Insulin

Question 1

How to calculate ISF with short acting

Answer 1

83/TDD (as opposed to 100/TDD)

Question 2

BG level where endogenous insulin secretion is suppressed

Answer 2

3.9-5.5mmol/L

Question 3

If BG is 2.8-3.9mmol/L, what is secreted to help?

Answer 3

Counter regulatory hormones like glucagon and epinephrine. These lead to neurogenic symptoms (autonomic)

Below 2.8mmol/L, brain function is impaired

Question 4

Neurogenic vs neuroglycopenic symptoms

Answer 4

Neurogenic
- trembling
- palpitations
- sweating
- anxiety
- tingling
- nausea

Neuroglycopenic
- difficulty concentrating
- confusion, weakness, drowsiness
- vision changes
- slurred speech
- headache

Question 5

Neurogenic symptoms of Hypoglycemia typically occur at what BG level

Answer 5

2.8-3.9mmol/L
With repeated Hypoglycemia, secretion of counter regulatory hormones is impacted and Hypoglycemia unawareness happens (people start only feeling neuroglycopenic symptoms)

Question 6

Average TTD requirements in T1DM

Answer 6

0.3-0.8 units/kg/day
In adolescence, requirements may increase to 1 to 1.5 units/kg/day

Question 7

Average TDD for T2DM

Answer 7

1-1.5 unit/Kg/day
Can be up to 2
Anyone needing >200 units a day is considered to be severely insulin resistant

Question 8

When to consider the addition of bolus insulin to basal insulin?

Answer 8

If basal insulin dose exceeds 0.5 units/kg/day.
Basal doses of greater than this is associated with an increased risk of hypoglycaemia without significant improvements to A1c

Question 9

Starting dose for basal insulin

Answer 9

10units at HS
Could start patients <50kg at 0.1 - 0.2 units per kg instead

Question 10

Most people will need … units of basal insulin

Answer 10

40-50 units

Question 11

Titration for Tresiba

Answer 11

Add 2 units every 3-4 days or 4units once a week

Question 12

Basal + bolus calculation

Answer 12

0.5 units/kg = total daily insulin
40% as basal
60% as bolus, divided by 3 to get TID meal time doses

Question 13

If already on basal, how much bolus should be added to start?

Answer 13

10% of basal TID with meals

Question 14

For new insulin users, ….. units/kg to get total daily insulin

Answer 14

0.3 - 0.5 units/kg/day
40% basal
60% bolus

Or 50/50%

Question 15

Starting dose for premixed insulins

Answer 15

5-10 units BID (before breakfast and before supper)
Titratie up morning dose by 1 unit until pre-supper BG is at target and then supper dose by 1 unit until fasting am BG is at target

Take 10min before meals
Take humulin 30/70 and novolin 30/70 30min before meals

Question 16

Rapid acting insulins

Answer 16

Rapid-acting insulin analogues (clear)
• Insulin aspart (NovoRapid®)
• Insulin glulisine (Apidra®)
• Insulin lispro (Humalog®) U- 100 U-200
• Faster-acting insulin aspart (Fiasp*)

Question 17

Short acting insulins

Answer 17

Short-acting insulins (clear)
• Insulin regular (Humulin®-R, Novolin® ge Toronto]
• Insulin regular (Entuzity® (U-500)]

Question 18

Basal insulins
Intermediate-acting

Answer 18

(Cloudy)
• Insulin neutral protamine Hagedorn (Humulin® -N, Novolin® ge NPH)

Question 19

Long-acting insulin

Answer 19

(clear)
• Insulin detemir (Levemir®)
• Insulin glargine U-100 (Lantus®)
• Insulin glargine U-300 (Toujeo®)
• Insulin glargine biosimilar (Basaglar*)
• Degludec U-100, U-200 (Tresiba®)

Question 20

Long acting insulin onset, duration, and peak

Answer 20

Onset
90min

No peak (technically there is for some)

Duration
U-100 glargine 24h,
Levemir 16-24h
U-300 glargine >30h
degludec 42h

Question 21

Intermediate acting insulin onset, peak, duration
Humulin-N, novolin, NPH

Answer 21

Onset
1-3 hours

Peak
5-8hours

Duration
Up to 18 hours

Question 22

Short acting insulin onset, peak, and duration

Answer 22

Insulin regular (Humulin®-R, Novolin® ge Toronto]
30min, 2-3hrs, 6.5hrs

Insulin regular (Entuzity® (U-500)
15min, 4-8 hrs, 17-24hrs

Question 23

Rapid-acting insulins onset, peaks, and duration

Answer 23

• aspart (NovoRapid®)
9-20min, 1-1.5hrs, 3-5hrs

• glulisine (Apidra®)
10-15min, 1-1.5hrs, 3.5-5hrs

• lispro (Humalog®) U- 100 U-200
10-15min, 1-2hrs, 3-4.75hrs

• Faster-acting insulin aspart (Fiasp*)
4min, 0.5-1.5hrs, 3-5hrs