Insulin Flashcards
How to calculate ISF with short acting
83/TDD (as opposed to 100/TDD)
BG level where endogenous insulin secretion is suppressed
3.9-5.5mmol/L
If BG is 2.8-3.9mmol/L, what is secreted to help?
Counter regulatory hormones like glucagon and epinephrine. These lead to neurogenic symptoms (autonomic)
Below 2.8mmol/L, brain function is impaired
Neurogenic vs neuroglycopenic symptoms
Neurogenic
- trembling
- palpitations
- sweating
- anxiety
- tingling
- nausea
Neuroglycopenic
- difficulty concentrating
- confusion, weakness, drowsiness
- vision changes
- slurred speech
- headache
Neurogenic symptoms of Hypoglycemia typically occur at what BG level
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)
Average TTD requirements in T1DM
0.3-0.8 units/kg/day
In adolescence, requirements may increase to 1 to 1.5 units/kg/day
Average TDD for T2DM
1-1.5 unit/Kg/day
Can be up to 2
Anyone needing >200 units a day is considered to be severely insulin resistant
When to consider the addition of bolus insulin to basal insulin?
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
Starting dose for basal insulin
10units at HS
Could start patients <50kg at 0.1 - 0.2 units per kg instead
Most people will need … units of basal insulin
40-50 units
Titration for Tresiba
Add 2 units every 3-4 days or 4units once a week
Basal + bolus calculation
0.5 units/kg = total daily insulin
40% as basal
60% as bolus, divided by 3 to get TID meal time doses
If already on basal, how much bolus should be added to start?
10% of basal TID with meals
For new insulin users, ….. units/kg to get total daily insulin
0.3 - 0.5 units/kg/day
40% basal
60% bolus
Or 50/50%
Starting dose for premixed insulins
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
Rapid acting insulins
Rapid-acting insulin analogues (clear)
• Insulin aspart (NovoRapid®)
• Insulin glulisine (Apidra®)
• Insulin lispro (Humalog®) U- 100 U-200
• Faster-acting insulin aspart (Fiasp*)
Short acting insulins
Short-acting insulins (clear)
• Insulin regular (Humulin®-R, Novolin® ge Toronto]
• Insulin regular (Entuzity® (U-500)]
Basal insulins
Intermediate-acting
(Cloudy)
• Insulin neutral protamine Hagedorn (Humulin® -N, Novolin® ge NPH)
Long-acting insulin
(clear)
• Insulin detemir (Levemir®)
• Insulin glargine U-100 (Lantus®)
• Insulin glargine U-300 (Toujeo®)
• Insulin glargine biosimilar (Basaglar*)
• Degludec U-100, U-200 (Tresiba®)
Long acting insulin onset, duration, and peak
Onset
90min
No peak (technically there is for some)
Duration
U-100 glargine 24h,
Levemir 16-24h
U-300 glargine >30h
degludec 42h
Intermediate acting insulin onset, peak, duration
Humulin-N, novolin, NPH
Onset
1-3 hours
Peak
5-8hours
Duration
Up to 18 hours
Short acting insulin onset, peak, and duration
Insulin regular (Humulin®-R, Novolin® ge Toronto]
30min, 2-3hrs, 6.5hrs
Insulin regular (Entuzity® (U-500)
15min, 4-8 hrs, 17-24hrs
Rapid-acting insulins onset, peaks, and duration
• 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
