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PHAR 152 > Diabetes - Part 3 > Flashcards

Diabetes - Part 3 Flashcards

1
Q

What is insulin?

A

A hormone secreted from pancreatic beta cells to help regulate blood glucose

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2
Q

How was the first human insulin created?

A

Using rDNA technology

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3
Q

What is the structure of insulin?

A

Consists of 51 amino acids in 2 chains (A and B) linked by 2 disulfide bonds

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4
Q

Basal insulin

A

Beta cells secrete small amounts of insulin throughout the day
(Background insulin)

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5
Q

Bolus insulin

A

At mealtime, insulin is rapidly released in response to food
(Mealtime or prandial insulin)

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6
Q

What are the Bolus insulins?

A

Rapid acting insulin analogues (clear)
Short acting insulins (clear)

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7
Q

What are the short acting insulins?

A

Insulin regular (Humulin-R, Novolin ge Toronto, Hyperion R)

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8
Q

When do you administer short acting insulins?

A

30-45 minutes prior to meals

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9
Q

What is the time for onset, peak and DoA for short acting insulins?

A

Onset: ~30 minutes
Peak: ~2-3 hours
DoA: ~6 hours

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10
Q

What are the rapid acting insulin analogues?

A

Insulin lispro (humalog, admelog)
Insulin aspart (novorapid, Kirsty, Trurapi)
Insulin aspart (Fiasp)
Insulin glulisine (apidra)

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11
Q

When are RAIA administered?

A

With or just prior (0-15min) to meals

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12
Q

What is the onset, peak, and DOA for RAIAs?

A

Onset: 4-20 minutes
Peak: 0.5-2 hours
DoA: 3-5 hours

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13
Q

What are the advantages to RAIAs?

A

More rapid absorption
Convenience
Better PPG control
Decrease hypoglycemia
BUT they do cost more and have similar effectiveness

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14
Q

What is humalog (insulin lispro) 200U/ml and how should it be administered?

A

It’s a more concentrated formulation for those who require higher doses.
Should ONLY be injected using a KwikPen to avoid overdose causing severe low blood sugar.

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15
Q

What is insulin regular U-500(entuzity)?

A

A very concentrated form of insulin (500U/ml)
For those who require >200U/d
Given 2-3 times per day

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16
Q

When is Entuzity (U-500) administered?

A

30 min before a meal because it is short acting

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17
Q

What is the onset, peak and DoA of entuzity (u-500)?

A

Onset: ~15 minutes
Peak: ~4-8 hours
DoA: ~17-24 hours

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18
Q

What are the basal insulins?

A

Intermediate acting (cloudy)
Long acting insulin (clear)

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19
Q

What are the intermediate acting insulins?

A

Insulin neutral protamine hagedorn(NPH) (humulin N, novolin ge NPH, Hyperion NPH)

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20
Q

What are the long acting insulins?

A

Insulin detemir U-100 (levemir)
Insulin glargine U-100(lantus)
Insulin glargine U-300(Toujeo)
Insulin degludec U-100, U-200(tresiba)

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21
Q

What is the onset, peak and DoA for intermediate acting?

A

Onset: 1-2 hours
Peak: 5-8 hours
Duration: up to 18 hours

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22
Q

What is the onset, peak and DoA for long acting insulins?

A

Onset: 90 minutes
Peak: peakless
Duration:
- detemir 16-24 hours
- U-100 glargine 24 hours
- U-300 glargine >30 hours
- degludec 42 hours

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23
Q

How often is intermediate acting insulins administered?

A

Once or twice daily

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24
Q

What must you do with intermediate acting insulins before use?

A

Hand-roll and invert 10X to re-suspend since they are a suspension

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25
Q

What are the advantages of LAIAs?

A

Peakless
More consistent / less variable BG
Less hypoglycemia
BUT they cost more and have similar efficacy

26
Q

What is the protocol for switching from insulin glargine (lantus) OD to newer insulins?

A

Use the same dose

27
Q

What is the protocol for switching from insulin NPH BID to newer basal insulins?

A

Reduce by 20%

28
Q

What are the most expensive injection pens?

A

Toujeo

29
Q

What is the cheapest insulin pen?

A

Humulin N KwikPen

30
Q

How can insulin be delivered?

A

Syringes and vials
Insulin pens
Insulin pumps

31
Q

What is the traditional method for insulin delivery and its pros?

A

Syringes and vials
- least expensive
- people are used to it
- may prefer less injections so they can combine some insulins in the same syringe

32
Q

What syringe would you use for a does of 30U, 31-50U, and 51-100U?

A

30 units - 3/10 cc with half unit marking
31-50 units - 1/2 cc
51-100 units - 1cc

33
Q

What are the pros to insulin pens?

A

Portable / convenient / easier to use
Good if dexterity/visually impaired
Allows for precision dosing

34
Q

What is an insulin pump called?

A

Continuous subcutaneous insulin infusion (CSII)

35
Q

What is an insulin pump?

A

A small computerized device that delivers insulin continuously 24 hours a day

36
Q

What type of insulin does and insulin pump use?

A

RAIA - deceivers it continuously and increased amounts when a Bolus is required

37
Q

What are the adverse effects of insulin?

A

Hypoglycemia
Weight gain
Localized fat Hypertrophy
Blurry vision - usually temporary
Allergic reactions (rare)

38
Q

What factors affect insulin absorption?

A

Injection site
Exercise of injected area = increase
Massage - vigorous massage = increase
Temp - heat = increase
Lipohypertrophy = delays
Dose - larger dose = delays
Renal function - renal failure = decrease
Depth of injection - IV > IM > SC

39
Q

What area of the body is insulin absorbed the fastest?

A

Abdomen, then arm, thigh and slowest from butt

40
Q

What is it important to do when injecting?

A

Rotate between injection sites

41
Q

What are the steps for injecting insulin with a syringe?

A
  1. Pull in air
  2. Push air into the bottle
  3. Pull in and push out a little insulin to remove air bubbles
  4. Pull exact dose of insulin into the syringe
42
Q

What length of syringe is recommended?

A

6mm - can use with or without skin lift

43
Q

What to do when mixing insulin N + R in the same syringe

A

Must always draw up the quick-acting insulin first
- fill syringe with air up to # of units needed of NPH
- push air into vial and remove needle
- fill syringe with air to # of units needed of R
- push air into vial and draw up desired number of units of R
- insert needle back into NPH vial and draw up desired units of NPH
- make sure there are no air bubbles by tapping

44
Q

How do you use a pen?

A

Prime the pen
Dial up amount of insulin required
Inject at 90º

45
Q

How is insulin stored?

A

If unopened - in fridge
When in use - room temp

46
Q

When should you discard in use insulin?

A

After 28-56 days

47
Q

What should you avoid when storing insulin?

A

Freezing, extreme heat and direct sunlight

48
Q

Which insulin cannot be mixed in syringe with any other insulin?

A

LAIA

49
Q

What is the usual split for insulin in T1 or those who are on MDI with T2?

A

Basal: 40-50%
Bolus:50-60%

50
Q

What is the dosing for T1 in units/kg for: initial dose, honeymoon phase, and ketosis or acute illness?

A

Initial: 0.5-0.6 (usually 0.5)
Honeymoon: 0.1-0.4
Ketosis or acute illness: 0.5-1.0 (usually 1.0)

51
Q

What is the dosing for T2 in units/kg for: initial dose, and with insulin resistance?

A

Initial: 0.1 (or more commonly 10U of basal insulin hs)
Resistance: up to 2.5U/kg (or greater)

52
Q

What is MDI?

A

Multiple daily injections
- a regimen of Bolus injections of insulin before each meal + an evening basal insulin

53
Q

What is a typical C:I ratio?

A

15:1 - 15h CHO: 1 unit insulin

54
Q

How can the initial C:I be estimated?

A

By diving 500 or 550 by the total daily dose (TDD) of insulin

55
Q

What is the correction factor?

A

The expected amount that 1 unit of insulin will normally decrease the BG by
Typically 1U of insulin will decrease BG by 2-3mmol/L over the next 2-4 hours

56
Q

How do we estimate the initial CF?

A

100 / TTD
Ex. If TTD = 40U/day CF would be 100/4 = 2.5

57
Q

What is the formula if someone’s premeal BG is off?

A

Current glucose - target glucose / CF
Ex. Current is 11.1 but target is 5.6 and the CF is 2.5
Answer: add 2 Units

58
Q

What are the general rules when interpreting BG / adjusting dose?

A

Fix the lows first - 1U of insulin can be expected to decrease BG ~2-3 molecules/L
Only adjust 1 dose at a time
Make dose adjustments every few days based on glucose trends

59
Q

When evaluating morning hyperglycemia what is the somogyi effect?

A

Glucose is <4mmol/L

60
Q

When evaluating morning hyperglycemia what is the dawn phenomenon?

A

Glucose is >4mmol/L

61
Q

What are some signs of nocturnal hypoglycemia?

A

Nightmares, restless sleep, sweating, headache in am, hunger

62
Q

If someone’s readings are off how do we fix it?

A

We change the dose of the insulin given before the time that the highs or lows are being experienced
Ex. If high in the morning - increase bedtime dose, if low at bedtime - decrease supper time dose

PHAR 152 (10 decks)

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