPH 75%, Rapid 25%)
-Weight based or sliding scale; carbohydrate counting; insulin pumps

Nursing interventions for Insulin
-Monitor blood sugars, Hbg A1C
-Safety – peak action of insulin
-Teach – techniques for admin.; need to time food w/ peaks; emergency simple sugars on hand; signs/symptoms hypo/hyperglycemia; sick day

Biguanides
metformin (Glucophage)

Action of metformin (Glucophage)
Decreases hepatic glucose production and decrease intestinal absorption of glucose

Use of metformin (Glucophage)
1st line treatment for type 2 diabetes

Contraindications of metformin (Glucophage)
Renal disease

Adverse effects of metformin (Glucophage)
GI bloating, N/D, does NOT cause hypoglycemia

Nursing implications of metformin (Glucophage)
Take w/ meals to decrease stomach upset, discontinue 48 hrs before diagnostic tests, monitor blood glucose, need for diet/exercise

Sulfonylureas
glipizide (Glucotrol) – 2nd generation
glyburide (Diabeta)

Action of Sulfonylureas
Increase insulin excretion from pancreas

Use of Sulfonylureas
Type 2 DM

Adverse effects of Sulfonylureas
Hypoglycemia

Contraindications of Sulfonylureas
Renal disease

Nursing implications of Sulfonylureas
Monitor blood glucose
Take before meals
Teach s/sx of hypoglycemia
Diet/exercise

Meglitinides
repaglinide (Prandin)

Action of repaglinide (Prandin)
Facilitates pancreas to produce more insulin after a meal

Use of repaglinide (Prandin)
Type 2 DM

Adverse effects of repaglinide (Prandin)
Hypoglycemia, weight gain, GI disturbances

Nursing implications of repaglinide (Prandin)
-Give a dose w/ each meal, if skip a meal..no dose
-Give 15-30 min before meal
-Monitor blood glucose
-Never given w/ Sulfonylureas

Alpha glucosidase inhibitors
miglitol (Glycet)
acarbose (Precose)

Action of miglitol (Glucet) & acarbose (Precose)
Inhibit enzymes in GI tract delaying digestion of complex carbohydrates

Adverse effects of miglitol (Glycet) & acarbose (Precose)
GI upset, bloating, will not cause hypoglycemia

Nursing implications of miglitol (Glycet) & acarbose (Precose)
Must take with meal

Incretin Mimetics
exenatide (Byetta) – subQ

Action of exenatide (Byetta)
Hormones release by GI tract in response to food, slows gastric emptying, increases satiety

Use of exenatide (Byetta)
Type 2 DM

Adverse effects of exenatide (Byetta)
GI symptoms

DPP-4 Inhibitors
sitagliptin (Januvia) – po

Action of sitagliptin (Januvia)
Stimulate insulin release in response to a meal

Use of sitagliptin (Januvia)
Type 2 DM

Caution of sitagliptin (Januvia)
Renal

Adverse effects of sitagliptin (Januvia)
Respiratory tract infection

Action of rosiglitazone (Avandia)
Increases effectiveness of circulating insulin
-Limited use, black box: causes edema, heart failure

Action of pramlintide (Symlin)
Slows gastric emptying

Use of pramlintide (Symlin)
Can be used with insulin, sulfonylureas or metformin
-Hypoglycemia issues
-Given subQ

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