Insulin

Question 1

Give an example of a rapid acting insulin

Answer 1

Novorapid

Humalog

Apidra

Question 2

Give an example of a short acting insulin

Answer 2

Actrapid

Humulin S

Question 3

Give an example of a intermediate acting insulin

Answer 3

Humulin I

Insulatard

Insuman basal

Question 4

Give an example of a long acting insulin

Answer 4

Lantus

Levemir

Tresiba

Question 5

Give an example of a mixed insulin

Answer 5

Humulin M3 (30% short acting, 70% intermediate acting)

Novomix 30 (30% rapid acting, 70% intermediate acting)

Humalog Mix 25/50 (25/50% rapid acting, 75/50% intermediate acting)

Question 6

What type of insulin (and percentage) are in Humulin M3 (mixed type of insulin)

Answer 6

30% short acting

70% intermediate acting

Question 7

Give an example of a xultophy

Answer 7

Used to treat T2DM

Contains liraglutide (GLP-1 mimetic) with Tresiba (long acting insulin)

The long acting insulin (basal insulin) helps control your sugar levels throughout the day

Hence useful to improve glycaemic control

Question 8

Name the two most common insulin regimens

Answer 8

Basal-bolus regime

Twice daily pre-mixed region

Question 9

Describe the basal-bolus insulin regimen

Answer 9

Basal long-acting insulin given at night.

Rapid acting (bolus) insulin given before every meal.

Question 10

Describe the twice daily pre-mixed insulin regimen

Answer 10

Mixed intermediate and short/rapid insulin given twice daily (before breakfast and before dinner)

Question 11

When is insulin used?

Answer 11

Mainstay management of T1DM

Used to supplement oral hypoglycaemic medication in T2DM

Question 12

Name some situations in which there would be an increase in insulin requirement

Answer 12

DKA

Sepsis

Steroid use

Missed doses

Pancreatitis

Dehydration

Question 13

Name some situations in which there would be an decrease in insulin requirement

Answer 13

Reduced calorie intake

Reduced renal function

Alcohol

Question 14

On the drug kardex, what would you write in regards to prescribing insulin

Answer 14

Write “insulin as per insulin prescription chart” on Kardex

Question 15

What kind of device types can be patient use to administer insulin

Answer 15

Disposable pen

Vial

Pen cartridge

Question 16

When is mixed insulin dose usually given

Answer 16

Patients would normally take this insulin with breakfast and evening meal, therefore the fast-acting insulin would be in their system for post-prandial spike

NOT TO BE USED BEFORE BED

Question 17

Define the term post-prandial spike

Answer 17

Refers to temporary high blood sugars that occur soon after eating.

Question 18

When prescribing insulin what would you write for units

Answer 18

Write “units” not “u” as this can be mistaken as a “0”

Question 19

What do you do if a patient must fast after insulin has been prescribed

Answer 19

They should be given a variable rate intravenous insulin infusion (VRIII)

Question 20

If the blood glucose levels are rising. How would you adjust insulin:

a) Decrease
b) Increase

Answer 20

a) Decrease

Question 21

If you are going to adjust insulin dose. What percentage increase/decreases would be considered safe?

Answer 21

10-20%

Question 22

What is the equation to calculate the insulin correctin dose if a patient has hyperglycaemia

Answer 22

Dose 1 unit of short acting insulin will reduce the blood glucose by (D₁)= 100/Total Daily Insulin Dose

Dose of shortacting insulin = How much you want to reduce blood glucose by/D₁

For example:

Total Daily Insulin Dose: 40 units

BM currently: 24.1 mmol/L

BM target: 12 mmol/L

Difference between BM targe and currnet: 12.1 mmol/L

D₁= 100/Total Daily Insulin Dose = 100/40 = 2.5 i.e. 1 unit of short acting insulin will drop the blood glucose by 2.5 mmol/L.

Dose of shortacting insulin = How much you want to reduce blood glucose by/D₁ = 12.1/2.5 = 4.8 units of shortacting insulin as a correction dose

Question 23

How to treat hyperglycaemia post-hypoglycaemia

Answer 23

Should not be treated