Diabets Insulin

Question 1

Who takes Insulin?

Answer 1

All Type 1
PREG
SURGERY
HIGH A1C

Question 2

What insulins are long acting helps btwn meals?

Answer 2

BASAL
lower glucose by liver production btwn meals and overnight

lipid and protein synthesis
intermediate or long-acting
50 % of daily needs

Question 3

What type of insulin controls hyperglycemia post meal?

Answer 3

BOLUS
stores nutrients)
Use rapid (best) or regular insulin
10-20 % of daily insulin requirement for each meal

Question 4

Which insulin is immediate basal?

Answer 4

NPH- more frequent dosing

Question 5

What are the other Long acting?

Answer 5

DOT GO!
Determir
Degludec
Glulisne- 1 daily. NO MIXING

Question 6

Which bolus drug lowers risk of hypoglycemia and need to be taking 15min b4 meal?

Answer 6

RAPID
Lispro
Aspart
Glargine

LAG opposite of Rapid

Question 7

What is the SHORT acting?

Answer 7

Regular insulin

Question 8

What is the initiating steps for Insulin TYPE 1?

Answer 8

QD 0.4-0.5 u/kg/day
half as basal
half as bolus(divide by 3 meals.

Question 9

What do you consider 1st, prior to Inuslin for DM2

Answer 9

GLP 1RA

Start BASAL insulin 10 units/day OR
0.1-0.2units / KG / day
.1 x 125= units

Question 10

What is ideal for obese patient with A1C greater than >10%?

Answer 10

GLP-1 RA and BASAL insulin

Question 11

What is next if A1c goal not met?

Answer 11

Consider GLP-1 OR
Add bolus/rapid insulin for 1 meal

start with 4 units QD
OR 0.1 units/kg
OR 10 % of basal

***ADD Bolus to meal if GOAL not met Q3mo

Question 12

what are the goals for DM2 on insulin?

Answer 12

Pre meal/bedtime glucose 80-130

1-2 hr post-prandial <180mg/dl

Question 13

How dose premixed insulin in DM2?

Answer 13

Switch to pre-mixed insulin BID
Divide current basal dose to 2/3 AM and 1/3 PM
or ½ AM ½ PM
Adjust dose by 1-2 units or 10-15% 1-2X/WK until SMBG target is reached

Question 14

NEVER mix LONG TERM with…?

Answer 14

other insulins
LONG term pH level is off

MIXED ARE ONLY
BOLUS + INTERMEDIATE

Question 15

When should pt on multiple insulins self monitor glucose?

Answer 15

Prior to meals and snacks
Rarely post-prandially
bedtime
exercise 
suspect hypoglycemia 
critical tasks such as driving

Question 16

When should A1c be tested?

Answer 16

MET goal-2x/year

NOT MET goal= 4x/yr

Question 17

When should your insulin dose adjust?

Answer 17

Insulin log plus food/activity diary 
Based over several 7-14 days
CHO should be consistent 
ONE change at a time 
small increments (10%)
Adjust during earliest time of hyperglycemia 

Basal insulin- check Fasting plasma glucose

Bolus insulin- check post prandial plasma glucose levels

Question 18

How should you dose for Hypoglycemia?

Answer 18

2-4 units 10-20% related to that meal

<70 BG- alert
<54= clinically significant ED (ASY often)

<40- Symptomatic
<20- seizures, coma
Glucagon on tap- 1mg SC, 6.5 min response

RISK of INC HYPO- ELDERLY, RENAL,LIVER DZ, LONG HISTORY OF DM, INC PHYSICAL ACTIVITY, GASTROPARESIS, MEDS, ETOH

Question 19

How do you dec affects of insulin d/t injection?

Answer 19

clean
Rotate injection site
LIPOhypertrophy- d/t fatty build up

Question 20

What drugs should you stop with insulin?

Answer 20

any insulin increase RX

Sulfoureas, Non-sulfoureas (metGLITINIDES)

Question 21

What should be on had for all on insulin?

Answer 21

15-20g CHO- candy
REpeat 15-20min
check BG

Still <60

Complex w/ protein
Check 15-20

15-15-15= no change seek ED

10g- orange juic 1/2 cup, grape juice, 2stp sugar, 5-6lifesavers
2 glucose tabs

Question 22

What are BP goal for DM patients?

Answer 22

HIGHER CV risk
<130/80 mmHg

LOWER CV risk <140/90

Question 23

What annual immunization are important?

Answer 23

Annual influenza vaccine
Pneumococcal vaccine
Ages 2-64 received PPSV23
Age >65 receive an additional PPSV23

Hepatitis B vaccine-3 dose