Exam 3 lecture 1

Question 1

How to tell if patient is making Insulin

Answer 1

They have c peptide

Question 2

What are some short acting insulins

Answer 2

Aspart, glulisine, lispro, regular insulin

Question 3

Can NPH be given IV

Answer 3

No

Question 4

Can we give the long actings as IV

Answer 4

No, only as subq.
The only one sued as IV is regular insulin

Question 5

Glargine MOA

Answer 5

soluble at acidic PH, not soluble at physiologic PH

Question 6

Detemir MOA

Answer 6

Binds albumin because of fatty acid chain

Question 7

When do we start Insulin for TYPE 1 and TYPE 2 diabetics

Answer 7

Type I- always, right away
Type 2- Gestational diabetes
-ketoacidosis
- Blood sugar in 300s

Question 8

What other use does Insulin have

Answer 8

Hyperkalemia. Insulin pushes K back into the cells. This is followed up with dextrose to avoid hypoglycemia

Question 9

Which insulins should always be given immediately before a meal

Answer 9

Lispro, Aspart, glulisine, regular

Question 10

Which insulins can be mixed? which can not

Answer 10

SHorts can be mixed with NPH, but long actings can not be mixed with anything else.

Question 11

What are some concentrated insuline?

Answer 11

Regular U500, Degludec U 200, Toujeo U300, Lispro U200, Toujeo Max U300

Question 12

What is the only bolus insulin that is concentrated

Answer 12

Lispro U200

Question 13

What is unique about regular U500?

Answer 13

Can replace both short and long acting insulins

Question 14

Route of administration interms of speed

Answer 14

IV (fastest), IM, SQ (slowest)

Question 15

Fastest site of injection? Slowest?

Answer 15

Fastest- stomach
slowest- Buttocks, thighs

Question 16

How does temperature affect absorption of insulin? Exercise?

Answer 16

Temperature increases absorption and so does exercise

Question 17

In mixtures, does short acting need to be drawn first or second?

Answer 17

Always drawn first

Question 18

Smaller dose vs larger dose absorbed more quickly?

Answer 18

Smaller dose

Question 19

How does renal failure affect insulin clearence

Answer 19

Renal failure decreases insulin clearence, increasing insulin action

Question 20

How long are vials stable at room temp

Answer 20

28 days (42 with levemir)

Question 21

Opened vials/pens should be discarded after

Answer 21

28 days

Question 22

regular/NPH is stable for

Answer 22

7 days in refrigerator

Question 23

what are some complications of insulin therapy

Answer 23

Hypoglycemia
Weight gain (5-10 lbs)
lipohypertrophy, lipoatrophy
allergic rxn

Question 24

Hypoglycemia ranges

Answer 24

Lvl 1- <70
Lvl2-<54
lvl 3- severe, passed out etc

Question 25

causes of hypoglycemia? symptoms?

Answer 25

Too much insulin Decreased calorie intake Increased muscle utilization excessive alcohol Shaking, irritability, dizziness

Question 26

treatment of hypoglycemia

Answer 26

Rule of 15s, start with 15 g of carbohydrate (unless BS<50, in which case do 30 gms), wait 15 minutes, check BS, if not >70 repeat with another 15gms

Question 27

quick carbohydrate sources

Answer 27

6 Oz coke, 4 Oz Orange juics, 2 tsp sugar, 1 table spoon honey, 4-5 glucose tabs. Follow with 30 g of complex carb if meal is not planned after.

Question 28

Severe hypoglycemia fixes

Answer 28

Glucagon (IV baqsimi, Dasiglucagon)

Question 29

What is the use of dasiglucagon

Answer 29

Dasiglucagon is used in severe hypoglycemia and recovery time to normal BS is quicker.

Question 30

lipohypertrophy vs lipoatrophy

Answer 30

lipoatrophy- concavity in skin (pimple) due to allergic rxn Lipohypertrophy- formation of fat pads. insulin can not be absorbed anymore

Question 31

Which long acting insulin may require BID dosing

Answer 31

Detemir

Question 32

converting from daily NPH to glargine, detemir or degludec

Answer 32

Keep dose same

Question 33

Twice daily NPH to Glargine detemir or degludec conversion

Answer 33

Decrease dose by 20%

Question 34

conversion from Glargine, detemir and degludec to U 500

Answer 34

If A1c is >8, 1:1 conversion If A1c is < 8, 20 percent dose reduction

Question 35

Avg daily dose of insulin for type 1 diabetics how often should we test BG levels in type 1 diabetics? what treatment should type 1 diabetics be on?

Answer 35

0.5-0.6 units/kg/day starting dose 0.1-0.4 units/kg/day 4 times...before meals and HS should be basal and bolus

Question 36

How many units of fast acting should we put in for a certain gram of carbohydrate

Answer 36

15 grams of carbs=1 unit of fast acting.

Question 37

How to dose Intermediate insulin+ short acting

Answer 37

morning- 40% NPH+15% short acting evening- 30% NPH + 15% short acting

Question 38

With the intermediate+short acting, what do we do when we struggle with hypoglycemia

Answer 38

Switch NPH to HS so it peaks when the patinet wakes up

Question 39

How can pumps replace basal dose with bolus

Answer 39

It releases small amounts throughout the dayc acting as both basal and prandial insulin

Question 40

When do we start insulin for type 2 diabetes

Answer 40

A1c>10, if not we look at using other agents

Question 41

Dosing for type 2 agents and adjustment

Answer 41

If A1c<8- 0.1-0.2 units/kg/day If A1c>8- 0.2-0.3 units/kh/day of long acting Increase dose by 2 units every 3 days until goal is met (80-130)

Question 42

When should we consider the addition of bolus for type 2 patients? DOsing?

Answer 42

When they get to 0.5 units/kg/day of basal. Dose at 10% of basal dose with largest meal of the day