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Insulin (Intermediate-acting, NPH, Lente):wholehealthmd.com:"Drug Interactions A large number of drugs can promote either elevated blood glucose levels or hypoglycemia. Be sure that your doctor knows about all of the medications you take and is informed before you start taking any new drugs, either by prescription or over the counter. Corticosteroids in particular are likely to raise blood glucose levels and insulin requirements. Beta-blockers (commonly prescribed for hypertension) may cause either high blood glucose levels or hypoglycemia; in addition, because these medications may dampen the symptoms of hypoglycemia that are caused by adrenaline release, mild degrees of hypoglycemia may progress unnoticed to more serious hypoglycemia affecting the brain." http://www.wholehealthmd.com/print/view/1%2C1560%2CDR_698%2C00.html Intermediate-acting insulin:insulinpen.com:"An insulin formulation that contains a substance, which delays the absorption of insulin. The combination of insulin and a delaying substance usually results in the formation of crystals that give the liquid a cloudy look. The insulin crystals must be homogenised (mixed) evenly before each injection. Intermediate-acting insulin takes approximately 1 1/2 hours before it begins to have an effect. The largest effect occurs between 4 and 12 hours after the injection, and after approximately 24 hours, the whole dose has been absorbed. " http://www.insulinpen.com/view.asp?ID=2190 The Problem with Intermediate and Long-Acting Insulins:powerpak.com:"Slowing absorption by slowing insulin hexamer dissociation generally produces longer-acting insulins with slower onset of action yet minimal impact on overall efficacy of the insulin molecule. This has been accomplished (in the case of Lente insulin) through the addition of zinc ions (Zn++) to insulin solution, which facilitates formation and stabilizes the hexamer microcrystals, thus prolonging dissociation and absorption processes. With the recent focus on mimicking normal daily patterns of insulin production by combining multiple doses of short-acting insulin to control postprandial glucose levels and longer-acting insulins to provide basal levels to control fasting glucose production, the deficiencies of these older technologies have become more apparent. Not only are even the longest-acting insulins often unable to provide adequate basal insulin levels in some patients, but multiple injections of intermediate-acting insulins can cause additional problems." http://www.powerpak.com/powergraphs/1999/nov/problem.cfm Pharmacodynamic effects of Intermediate acting insulin::"The primary activity of human insulin is the regulation of glucose metabolism. In addition, insulin has several anabolic and anti-catabolic actions on many tissues in the body. In muscle and other tissues (except the brain), insulin causes rapid transport of glucose and amino acids intracellularly, promotes anabolism, and inhibits protein catabolism. In the liver, insulin promotes the uptake and storage of glucose in the form of glycogen, inhibits gluconeogenesis, and promotes the conversion of excess glucose into fat. The typical activity profile (glucose utilisation curves) are illustrated below by the heavy line. Variations that a patient may experience in timing and/or intensity of insulin activity are illustrated by the shaded area. Individual variability will depend on factors such as size of dose, site of injection temperature and physical activity of the patient" http://www.medsafe.govt.nz/Profs/Datasheet/h/Humulininj.htm Effects of different insulin doses and regimens on the blood glucose profile of an example insulin-dependent diabetic patient.:2aida.org:"The first graph in the panel below shows a 24-hour blood glucose profile for a typical patient (in red). His carbohydrate intake is shown in grams on the second graph (in green). The next panel below shows the patient's simulated plasma insulin level on the upper graph (in red), and his insulin regimen of Humulin S insulin (in red) and intermediate-acting Humulin I insulin (in green) on the lower graph." http://www.2aida.org/aida/fast-track11.htm Classification: Intermediate-acting insulin :nursespdr.com:"Dosage •SC Diabetes. Adults, initial: 7-26 units 30-60 min before breakfast. Dosage is then increased by daily or weekly increments of 2-10 units until satisfactory readjustment is established. A second smaller dose may be given prior to the evening meal or at bedtime. Clients on NPH can be transferred to insulin zinc suspension on a unit-for-unit basis. Clients being transferred from regular insulin should begin zinc insulin at two-thirds to three-fourths the regular insulin dosage. If the client is being transferred from protamine zinc insulin, the dose of zinc insulin should be about 50% of that required for protamine zinc insulin." http://www.nursespdr.com/members/database/ndrhtml/insulinzincsuspensionlente.html Lente® L Antidiabetic Agent (Insulin); Antidote:brainybrawn.com:"Insulin is a hormone necessary for the body's use of food, especially sugar. Type 1 diabetics have no insulin of their own and require complete replacement. Type 2 diabetics still make insulin, but may require an outside source if their blood sugars are very elevated. Sometimes only short-term use of this medicine is needed for type 2 diabetes. What are the common side effects of this medicine? Low blood sugar. This can cause anger, shaking, rapid heartbeats, confusion, sweating. Can be life-threatening if not treated with hard candies, liquid glucose, milk. Nausea or vomiting. Small frequent meals, frequent mouth care, sucking hard candy, or chewing gum may help. Weight gain (seen in type 2 diabetics)" http://www.brainybrawn.com/IMCAccess/ConsDrugs/InsulinPreparationscd.html Novolin® N Antidiabetic Agent, Parenteral; Antidote, Hyperglycemia :healthtrust.com:"What should I monitor? Check blood sugar as ordered by healthcare provider. Call if glucose is less than 80 mg/dL or greater than 250 mg/dL. Bring results to follow-up visits. Watch for low blood sugar. Causes anger, shaking, rapid heartbeats, confusion, sweating. Watch for high blood sugar. Causes many trips to the bathroom, thirst, and weight loss. Check blood work. Talk with healthcare provider. Follow diet plan and exercise program as recommended by healthcare provider. Have an eye exam and visit to the foot doctor every year. Check weight." http://www.healthtrust.com/intmed/Access2Cons2/ConsDrugs/InsulinPreparationscd.shtml Insulin Preparations chart:fda.gov:"Since 1982, most of the newly approved insulin preparations have been produced by inserting portions of DNA ("recombinant DNA") into special lab-cultivated bacteria or yeast. This process allows the bacteria or yeast cells to produce complete human insulin. Recombinant human insulin has, for the most part, replaced animal-derived insulin, such as pork and beef insulin. More recently, insulin products called "insulin analogs" have been produced so that the structure differs slightly from human insulin (by one or two amino acids) to change onset and peak of action. The following table lists some of the more common insulin preparations available today. Onset, peak, and duration of action are approximate for each insulin product, as there may be variability depending on each individual, the injection site, and the individual's exercise program" http://www.fda.gov/fdac/features/2002/chrt_insulin.html Search Nursing Diabetics http://www.nursingdiabetics.com/A-Z_list/ ******************************************************
Amputation:
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Ulcer (diabetic ulcer):
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