EXAM 4 Basal Insulin Dr. Hess

Question 1

iWhere in the body does Insulin need to be injected?

Answer 1

area of Fat tissue

15-30 min before eating (glucose from food gets into blood pretty fast)

Question 2

Ultra-Rapid Acting Insulin

Answer 2

Fiasp, Lyumjev
5 min faster than rapid-acting

Question 3

Which of the basal Insulin has the highest risk for Hypoglycemia?

Answer 3

NPH Insulin (intermediate)
-> peak in insulin

Question 4

Which of the basal Insulin has the lowest risk for Hypoglycemia?

Answer 4

Insulin degludec (tresiba)
-> flexible dosing (40h and 8h intervals)

-Insulin glargine U-300

Question 5

What are the biosimilars of Insulin Glargine (Lantus)?

Answer 5

Semeglee
Rezvoglar

Question 6

What is the brand name of U-300 Glargine?

Answer 6

Toujeo

-> duration is longer than 24H (vs 24h for U100 glargine)

Question 7

Name the rapid-acting Insulins

Answer 7

Humalog (lispro)
Novolog (aspart)
Admelog
Apidra (Glulisine)

Question 8

When should T2DM patients be started on Insulin?

Answer 8

A1c >10 and symptomatic
-insulin deficiency

-if blood glucose under control -> transition to non-insulin therapy

Question 9

How is basal Insulin dosed?

Answer 9

empirically: 10U per day
OR
based on actual body weight: 0.1 - 0.2U/kg per day

Question 10

Which glucose levels are targeted by basal insulin and should be monitored when starting basal insulin?

Answer 10

Fasting glucose: measure the fasting glucose in the morning, if not at goal -> insulin dose adjustment

-set FPG target

Question 11

How should the basal insulin dose be increased?

Answer 11

increase 2U every 3 days until they reach the fasting glucose goal without hypoglycemia

Question 12

The patients blood glucose has improved, they lose weights, started exercising and now experiencing hypoglycemia. How should insulin doses be decreased?

Answer 12

lower the basal insulin dose by 10-20%

Question 13

When should adding a bolus of insulin in T2DM be considered?

Answer 13

-A1c not at goal
-the patient is on 0.5U/kg per day and still not at goal

Question 14

How much Insulin does the pancreas secrete in a healthy individual?

FYI

Answer 14

on average 1U/kg per day
->half of it is for basal insulin (0.5U/kg per day)

Question 15

What should be considered in renal/hepatic impaired patients?

Answer 15

-the insulin clearance is reduced
-no dose adjustments
-may need less insulin

Question 16

ADR of Insulin

Answer 16

-Hypoglycemia
-Weight gain

-Lipodystrophy (seen in T1DM patients who did not rotate sites)
Lipohypertrophy, Lipoatrophy (caused by insulin impurities (animal source, not seen anymore))
->affects insulin absorption

Question 17

What is the difference between the Biosimilars and the follow-up insulin?

Answer 17

Follow-ons (Basaglar) are not interchangeable with Lantus

Biosimilars (Semeglee, Rezvoglar) are interchangeable with Lantus

Question 18

Benefits of Insulin U-300 vs U-100

Answer 18

Toujeo

steady state is reached >5 days
3x more volume
and 56 days stable at room temperature

Question 19

What is special about Insulin Detemir?

Answer 19

its duration depends on the dose
-the smaller the dose, the shorter the duration
often requires BID dosing

Question 20

Which device is used for concentrated Insulin (U-100, U-200)?

Answer 20

Pen

Question 21

Which drug should be stopped or reduced when using Insulin in T2DM?

Answer 21

Sulfonylureas

Question 22

What is the starting dose of basal insulin when used with bolus insulin in T1DM?

Answer 22

0.3U/kg per day