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Therapeutics P2 > Exam 3 lecture 1 > Flashcards

Exam 3 lecture 1 Flashcards

1
Q

How to tell if patient is making Insulin

A

They have c peptide

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2
Q

What are some short acting insulins

A

Aspart, glulisine, lispro, regular insulin

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3
Q

Can NPH be given IV

A

No

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4
Q

Can we give the long actings as IV

A

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

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5
Q

Glargine MOA

A

soluble at acidic PH, not soluble at physiologic PH

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6
Q

Detemir MOA

A

Binds albumin because of fatty acid chain

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7
Q

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

A

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

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8
Q

What other use does Insulin have

A

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

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9
Q

Which insulins should always be given immediately before a meal

A

Lispro, Aspart, glulisine, regular

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10
Q

Which insulins can be mixed? which can not

A

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

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11
Q

What are some concentrated insuline?

A

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

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12
Q

What is the only bolus insulin that is concentrated

A

Lispro U200

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13
Q

What is unique about regular U500?

A

Can replace both short and long acting insulins

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14
Q

Route of administration interms of speed

A

IV (fastest), IM, SQ (slowest)

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15
Q

Fastest site of injection? Slowest?

A

Fastest- stomach
slowest- Buttocks, thighs

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16
Q

How does temperature affect absorption of insulin? Exercise?

A

Temperature increases absorption and so does exercise

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17
Q

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

A

Always drawn first

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18
Q

Smaller dose vs larger dose absorbed more quickly?

A

Smaller dose

19
Q

How does renal failure affect insulin clearence

A

Renal failure decreases insulin clearence, increasing insulin action

20
Q

How long are vials stable at room temp

A

28 days (42 with levemir)

21
Q

Opened vials/pens should be discarded after

A

28 days

22
Q

regular/NPH is stable for

A

7 days in refrigerator

23
Q

what are some complications of insulin therapy

A

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

24
Q

Hypoglycemia ranges

A

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

25
Q

causes of hypoglycemia? symptoms?

A

Too much insulin
Decreased calorie intake
Increased muscle utilization
excessive alcohol

Shaking, irritability, dizziness

26
Q

treatment of hypoglycemia

A

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

27
Q

quick carbohydrate sources

A

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.

28
Q

Severe hypoglycemia fixes

A

Glucagon (IV baqsimi, Dasiglucagon)

29
Q

What is the use of dasiglucagon

A

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

30
Q

lipohypertrophy vs lipoatrophy

A

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

31
Q

Which long acting insulin may require BID dosing

A

Detemir

32
Q

converting from daily NPH to glargine, detemir or degludec

A

Keep dose same

33
Q

Twice daily NPH to Glargine detemir or degludec conversion

A

Decrease dose by 20%

34
Q

conversion from Glargine, detemir and degludec to U 500

A

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

35
Q

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?

A

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

36
Q

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

A

15 grams of carbs=1 unit of fast acting.

37
Q

How to dose Intermediate insulin+ short acting

A

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

38
Q

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

A

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

39
Q

How can pumps replace basal dose with bolus

A

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

40
Q

When do we start insulin for type 2 diabetes

A

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

41
Q

Dosing for type 2 agents and adjustment

A

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)

42
Q

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

A

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

43
Q
A

Therapeutics P2 (41 decks)

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