Insulin therapy indications

Avandia contains rosiglitazone, which is a thiazolidinedione that is used as oral antidiabetic therapy. Thiazolidinediones reduce peripheral insulin resistance, resulting in reductions in blood-glucose concentrations. Inadequate response to oral antidiabetic therapy indicates failing insulin release and the impact of the introduction of rosiglitazone is of limited benefit on patient outcomes. Insulin should be considered. 

Hypoglycemia Pramlintide alone does not cause hypoglycemia. However, pramlintide is indicated to be coadministered with insulin therapy, and, in this setting, pramlintide increases the risk of insulin-induced severe hypoglycemia, particularly in patients with type 1 diabetes. Severe hypoglycemia associated with pramlintide occurs within the first 3 hours following a pramlintide injection. 

Occasionally, conversion to tolbutamide in the hospital may be advisable in candidates who require more than 40 units of insulin daily. During this conversion period when insulin and tolbutamide are being used, hypoglycemia rarely may occur. During insulin withdrawal, have patients test urine for glucose and acetone at least 3 times/day and report results to their physician. The appearance of persistent acetonuria with glycosuria indicates that the patient is a type 1 diabetes patient who requires insulin therapy. 

Like much mischief in medicine, the notion that we can infer disease from treatability was created by psychiatrists. Yet, a famous psychiatrist—Manfred Bleuler (1903—1994), the son of the famed psychiatrist Eugen Bleuler (1857—1939), aprofessor of psychiatry at the University of Zurich and director of the Burgholzli mental hospital— warned After the introduction of sleep therapy, and cardiazole-, insulin-, and electroshock therapies for schizophrenics, the argument was often raised that the discovery of a specific physical therapy indicated a specific physical disease. Subsequent experience effectively refuted such assumptions. The assumption is, a priori, fallacious. 

In most cases, rehydration and insulin therapy will correct the metabolic acidosis, and no further therapy is indicated. However, in the most severe ca.ses when the hydrogen ion concentration is greater than 100 nmol/l. i.v. sodium bicarbonate may be indicated. 

The nurse is teaching a client with newly diagnosed Type 1 diabetes about insulin therapy. Which statement indicates the client needs more teaching concerning insulin therapy ... 

Even with insulin therapy the client should adhere to the American Diabetic Association diet, which recommends carbohydrate counting. This statement indicates the client needs more teaching. 

Insulin therapy is adjusted based on hourly measurements of blood glucose and - if possible -blood ketones, the overall aim being a gradual decline in both. The initial decline is to a large extent due to rehydration and expansion of the extracellular volume. Repeated analysis of arterial blood gases may be indicated but only in those patients with very low pH values and/or poor chn-ical condition. Measurements of ketone levels in urine is in general unreliable in this phase these methods measure acetoacetate, which is quantitatively of minor importance compared with... 

Monitor for hypoglycemia as a result of insulin therapy if indicated. 6... 

The pharmacokinetic profiles for both the NPH crystals and the co-crystals also reflected a similar pattern. Co-crystals containing 75% C8-HI demonstrated a more uniform and favorable pharmacokinetic profile over a period of 24 hours than the NPH crystals. Studies measuring the insulin AUC indicated a much faster absorption rate for the NPH crystals i.e. higher insulin AUC values) in the first 12 hours than the co-crystals, in accordance with the dissolution results. However, in the 12-24 hour period, there was a significant decrease in the AUC for the NPH insulin, while that for the co-crystals remained comparable to the 0-12 hour period. This uniformity and prolonged absorption rate made the co-crystals more suitable for basal therapy in gly-cemic control than the existing intermediate-acting NPH crystals. 

Pramlintide is indicated as combination therapy with insulin in patients with type 1 or 2 DM. It has been shown to decrease... 

Because of the polyfactorial nature of disease states, such as obesity, type 2 diabetes, and Metabolic Syndrome, it is expected that drugs targeting the lipid synthesis and metabolism pathways will be used in the context of combination therapy [7]. Pre-clinical and clinical results to date indicate that pronounced efficacy could be achieved toward the management of associated lipid levels and insulin resistance, and thus, investigation in these areas provides significant promise. 

Insulin For patients stabilized on insulin, continue the insulin dose upon initiation of rosiglitazone therapy. Dose rosiglitazone at 4 mg daily. Doses greater than 4 mg daily in combination with insulin are not currently indicated. It is recommended that the insulin dose be decreased 10% to 25% if the patient reports hypoglycemia or if fasting plasma glucose concentrations decrease to less than 100 mg/dL. 

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