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PHRM 844 Therapeutics > Exam 3 - Diabetes Handout 2 Kania > Flashcards

Exam 3 - Diabetes Handout 2 Kania Flashcards

1
Q

which insulin is used as IV?

A

regular insulin

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2
Q

NPH is a __________ and is not given IV

A

suspension

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3
Q

ultra long-acting insulin (1)

A

degludec (Tresiba)

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4
Q

true or false: ultra-short acting insulins are compatible when mixed with NPH

A

true

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5
Q

true or false: long and ultra long-acting insulins are compatible when mixed with NPH

A

false

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6
Q

what is the only BOLUS insulin that is concentrated?

A

lispro U200 (Humalog Kwikpen)

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7
Q

which concentrated insulin has the best A1C reduction in T2DM?

a. Humulin-R U500
b. degludec U200 (Tresiba)
c. glargine U300 (Toujeo)
d. glargine U300 (Toujeo Max)
e. Lispro U200 (Humalog Kwikpen)

A

a. Humulin-R U500

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8
Q

max single dose delivery Humulin-R U500

A

300 units

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9
Q

max single dose delivery degludec U200 (Tresiba)

A

160 units

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10
Q

max single dose delivery Glargine U300 (Toujeo)

A

80 units

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11
Q

max single dose delivery glargine U300 (Toujeo Max)

A

160 units

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12
Q

max single dose delivery Lispro U200 (Humalog Kwikpen)

A

60 units

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13
Q

which is the fastest route of administration for insulin?

a. subQ
b. IV
c. IM

A

b. IV

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14
Q

fastest site of injection for insulin

a. thigh
b. buttocks
c. stomach

A

c. stomach

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15
Q

heat _____ absorption and action of insulin

a. increases
b. decreases

A

a. increases

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16
Q

exercise/massages _____ absorption and action of insulin

a. increases
b. decreases

A

a. increases

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17
Q

in insulin preparations/mixtures, the short acting effect of insulin may be _____ if mixed incorrectly

A

lost

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18
Q

lower dose of insulin is absorbed more

a. slowly
b. rapidly

A

b. rapidly

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19
Q

what does “decreased insulin clearance” mean?

A

it means the pt hangs onto insulin longer

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20
Q

renal failure ___ insulin clearance, thereby ___ insulin action

a. inc; inc
b. dec; dec
c. inc; dec
d. dec; inc

A

d. dec; inc

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21
Q

what % of insulin metabolism occurs in the kidneys? (range)

A

15-20%

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22
Q

stress ___ insulin clearance

a. inc
b. dec

A

a. inc

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23
Q

insulin vials are stable at room temp for ___ days

A

28

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24
Q

how long is levemir stable at room temp?

A

42 days

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25
Q

opened insulin vials/pens should be discarded after how many days?

A

28

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26
Q

insulin you prefill in syringes is stable for ___ days with refrigeration, as long as not mixed

A

28

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27
Q

insulin you prefill in syringes is stable for ___-___ days at room temp

A

10-28

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28
Q

mixture stability of regular/NPH: how many days in fridge?

A

7 days

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29
Q

mixture stability of aspart, glulisine, or lispro with NPH

A

give immediately (cannot be stored)

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30
Q

mixture stability of degludec, detemir, and glargine with any other insulin

A

never, not compatible

(can give at same time, but don’t mix and inject at diff spots)

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31
Q

hypoglycemia level is glucose < ___

A

70 mg/dL

32
Q

hypoglycemia level 2 is glucose < ___

A

54 mg/dL

33
Q

hypoglycemia level 3

A

severe event with altered mental and/or physical functioning needing another person for recovery (passed out/altered mental status)

34
Q

rule of 15’s: start with 15 grams of fast-acting carbs unless BS < 50 mg/dL. If BS < 50 mg/dL then use ___ grams

A

30

35
Q

glucagon for level 2 or 3 patients (3 of them)

A

-3 mg intranasal Baqsimi
-1 mg SQ, IM, or IV glucagon (Gvoke Hypopen, GlucaGen)
-0.6 mg SQ dasiglucagon (Zegalogue)

36
Q

which is not a disadvantage of the ultra short insulins?

a. risk of hypoglycemia if no meal within 15 min of dose
b. will need to combine with a longer acting insulin for optimal BS control
c. if mixed with another insulin, give immediately after mixing
d. decreases post-prandial hypoglycemia and superior postprandial lowering of BS
e. hyperglycemia/ketosis may occur more rapidly if insulin delivery is interrupted

A

d. decreases post-prandial hypoglycemia and superior postprandial lowering of BS

(this is an advantage)

37
Q

which may be beneficial in pts suffering from nocturnal hypoglycemic episodes?

a. ultra short-acting insulin
b. long/ultra long-acting insulin

A

b. long/ultra long-acting insulin

38
Q

2 disadvantages of long/ultra long-acting insulins

A

-risk of malignancy (cancers)
-can NOT be mixed with any other insulin

39
Q

changing between U-100 therapies: what would the dose be if pt changes from daily NPH to glargine/detemir/degludec?

A

keep dose same (1:1 ratio)

40
Q

changing between U-100 therapies: how would you change the dose if pts change from BID NPH to glargine/detemir/degludec?

A

dec dose by 20%

(ex. 50 units NPH BID is 100 units daily. Give 80 units of glargine, either daily or split the doses)

41
Q

insulin dosing for type 1 pts for newly diagnosed pt

A

0.1-0.4 units/kg/day (honeymoon phase)

42
Q

average daily dose for type 1 pts (not newly diagnosed)

A

0.5-0.6 units/kg/day

(use actual BW)

43
Q

for type 1 pts using basal-bolus dosing, usually 50-70% of insulin are given as _____ while the other 30-50% are divided among meals as _____ insulin

A

basal; bolus

44
Q

prandial doses can be adjusted based on carb content of meals; a good starting point is 1 unit for every ___ grams of CHO

A

15

(1:15 insulin: CHO ratio)

45
Q

starting dose for type 2 pts (ADA; 2 options)

A

0.1-0.2 units/kg/day OR 10 units/day (sometimes 10-15 units/day)

46
Q

starting dose for type 2 pts (AACE; 2 options based on A1C)

A

-A1C < 8%, start 0.1-0.2 units/kg/day
-A1C > 8%, start 0.2-0.3 units/kg/day

47
Q

the rule of 1800 is for patients taking which insulins?

A

ultra-short acting

48
Q

use “1500” instead of 1800 if pt is on which insulin?

A

regular

49
Q

if patients change from BID NPH to U-300 glargine (Toujeo), dec dose by

a. 5%
b. 10%
c. 20%
d. 50%

A

c. 20%

50
Q

changing U-100 to concentrated insulin therapy: there is a 1:1 conversion between _____ insulin and U-200 insulin degludec (Tresiba)

A

basal

51
Q

changing U-100 to concentrated insulin therapy: there is a 1:1 conversion between _____ U-100 to U-200

A

lispro

52
Q

changing from U-100 to U-500 regimens may require ___% dose reduction depending upon BS and A1C

A

20%

53
Q

true or false: U-500 replaces only basal insulin

A

false (replaces both basal and bolus insulin types)

54
Q

changing from U-100 to U-500: calculate pt’s TDD, and if A1C is > 8%

a. use a 20% dosage reduction
b. consider 1:1 conversion

A

b. consider 1:1 conversion

55
Q

changing from U-100 to U-500: calculate pt’s TDD, and if A1C is < or = to 8%

a. use a 20% dosage reduction
b. consider 1:1 conversion

A

a. use a 20% dosage reduction

56
Q

BID dosing example for U-500 regimen

A

60% breakfast - 40% dinner

57
Q

TID dosing examples for U-500 regimen (2 of them)

A

40% breakfast - 30% lunch - 30% dinner
40% breakfast - 40% lunch - 20% dinner

58
Q

TDD for 60 kg non-newly diagnosed T1DM pt

A

30 units/day

(0.5-0.6 units/kg/day)

59
Q

for type 2 patients, the ADA says we can adjust the dose by ___ units every ___ days to reach FBS goal of 80-130

A

2 units; 3 days

60
Q

what is the rule of 500s?

A

500 divided by TDD will equal the grams of carbs needed for 1 unit of insulin

61
Q

ex. rule of 500s for patient taking 40 units daily

A

500/40 = 12.5
1 unit of insulin needed for every 12.5 grams of carbs

62
Q

for type 2 pts, consider addition of bolus for pts on > or = to ___ units/kg/day

a. 0.3
b. 0.4
c. 0.5
d. 1.0

A

c. 0.5

63
Q

average insulin dose for pts with T2DM is often > ___ U/kg

a. 0.3
b. 0.4
c. 0.5
d. 1

A

d. 1

64
Q

with A1C > 10%, 70% of the problem involves

a. PPG
b. FBS

A

b. FBS

65
Q

with A1C < 7.5%, 70% of the problem involves

a. PPG
b. FBS

A

a. PPG

66
Q

If a pt uses 90 units of insulin daily, how much will 1 unit of short-acting insulin decrease BS?

A

20 mg/dL

(Rule of 1800s: 1800/90 = 20; so for ex. if we need to drop BS by 100, we would need 5 units of insulin)

67
Q

empiric starting point: for many T1DM pts, an inc insulin dose by ~ ___ units dec BS by ~ 50 mg/dL

A

2 units

68
Q

empiric starting point: for many T2DM pts, an inc insulin dose by ~ ___ units dec BS by ~ 50 mg/dL

A

4 units

69
Q

adjusting insulin example:

67 YOM, type 2 diabetic x 10 years
On metformin 1000mg BID and insulin
Humalog 12-8-12-0
Glargine 40 units daily
Home Blood Glucose Readings
FBS Noon PM HS
130-160’s 90-140’s 150-180’s 240-280’s

How would you adjust his dose empirically?

A

inc Humalog in evening to 16 units

(T2DM pt, empiric starting point is to inc dose by 4 units)

70
Q

adjusting insulin example:

67 YOM, type 2 diabetic x 10 years
On metformin 1000mg BID and insulin
Humalog 12-8-12-0
Glargine 40 units daily
Home Blood Glucose Readings
FBS Noon PM HS
130-160’s 90-140’s 150-180’s 240-280’s

Calculate the correction factor. How would you adjust the dose?

A

1800/72 = 25 mg/dL

This means 2 units will dec BS by 50 mg/dL, so we should add 2 units to evening Humalog dose, so inc to 14 or 16 units with dinner (this should get HS levels at 140-180 range)

71
Q

Somogyi effect: _____ hypoglycemia with _____ hyperglycemia

A

nocturnal; rebound

(low BS at night leads to high BS in the morning)

72
Q

Somogyi effect treatment (2 of them)

A

-add a bedtime snack
-if applicable, move NPH from dinner to bedtime or dec long-acting dose at HS

73
Q

sick day management for insulin dependent pts: test BG every ___ hours at minimum; test urine for ______ with each urination

A

4
ketones

74
Q

sick day management for insulin dependent pts: seek medical attention if _____ _____ are present and BG is > ___

A

urine ketones
250 mg/dL

75
Q

many practitioners consider concentrated forms of insulin in pts with TDD ___-___ units/day

a. 100-200
b. 200-300
c. 300-400
d. 400-500

A

b. 200-300

PHRM 844 Therapeutics (28 decks)

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