EXAM 4 Bolus Insulin Dr. Hess Flashcards
Which Insulin is considered Ultra-rapid and what makes it faster?
-Fiasp
F: faster
i: Insulin
Asp: Aspart
-Lispro - aabc (Lyumjev):
-minutes faster
-the faster onset is due to the excipients in the formulation
What makes Lispro - aabc (Lyumjev) ultra-rapid?
Treprostinil (prostaglandin analog):
-increases blood flow to the area of injection
-increases the permeability of the monomers to cross into the blood
What makes Aspart Fiasp ultra-rapid?
Niacinamide (Vitamin B3)
-localized vasodilation on the injection site, more blood flow -> better absorption of injected insulin)
Which of the insulin has the option to be administered 20 mins after eating?
FDA indication
Ultra-rapid:
-Lispro - aabc (Lyumjev)
-Aspart Fiasp
Rapid-acting:
-Glulisine Apidra
When is it too late after a meal to administer Insulin?
more than 1 hour from the meal
-risk for hypoglycemia
When do T2DM patients be treated with bolus insulin?
after they tried oral antidiabetic drugs and basal insulin and their A1c is still not at goal
How is bolus insulin dosed?
start with:
empirically 4U or 10% of basal insulin with the largest meal: only 1 bolus
-if A1c gets <8% reduce the basal insulin by 4U or 10%
-> to reduce risk of nocturnal hypoglycemia
How should the dose of bolus insulin be increased if needed?
increase by 1-2U or 10-15% twice weekly
-if hypoglycemia occurs investigate the cause or reduce it by 10-20%
What is the sliding scale approach?
used to correct hyperglycemia within 4 hours after injection
-not used to cover glucose meals after meals
How often should a correction by sliding scale be performed?
not more than every 4 hours
Disadvantages of the sliding scale
-it is reactive, not proactive (sometimes kind of proactive when the patient’s glucose is high before a meal and given before the meal to account for the high glucose)
-no improved clinical outcomes
-risk of hypoglycemia
When would a patient need a high dose of sliding scale insulin?
-Overweight
-infection
-when on steroids (increases glucose)
-> use lower dose when underweight or elderly
Which units are available for regular Insulin?
U-100
When should regular Insulin be discarded?
Humulin R:
-Vial: 40 days
Novolin R:
-Vial: 42 days
-Pen: 28 days
Which units are available for Insulin Lispro?
U-100
U-200 (pen only)
discard the pen after 28 days (room temperature)
Which units are available for Insulin Aspart (Novolog)?
U-100
discard the pen after 28 days
Which units are available for Insulin Glulisine?
U-100
discard the pen after 28 days
When should a T2DM patient on bolus insulin measure their blood glucose?
post-prandial - 2h after the mea!!
should be <180 mg/dl
Can bolus insulin be given IV?
Yes, usually they use regular insulin inpatient (rapid-acting is not faster, since it is IV and it goes into the blood immediately)
-basal insulin is not used for IV
If a patient used a long-acting and short-acting insulin and was started on a pump, what should be changed?
discontinue the long-acting insulin
How are bolus insulin converted within each other?
1:1 dosing conversion (except for inhaled insulin)
-in case the patients need to change their bolus insulin (insurance issues fe)
-they all work equally
How fast do insulin inhalers work?
Ultra-rapid
(ex: Afreeza)
How often do insulin inhalers need to be replaced?
every 15 days
-so for a month’s supply they need 2 inhalers
What is the conversion from insulin inhalers to injectables?
1 injection = 1.5 inhaler
Side effects of inhaled insulin
-Hypoglycemia
-Cough
-Throat pain
-acute bronchospasm in patients with chronic lung disease (BBW)
-decline in pulmonary function (FEV1 goes down)
-> needs spirometry test before use and 6 months after !!!
-may cause lung cancer
Which patient population is contraindicated for insulin inhaler use?
-chronic lung disease: COPD, asthma
-not in patients who have smoked in the past 6 months
Basal insulin + Bolus insulin = …
MDI (multiple dose insulin)
What is the TDD?
total daily dose of insulin = consists of 50% basal and 50% bolus insulin
-0.3U/kg/day
-0.3U/kg/day
->divided across the meals
How to calculate the bolus dose based on the carb intake with rapid-acting or ultra-rapid insulin?
ICR: 500 rule
500/TDD = g of carbs that 1U will cover
How to calculate the bolus dose based on the carb intake with short-acting insulin?
ICR: 450 rule
450/TDD
Which factor is used for hyperglycemia correction in T1DM patients?
Insulin sensitivity factor ISF:
how much 1U of insulin lowers their blood sugar
ISF for different insulins
ultra-rapid and rapid-acting: 1800/TDD
short-acting: 1500/TDD
Calculation
- calculate their TDD: 0.6U/kg/day
- divide TDD into basal and bolus (50/50)
- ICR = 500/TDD (for rapid-acting)
ex: 500/40 = 13g of carbs that 1U of insulin will cover - ISF = 1800/TDD
ex: 1800/40 = 45 mg/dl reduction with 1U of insulin
If the patient is eating 60g of carbs for a meal, how many units of insulin does the patient need?
60/13 = 4.6 or 5 units of bolus insulin for the meal (PENS can give 4.6, round up for syringes)
If a patient’s fasting blood glucose is 214 mg/dl, what would be the unit of insulin to correct it? (goal: 120 mg/dl)
214 - 120 = 94 mg/dl
94/45 = 2 units of insulin
5 + 2 = 7 Units (for the meal and the correction)
Which type of insulin is used in insulin pumps?
bolus insulin (no basal insulin needed!)
it continuously pumps bolus insulin at specific rate that resembles the basal insulin in addition to the calculated bolus dose for meals
