Exam 3 lecture 1 Flashcards
How to tell if patient is making Insulin
They have c peptide
What are some short acting insulins
Aspart, glulisine, lispro, regular insulin
Can NPH be given IV
No
Can we give the long actings as IV
No, only as subq.
The only one sued as IV is regular insulin
Glargine MOA
soluble at acidic PH, not soluble at physiologic PH
Detemir MOA
Binds albumin because of fatty acid chain
When do we start Insulin for TYPE 1 and TYPE 2 diabetics
Type I- always, right away
Type 2- Gestational diabetes
-ketoacidosis
- Blood sugar in 300s
What other use does Insulin have
Hyperkalemia. Insulin pushes K back into the cells. This is followed up with dextrose to avoid hypoglycemia
Which insulins should always be given immediately before a meal
Lispro, Aspart, glulisine, regular
Which insulins can be mixed? which can not
SHorts can be mixed with NPH, but long actings can not be mixed with anything else.
What are some concentrated insuline?
Regular U500, Degludec U 200, Toujeo U300, Lispro U200, Toujeo Max U300
What is the only bolus insulin that is concentrated
Lispro U200
What is unique about regular U500?
Can replace both short and long acting insulins
Route of administration interms of speed
IV (fastest), IM, SQ (slowest)
Fastest site of injection? Slowest?
Fastest- stomach
slowest- Buttocks, thighs
How does temperature affect absorption of insulin? Exercise?
Temperature increases absorption and so does exercise
In mixtures, does short acting need to be drawn first or second?
Always drawn first
Smaller dose vs larger dose absorbed more quickly?
Smaller dose
How does renal failure affect insulin clearence
Renal failure decreases insulin clearence, increasing insulin action
How long are vials stable at room temp
28 days (42 with levemir)
Opened vials/pens should be discarded after
28 days
regular/NPH is stable for
7 days in refrigerator
what are some complications of insulin therapy
Hypoglycemia
Weight gain (5-10 lbs)
lipohypertrophy, lipoatrophy
allergic rxn
Hypoglycemia ranges
Lvl 1- <70
Lvl2-<54
lvl 3- severe, passed out etc
causes of hypoglycemia? symptoms?
Too much insulin
Decreased calorie intake
Increased muscle utilization
excessive alcohol
Shaking, irritability, dizziness
treatment of hypoglycemia
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
quick carbohydrate sources
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.
Severe hypoglycemia fixes
Glucagon (IV baqsimi, Dasiglucagon)
What is the use of dasiglucagon
Dasiglucagon is used in severe hypoglycemia and recovery time to normal BS is quicker.
lipohypertrophy vs lipoatrophy
lipoatrophy- concavity in skin (pimple) due to allergic rxn
Lipohypertrophy- formation of fat pads. insulin can not be absorbed anymore
Which long acting insulin may require BID dosing
Detemir
converting from daily NPH to glargine, detemir or degludec
Keep dose same
Twice daily NPH to Glargine detemir or degludec conversion
Decrease dose by 20%
conversion from Glargine, detemir and degludec to U 500
If A1c is >8, 1:1 conversion
If A1c is < 8, 20 percent dose reduction
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?
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
How many units of fast acting should we put in for a certain gram of carbohydrate
15 grams of carbs=1 unit of fast acting.
How to dose Intermediate insulin+ short acting
morning- 40% NPH+15% short acting
evening- 30% NPH + 15% short acting
With the intermediate+short acting, what do we do when we struggle with hypoglycemia
Switch NPH to HS so it peaks when the patinet wakes up
How can pumps replace basal dose with bolus
It releases small amounts throughout the dayc acting as both basal and prandial insulin
When do we start insulin for type 2 diabetes
A1c>10, if not we look at using other agents
Dosing for type 2 agents and adjustment
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)
When should we consider the addition of bolus for type 2 patients? DOsing?
When they get to 0.5 units/kg/day of basal.
Dose at 10% of basal dose with largest meal of the day
