Diabetes meds driving me crazy!

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Mar 25, '13 by dayanara

I always get mixed up with the onset and peak of the insulins and cannot see the bigger picture regarding oral meds.
Any suggestions on how to learn these better? Thanks:-)
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11 Comments so far...
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Mar 25, '13 by MendedHeart

I always have a hard time remembering too..lantus is the eadiest to remember. .24hours..try and relate each one to when you have to give it in relationship to the patient eating
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Mar 25, '13 by SherluckyRN

Remember RN regular before NPH. Regular is short acting I believe and NPH long acting then take it from there
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Mar 25, '13 by dayanara

Yeah Lantus is the easiest:-)

I believe NPH is intermediate acting:-) I don't have a problem knowing the rapid, short, intermediate and long. It's just the onset and peak that troubles me cuz I find different times on different sources.

Thank you both!

Mar 26, '13 by Esme12 Asst. Admin

Action of Commonly Prescribed Insulin......IOH types of insulin; chart of duration and action of insulin

Name	Type	Onset⁽¹⁾	Peak⁽¹⁾	Duration⁽¹⁾
Humalog (Lispro)	Rapid	5-15 minutes	30-75 minutes	2-3 hours
Apidra (glulisine)	Rapid	5-15 minutes	30-75 minutes	2-4 hours
Novolog (Aspart)	Rapid	10-20 minutes	1-3 hours	3-5 hours
Regular (R)	Short-Acting	30 minutes	2-5 hours	5-8 hours
NPH (N)	Intermediate	1-3 hours	6-12 hours	16-24 hours
Lente (L)	Intermediate	1-3 hours	6-12 hours	16-24 hours
Ultralente (U)	Long-Acting	3-5 hours	8-14 hours	18 hours
Glargine Lantus	Very Long-Acting	1 hour	Evenly for 24 hours	24-28 hours
NPH & Regular Mixed in either 50/50 mix, or 70/30 mix	Premixed	30-60 minutes	2-12 hours	up to 18 hours

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Mar 26, '13 by dayanara

Thank you Esme! Very helpful chart. Some sources say long-acting has no peak, and others like this one say it does...I'm just gonna go with what the book says:-)

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Mar 26, '13 by Esme12 Asst. Admin

If you click on the link it takes you to the page......where it breaks the individual insulin down. Great information!
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Mar 26, '13 by Floridatrail2006

In my experience, I commited to memory 3-5 of the most common insulins. For instance, humalog, novolog, regular, nph, and lantus. These five are very common. If you come acrossed another type in your studies or clinicals, look em up (as usual).

However, I too have had issues remembering insulin onset, peak, and duration. You can draw a graph for each one. Or, the main three. Novolog, regular, and lantus. That is what I did and I'm able to reproduce it to this day and not having drawn it in months. Try it.
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Mar 26, '13 by dayanara

I did Esme! Thanks. Great info:-)

Thank you Floridatrail! That's a good one! I'll try it for sure.
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Mar 26, '13 by eva123

Now that you have some good advice on the insulins here's some info on oral antidiabetics:
*Alpha-Glucosidase Inhibitors (Acarbose, Miglitol) act locally in GI tract to inhibit Alpha-glucosidase which is responsible for carb breakdown, because of it's mechanism of action it does not cause hypoglycemia.

*Biguanides (Metformin) works by multiple mechanisms. It reduces gluconeogenesis, decreases intestinal reabsorption of glucose, increases cellular uptake of glucose, and increases excretion of glucose. It also does not cause hypoglycemia.

*Incretin enhancers (Sitagliptan/Januvia) Inhibits DPP-4 from breaking down incretins, increased levels of incretins lowers blood glucose because incretins respond to glucose load and are responsible for 60% of insulin release. These can cause hypoglycemia.

*Meglitinides (Prandin) Stimulate insulin release from pancreatic beta-cells. These can cause hypoglycemia.

*Sulfonylureas (Glyburide, Glipizide) stimulate release of insulin from pancreatic beta cells and increase sensitivity of peripheral tissues to insulin. These can cause hypoglycemia.

*Thiazolidinedione aka TZDs (Avandia, Actose) increase cellular sensitivity to insulin and decrease gluconeogenesis by liver. These can cause hypoglycemia.

*Antihypoglycemic Agent (Glucogon/Gluca Gen) increases glycogenolysis, stimulates uptake of amino acids, increases gluconeogenesis, and promotes lipolysis.

You can find all of this in your drug book and much more information, but this should provide a brief overview. I pulled this information from Davis's Drug Guide and my teachers. Hope it helps.

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