Insulin Flashcards
Other than being a treatment for T1D/T2D, what else can insulin be used to treat?
Acute hyperkalemia (drip should not only contain insulin but should contain glucose as well)
What are general adverse effects of insulin?
- Hypoglycemia (dose depends on level of physical activity, alcohol consumption, and stress)
- Lipodystrophy at injection site (change injection sites)
- Weight gain
- Hypokalemia (activates Na/K-ATPase pump)
What are examples of rapid acting insulin?
Lispro, aspart, and glulisine
What are examples of long acting insulin?
Glargine, detemir, degludec (ultra long acting)
What is the duration for rapid acting insulin?
Onset of action- 15 min
Peak effect- 1 hr
Duration of action- 2-4 hrs
What is the duration for short acting insulin?
Onset of action- 30 min
Peak effect- 2-4 hours
Duration of action- 5-8 hours
What is the duration for intermediate insulin?
Onset of action- 2 hours
Peak effect- 6 hours
Duration of action- 12-16 hours
What is the duration for long acting insulin?
Onset of action- 2 hours
Peak effect- no peak
Duration of action- 20-26 hours
T/F: rapid acting insulin is basal insulin
False; rapid acting represents bolus insulin since it mimics insulin after meals while NPH,detemir, and glargine represent basal insulin since they tend to last long
T/F: Most insulins are a concentration of 100units/mL
True, this can be termed as U100
What are characteristics of basal insulin?
- Given once a day usually
- Covers the body’s 24 hour insulin needs in the fasting state or between meals (decreases hepatic glucose production and ketogenesis)
- Low risk of hypoglycemia
What are characteristics of bolus insulin?
- Usually given with a meal
- Two functions
- nutritional= reduce blood glucose rise with meals
- correctional= rapidly correct hyperglycemia - Higher risk of hypoglycemia
What is pre-mixed insulin?
- Basal and rapid acting insulin combined= typically 70/30 where 70 is basal and 30 is bolus (regular or rapid)
- Given 2x a day before meals
T/F: T1Ds need basal and bolus insulin
True
When would a patient with T2D need insulin?
- In cases of severe hyperglycemia where A1C> 9-10% despite trying oral meds
- Hyperglycemia where oral meds are CI like if pt has CKD
Note: typically start with basal first then see if they need bolus
What is insulin dosing for T1D?
0.4-0.7 units/kg/day of basal and bolus
What is insulin dosing for T2D?
- If on basal and bolus give 0.5-2 units/kg/day
- If basal only give 10 units daily or 0.2 units/kg/day
How to adjust dose for basal and bolus insulin?
Basal- adjust based off fasting glucose levels (goal of 80-130 mg/dL)
Bolus- adjust based on glucose levels 2 hours after meals or glucose before next meal (goal of <180 mg/dL)
How to adjust dose for premixed insulin?
Adjust morning (breakfast) dose based on pre-lunch and pre-dinner glucose. Adjust evening (dinner) dose based on post dinner, bedtime, and/or morning fasting glucose
