Exam 3 - Diabetes Handout 2 Kania Flashcards
1
Q
which insulin is used as IV?
A
regular insulin
2
Q
NPH is a __________ and is not given IV
A
suspension
3
Q
ultra long-acting insulin (1)
A
degludec (Tresiba)
4
Q
true or false: ultra-short acting insulins are compatible when mixed with NPH
A
true
5
Q
true or false: long and ultra long-acting insulins are compatible when mixed with NPH
A
false
6
Q
what is the only BOLUS insulin that is concentrated?
A
lispro U200 (Humalog Kwikpen)
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
8
Q
max single dose delivery Humulin-R U500
A
300 units
9
Q
max single dose delivery degludec U200 (Tresiba)
A
160 units
10
Q
max single dose delivery Glargine U300 (Toujeo)
A
80 units
11
Q
max single dose delivery glargine U300 (Toujeo Max)
A
160 units
12
Q
max single dose delivery Lispro U200 (Humalog Kwikpen)
A
60 units
13
Q
which is the fastest route of administration for insulin?
a. subQ
b. IV
c. IM
A
b. IV
14
Q
fastest site of injection for insulin
a. thigh
b. buttocks
c. stomach
A
c. stomach
15
Q
heat _____ absorption and action of insulin
a. increases
b. decreases
A
a. increases
16
Q
exercise/massages _____ absorption and action of insulin
a. increases
b. decreases
A
a. increases
17
Q
in insulin preparations/mixtures, the short acting effect of insulin may be _____ if mixed incorrectly
A
lost
18
Q
lower dose of insulin is absorbed more
a. slowly
b. rapidly
A
b. rapidly
19
Q
what does “decreased insulin clearance” mean?
A
it means the pt hangs onto insulin longer
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
21
Q
what % of insulin metabolism occurs in the kidneys? (range)
A
15-20%
22
Q
stress ___ insulin clearance
a. inc
b. dec
A
a. inc
23
Q
insulin vials are stable at room temp for ___ days
A
28
24
Q
how long is levemir stable at room temp?
A
42 days
25
opened insulin vials/pens should be discarded after how many days?
28
26
insulin you prefill in syringes is stable for ___ days with refrigeration, as long as not mixed
28
27
insulin you prefill in syringes is stable for ___-___ days at room temp
10-28
28
mixture stability of regular/NPH: how many days in fridge?
7 days
29
mixture stability of aspart, glulisine, or lispro with NPH
give immediately (cannot be stored)
30
mixture stability of degludec, detemir, and glargine with any other insulin
never, not compatible
(can give at same time, but don't mix and inject at diff spots)
31
hypoglycemia level is glucose < ___
70 mg/dL
32
hypoglycemia level 2 is glucose < ___
54 mg/dL
33
hypoglycemia level 3
severe event with altered mental and/or physical functioning needing another person for recovery (passed out/altered mental status)
34
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
30
35
glucagon for level 2 or 3 patients (3 of them)
-3 mg intranasal Baqsimi
-1 mg SQ, IM, or IV glucagon (Gvoke Hypopen, GlucaGen)
-0.6 mg SQ dasiglucagon (Zegalogue)
36
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
d. decreases post-prandial hypoglycemia and superior postprandial lowering of BS
(this is an advantage)
37
which may be beneficial in pts suffering from nocturnal hypoglycemic episodes?
a. ultra short-acting insulin
b. long/ultra long-acting insulin
b. long/ultra long-acting insulin
38
2 disadvantages of long/ultra long-acting insulins
-risk of malignancy (cancers)
-can NOT be mixed with any other insulin
39
changing between U-100 therapies: what would the dose be if pt changes from daily NPH to glargine/detemir/degludec?
keep dose same (1:1 ratio)
40
changing between U-100 therapies: how would you change the dose if pts change from BID NPH to glargine/detemir/degludec?
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
insulin dosing for type 1 pts for newly diagnosed pt
0.1-0.4 units/kg/day (honeymoon phase)
42
average daily dose for type 1 pts (not newly diagnosed)
0.5-0.6 units/kg/day
(use actual BW)
43
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
basal; bolus
44
prandial doses can be adjusted based on carb content of meals; a good starting point is 1 unit for every ___ grams of CHO
15
(1:15 insulin: CHO ratio)
45
starting dose for type 2 pts (ADA; 2 options)
0.1-0.2 units/kg/day OR 10 units/day (sometimes 10-15 units/day)
46
starting dose for type 2 pts (AACE; 2 options based on A1C)
-A1C < 8%, start 0.1-0.2 units/kg/day
-A1C > 8%, start 0.2-0.3 units/kg/day
47
the rule of 1800 is for patients taking which insulins?
ultra-short acting
48
use "1500" instead of 1800 if pt is on which insulin?
regular
49
if patients change from BID NPH to U-300 glargine (Toujeo), dec dose by
a. 5%
b. 10%
c. 20%
d. 50%
c. 20%
50
changing U-100 to concentrated insulin therapy: there is a 1:1 conversion between _____ insulin and U-200 insulin degludec (Tresiba)
basal
51
changing U-100 to concentrated insulin therapy: there is a 1:1 conversion between _____ U-100 to U-200
lispro
52
changing from U-100 to U-500 regimens may require ___% dose reduction depending upon BS and A1C
20%
53
true or false: U-500 replaces only basal insulin
false (replaces both basal and bolus insulin types)
54
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
b. consider 1:1 conversion
55
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. use a 20% dosage reduction
56
BID dosing example for U-500 regimen
60% breakfast - 40% dinner
57
TID dosing examples for U-500 regimen (2 of them)
40% breakfast - 30% lunch - 30% dinner
40% breakfast - 40% lunch - 20% dinner
58
TDD for 60 kg non-newly diagnosed T1DM pt
30 units/day
(0.5-0.6 units/kg/day)
59
for type 2 patients, the ADA says we can adjust the dose by ___ units every ___ days to reach FBS goal of 80-130
2 units; 3 days
60
what is the rule of 500s?
500 divided by TDD will equal the grams of carbs needed for 1 unit of insulin
61
ex. rule of 500s for patient taking 40 units daily
500/40 = 12.5
1 unit of insulin needed for every 12.5 grams of carbs
62
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
c. 0.5
63
average insulin dose for pts with T2DM is often > ___ U/kg
a. 0.3
b. 0.4
c. 0.5
d. 1
d. 1
64
with A1C > 10%, 70% of the problem involves
a. PPG
b. FBS
b. FBS
65
with A1C < 7.5%, 70% of the problem involves
a. PPG
b. FBS
a. PPG
66
If a pt uses 90 units of insulin daily, how much will 1 unit of short-acting insulin decrease BS?
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
empiric starting point: for many T1DM pts, an inc insulin dose by ~ ___ units dec BS by ~ 50 mg/dL
2 units
68
empiric starting point: for many T2DM pts, an inc insulin dose by ~ ___ units dec BS by ~ 50 mg/dL
4 units
69
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?
inc Humalog in evening to 16 units
(T2DM pt, empiric starting point is to inc dose by 4 units)
70
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?
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
Somogyi effect: _____ hypoglycemia with _____ hyperglycemia
nocturnal; rebound
(low BS at night leads to high BS in the morning)
72
Somogyi effect treatment (2 of them)
-add a bedtime snack
-if applicable, move NPH from dinner to bedtime or dec long-acting dose at HS
73
sick day management for insulin dependent pts: test BG every ___ hours at minimum; test urine for ______ with each urination
4
ketones
74
sick day management for insulin dependent pts: seek medical attention if _____ _____ are present and BG is > ___
urine ketones
250 mg/dL
75
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
b. 200-300
