Insulin

Question 1

Insulin

Answer 1

Categorized according to their strength, onset of action, duration, and species source

Question 2

Insulin strength

Answer 2

Most patients use U-100 (U-40 and U-500 are available). The numeral following the “U” indicates the number of units of insulin per milliliter

Question 3

Source of Insulin

Answer 3

All insulins currently on market are “semi-synthetic” or “human” insulin (using recombinant DNA technology ) Some products are referred to as human insulin identical to insulin produced in pancreas (Humulin R, Humulin N, Humulin 70/30); Other products, referred to as human insulin analogs, are modified forms of human insulin (Humalog, insulin lispro):

Question 4

Rapid Acting***

Answer 4

Trade Name: Humalog (insulin lispro) Onset: 15-30 min. Peak: 0.5-2.5 hrs. Duration: 3-6.5 hrs.

Question 5

Short Acting

Answer 5

Trade Name: Humulin R Regular Onset: 30-60 min. Peak: 1-5 hrs. Duration: 6-10 hrs.

Question 6

Intermediate Acting

Answer 6

Trade Name: Humulin N Levemir Onset: 60-120 mins Peak: 6-14 hrs. Duration: 16-24 hrs.

Question 7

Levemir

Answer 7

Onset: 6-8 hrs. Peak: 12-24 hours

Question 8

Long Acting

Answer 8

Trade Name: Lantus Onset: 70 min. Peak: NONE Duration: 24 hrs.

Question 9

what insulin is given now

Answer 9

humlin or humalog

Question 10

effects of rapid acting

Answer 10

immediate effects so blood glucose will drop fast so pt need to eat. don’t want pt blood glucose to bottom out

Question 11

how many units of insulin depends on

Answer 11

blood glucose level

Question 12

patients can be on both

Answer 12

rapid acting and intermediate acting

Question 13

Humalog (insulin lispro)

Answer 13

rapid acting; Can be injected immediately before eating instead of 30 minutes before meals

Question 14

Humalog (insulin lispro) eliminated

Answer 14

more quickly than regular

Question 15

Humalog (insulin lispro) effects

Answer 15

begin 15-30 minutes

Question 16

Humalog (insulin lispro) has a closer

Answer 16

approximation to physiologic insulin release

Question 17

which insulin has less nocturnal episodes of hypoglycemia than regular insulin

Answer 17

Humalog (insulin lispro)

Question 18

Which insulin can you administer close to meal times

Answer 18

Humalog (insulin lispro); Closer administration to meal times within 5-10 minutes; even shortly after the meal if necessary

Question 19

Humulin R/Regular

Answer 19

short acting

Question 20

Humulin R/Regular administered

Answer 20

subQ and can be given IV for hyperglycemia emergencies

Question 21

Humulin R/Regular is for

Answer 21

routine treatment, given subQ before meals to control postprandial hyperglycemia

Question 22

Humulin R/Regular effects

Answer 22

begin in 30-60 minutes, peaks 1-5 hours and persists up to 10 hours

Question 23

Humulin N (Neutral Protamine Hagedorn) prepared

Answer 23

by conjugating regular insulin with protamine; the protamine decreases the solubility of NPH insulin and prolongs absorption (intermediate acting)

Question 24

Humulin N (Neutral Protamine Hagedorn) onset of action

Answer 24

is delayed and duration of action extended

Question 25

Humulin N (Neutral Protamine Hagedorn) given

Answer 25

twice daily to provide glycemic control between meals and during night

Question 26

Humulin N (Neutral Protamine Hagedorn) can be mixed with

Answer 26

with regular insulin (draw up regular first in syringe)

Question 27

Humulin N (Neutral Protamine Hagedorn) onset

Answer 27

60-120 min. Peaks: 6-14 hrs. Lasts 16-24 hrs

Question 28

Humulin N (Neutral Protamine Hagedorn) supplied

Answer 28

as a cloudy suspension

Question 29

if mixing humulin N with regular then draw up

Answer 29

regular (clear) insulin first then humlin N (cloudy)

Question 30

Lantus (insulin glargine)

Answer 30

long acting

Question 31

Lantus (insulin glargine) ia a

Answer 31

modified human insulin with a prolonged duration of action (at least 24 hours)

Question 32

Lantus (insulin glargine) given

Answer 32

once-daily subQ, recommended at night

Question 33

Lantus (insulin glargine) allows for

Answer 33

Allows for once-daily dosing; most like patient’s basal insulin release Lantus

Question 34

after injection of Lantus (insulin glargine) the

Answer 34

the acidic solution is neutralized, leading to formation of microprecipitates from which small amounts of insulin are slowly released; • Result is a relatively constant concentration over 24 hours with no pronounced peak

Question 35

Can you mix other types of insulin with Lantus?

Answer 35

no

Question 36

Does Lantus “look” funny?

Answer 36

YES, compared to NPH, it’s clear

Question 37

pt on lantus would also most likely been on what for meal time

Answer 37

rapid acting insulin

Question 38

when administering insulin you should know

Answer 38

your onset, peak, & duration times

Question 39

pts must _______ when receiving insulin

Answer 39

EAT

Question 40

Consider holding or lowering insulin dose if patient

Answer 40

is NPO…Consult physician

Question 41

when administering insulin look for

Answer 41

signs & symptoms of hypoglycemia

Question 42

signs & symptoms of hypoglycemia ****

Answer 42

headache, light headedness; nervousness, apprehension, tremors; excess perspiration, cold, clammy skin; tachycardia, slurred speech, confusion

Question 43

signs of hypoglycemia appear when blood sugar level

Answer 43

is < 60 mg/dl (the more it drops the more pronounced the symptoms are

Question 44

pts must _______ when receiving insulin

Answer 44

EAT

Question 45

Consider holding or lowering insulin dose if patient

Answer 45

is NPO…Consult physician

Question 46

when administering insulin look for

Answer 46

signs & symptoms of hypoglycemia

Question 47

signs & symptoms of hypoglycemia ****

Answer 47

headache, light headedness; nervousness, apprehension, tremors; excess perspiration, cold, clammy skin; tachycardia, slurred speech, confusion

Question 48

signs of hypoglycemia appear when blood sugar level

Answer 48

is < 60 mg/dl (the more it drops the more pronounced the symptoms are

Question 49

insulin keep at

Answer 49

room temperature but only for 1 month after opening (date). Keep Unopened bottles in refrigerator

Question 50

for injections absorption is

Answer 50

fastest in abdomen, then deltoid, thigh, and buttocks

Question 51

for injections rotating sites prevent

Answer 51

lipohypertrophy (increased swelling of fat tissue in skin) and lipoatrophy (loss of fatty tissue); • Rotation WITHIN on anatomic site is preferred

Question 52

The equivalency of 10-15 grams of glucose (approximate servings) are:

Answer 52

Four lifesavers ; 4 teaspoons of sugar ; 1/2 can of regular soda or juice (can be used for Treatment of Hypoglycemia)

Question 53

Once the acute episode of hypoglycemia has been treated,

Answer 53

a healthy, long-acting carbohydrate to maintain blood sugars in the appropriate range should be consumed. Half a sandwich is a reasonable option

Question 54

What if pt is hypoglycemic and is comatose & cannot take anything by mouth?

Answer 54

then use glucagon

Question 55

glucagon

Answer 55

causes a rapid release of glucose stores from the liver. It is an injection given intramuscularly to a patient who cannot take glucose by mouth. A response is usually seen in minutes and lasts for about 90 minutes.

Question 56

If glucagon is not available and the patient is not able to take anything by mouth,

Answer 56

emergency services (for example 911) should be called immediately. An intravenous route of glucose (Dextrose 50%) should be administered immediately.