1. Endocrine Lecture Day 2b

2. Insulin History Lesson Instituted in 1923 – Beef – Pork 1979 – human insulin Can not be taken by mouth (digested)

3. Onset – Peak - Duration Onset – The time period from injection to when it begins to take effect Peak – When insulin is working its hardest and therefore blood glucose levels are at their lowest

4. Onset – Peak - Duration Duration – Length of time the insulin works or lasts

5. Types of Insulin – Very short acting/ rapid acting Lispro (Humalog) Aspart (Novolog) Insulin pumps Rapid reduction of glucose level AppearanceOnsetPeakDuration Clear ¼ hour1 hour3 hours

6. Types of Insulin – Short-acting / regular AppearanceOnsetPeakDuration Clear ½ - 1 hr (1 hour) 2-3 hrs (3 hour) 4-6 hrs (5 hours) Humalog R; Novolin R; Iletin II Regular Administered 20-30 minutes before meals IV Usually given 4 x a day May to taken alone or in combination

7. Types of Insulin – Intermediate-acting AppearanceOnsetPeakDuration Cloudy2-4 hrs (2 hrs) 6-12 hrs (12 hrs) 16-20 hrs (24 hrs) NPH; Humulin N; Lente: Novolin L; Novolin N Administer after meals Usually given 2x a day Eat at onset!

8. Types of Insulin – Long-acting Ultra Lente (UL) To control fasting glucose levels Cannot be mixed! AppearanceOnsetPeakDuration Cloudy4-8hour (6 hrs) 10-30 hrs (24 hrs) 36+ hours (36 hrs)

9. Learning Tip: Even and Odd Short-acting think odd – (1-3-5) Intermediate-acting think even – (2-12-24)

10. When should insulin be administered Short-acting / regular – 30 minutes before meals – Do not allow more than 30 minutes to pass by without eating  hypoglycemia Intermediate acting – After meals If mixed (regular & intermediate) – 30 minutes before meals

11. What route is insulin administered Sub-cutaneous IV – Regular Pump

12. Small Group Question Mrs. Evans is 60 year old women with type 2 DM. She is on Novolin L (Lente) insulin every morning. She normally eats her meals at 8:00 AM, 12:00 PM, and 6:00 PM. 1.What time should she take her morning insulin? 2.When should she be alert for S&S of hypoglycemia? 3.What should Mrs. Evans be told to do at this time. (see question #2)

14. Mrs. Sweet Peas takes 13 units of Humalog R q ac. Her meals are B-8:00 AM, L-12:00 PM, D-7:00PM What time should Mrs. Peas take her mid-day (lunch)dose of insulin? When will Mrs. peas blood sugar be at its lowest? What should she do, or not do at this time?

15. Miss Sweet Peas

16. Mrs. Gumdrop takes 6 units of NPH at HS (10PM). She eats her meals at: B-7AM, L-11AM, D-5PM. When is she most at risk for hypoglycemia? What can she do to prevent this?

17. Mrs. Gumdrop

18. Mr. Chocolate Chip Cookie takes 10 units of Novolin R q AM. His meals are at : B-7AM, L-11AM, D-5PM. When should he take his morning does of insulin? When will Mr. Cookie ’ s blood sugar levels be at their lowest? What should he do, or not do at this time?

19. Mr. Chip

20. Ms. Eng Ewe takes 10 units of Iletin II Lente q AM. Her meals are B-8AM, L-12PM, D- 7PM When will her blood sugar levels be at their lowest? What should she do or not do at this time? What can she do to prevent this?

21. Ms. Ewe