Diabetes - Insulin

Question 1

Adverse Effects of Insulin

Answer 1

-Weight gain
-Injection site issues (rotate)
-Hypoglycemia (15 gram glucose: 3-4 glucose tabs, 1-1/3 glucose gel, 1/2 cup fruit juice/soda, 1 cup milk, 8-10 candies, 5-6 skittles)
*dangerous for cardio, ACS, nuero

Question 2

Bolus

Answer 2

Very fast (Fiasp)

Rapid (lispro, aspart, glulisine, inhaled)

Short (reg 100)

Question 3

Basal

Answer 3

-INT (NPH, reg 500)- cloudy

Long (detemir, basaglar, semglee, glargine, degludec)

(T1D: 50% of daily need)

Question 4

Intermediate

Answer 4

NPH, dosed QD-BID or more, can be mixed

Question 5

Detemir

Answer 5

Long acting, SQ only, QD-BID, 42 days stable RT

Question 6

Glargine

Answer 6

Lantus, SQ, U100

Toujeo: U300, no need to convert dose, less WG

Both dosed QD

Question 7

Biosimilar Basaglar (Lilly & BI)

Answer 7

1:1 ratio to glargine dose, needs new RX

Question 8

Semglee for Lantus (glargine-yfgn)

Answer 8

Interchangeable bio similar

DOESNT NEED RX

Question 9

Glargine to Detemir Conversion

Answer 9

-Glargine is 20-40% stronger than detemir

-Increase the once daily glargine dose to 10% more for detemir

Question 10

BID NPH to Glargine U 100 or Glargine U300

Answer 10

Start dose is 80% of the total daily NPH dose administered once daily at the same time of day

Question 11

Glargine U100 to U300

Answer 11

insulin glargine U-100 TO U-300 (Toujeo)

it is expected that the total daily dose of Toujeo will be higher by at least 10%

Question 12

Rapid-acting (lispro, aspart, fiasco, glulisine)

Answer 12

-Inject right before meals, 5-15 mins
- 1:1 conversion when switch from regular
-Flexibility, less hypo, match CHO with insulin

Question 13

Short-acting: regular

Answer 13

-BID to QID 30 mins before meals, hypoglycemia risk

Question 14

Type 1 Diabetes: Guidelines

Answer 14

-Initially, start total daily insulin at 0.4-0.5 units/kg/day

Basal Bolus Method
-Divide half daily dose as basal and half as bolus
-Basal: *NPH, give 2/3 in AM and 1/3 in PM, *Long: one daily dose
-Bolus: rapid acting, divided between 3 meals

Doses usually <1.0 unit/kg/day

Question 15

Sick Day Management: esp. T1D

Answer 15

-Hydration
-Continue insulin even if decreased food intake (stress = more insulin needed)
-Increase SMBG to Q2-4hr

Question 16

Simplified Combination Injectable Therapy for T2D

Answer 16

Question 17

General Insulin Dose Adjustments

Answer 17

Question 18

Agrezza (Inhaled Insulin)

Answer 18

MEALTIME insulin ONLY
* T1D patients also on a longer-acting insulin
* T2D patients as monotherapy or in combination with oral agents or a longer-acting insulin

*Not in use: refrigerate
*In use: RT, use within 10 days, open strips use within 3 days

BBW: Acute Bronchospasm
-AE: hypo, cough, throat pain/irritation
-Avoid in smokers, asthma, COPD