EXAM 4 Premixed Insulin, Basal Bolus Dr. Hess Flashcards
What does Premixed Insulin consist of?
-Basal insulin (intermediate NPH)
-Bolus insulin
-> given before meals -> covers the meal and provides background insulin at the same time
2 peaks -> 1 high peak at the time of the meal and 1 lower peak after the meal
Which patients benefit from Premixed insulin?
-in older patients
-patients with low adherence (issues with calculating the dose, and measuring insulin)
If a patient gets 20U of 70/30 premixed insulin, how much intermediate and bolus insulin would they get?
70% of 20U = 14U intermediate insulin
30% of 20U = 6U of bolus insulin
Why is pre-mixed insulin not appropriate for T1DM patients?
because we can’t customize the bolus dose
What are the premixed formulations of lispro?
75% lispro protamine and 25% lispro
50% lispro protamine and 50% lispro
-> protamine causes the mixture to become a suspension -> need to be resuspended
What is the preparation order of a split mixture?
- inject air into the NPH vial
- inject air into Regular insulin vial
- withdraw insulin from regular insulin vial
- withdraw insulin from the NPH vial
Clear before cloudy (Steps 3 and 4)
When should Premixed Insulin be considered?
-in T2DM patients who are on basal and bolus (1x with the largest meal) insulin and their A1c is still not at goal
(could also increase bolus insulin to every meal)
-NOT for T1DM
When should premixed insulin be administered?
before the meals: breakfast and before supper
-not before bedtime -> it can cause hypoglycemia bc it contains the bolus shot and they are not eating
Which Insulin concentration should not be used in Insulin-naive patients?
U-500
-reserved for patients with severe insulin resistance and a TDD (basal + bolus) greater than 200U a day
Which type of Insulin is U-500?
Regular Insulin, short-acting
500 units/ml
-acts like a premixed insulin
-it is given like the premixed: before breakfast and supper
-act as basal and bolus (no other basal insulin needed)
-available as pen and in a vial
How many Units of a U-100 syringe would have to be withdrawn for 500 Units of Humulin R?
20 Units
Which drug is indicated in severe Hypoglycemia?
Glucagon
-Unresponsive (cant take oral glucose)
-Loss of consciousness
-Seizure activity
What is the dose of Glucagon given in severe Hypoglycemia?
1 mg IM/SQ
-reconstitute in NS administered into the thigh
-put the patient in a recovery position (vomiting)
-may repeat in 15 minutes
What is the nasal formulation for Glucagon?
Baqsimi
-3 mg
-put the patient in a recovery position (nausea is a side effect and it may cause vomiting)
-repeat after 15 minutes (until EMS arrives)
What is the pen formulation for Glucagon?
Gvoke HypoPen
