Insulin Flashcards
0
Q
Assessment of injection site to include:
A
Signs of infection (puffy/red)
Excessive bruising (from bleeding disorder/improper technique)
Redness (impure insulin or sensitivity)
Local irritation
1
Q
Thickening of fatty tissue from overuse at one injection site
A
Hyper trophy
2
Q
Pitting of the fatty tissue at injection site is called _______ and is caused by________.
A
Tissue atrophy
Impure insulin
3
Q
Correct carbohydrate to insulin ratio
A
15 grams: 1 unit
4
Q
How much should rapid or short acting insulins be adjusted prior to exercise?
A
30-50% reduction
5
Q
What % reduction is appropriate for intermediate acting insulin prior to exercise?
A
10%
6
Q
Intensive insulin is ____ or more injections per day
A
3
7
Q
Basal vs. bolus
A
Basal is intermediate or long and bolts is rapid or fast acting for post meal
8
Q
True or false: when intermediate acting is given in the AM bolus should NoT be given at lunch.
A
True-peak times together may cause hypoglycemia
9
Q
Examples of intensive insulin:
A
- Bolus before each meal
- Bolus each meal and basal at HS
- Bolus for breakfast and lunch, basal at HS
- Bolus of intermediate before breakfast and bolus before evening meal and intermediate at HS
10
Q
Temperature for room temp insulin storage
A
36-86 F
11
Q
Which insulins are clear?
A
Rapid and fast acting, as well as glargine (Lantus)
12
Q
______ acting insulins should be uniformly cloudy
A
Intermediate
13
Q
What happens to an insulin vial that is shaken vigorously?
A
Loss of potency
14
Q
Which insulin is drawn up first, and why? (Intermediate or rapid/regular)
A
Intermediate drawn up first to prevent protamine contamination of clear insulin.
15
Q
Which insulin should never be mixed?
A
Glargine (Lantus)
16
Q
Humulin 70/30 is combination of:
A
70% NPH and 30% regular
17
Q
Inspection of insulin before drawing up an injection should include:
A
Look for degradation (clumping, frosting, precipitation, or change in clarity/color)
18
Q
Regular and NPH can be mixed and stored in the fridge for ____
A
1 month (stored vertically with needle up to prevent needle clogging)
19
Q
Guidelines for needle reuse:
A
- Discard when dull/damaged or comes into contact with surface
- Cap after use
- Store at room temp
- Do not rub alcohol to clean it (removes silicone coating that makes injection comfortable)
- Watch injection site for infection/lipodystrophy)
20
Q
SQ injection
A
90 degree angle (45 degree angle for very thin)
21
Q
True or false: patient should check for aspiration of blood
A
False
22
Q
When using an insulin pen, needle should remain in after plunger depressed for ____ seconds
A
5
23
Q
What should be done if clear fluid escapes at injection site? What should not be done?
A
Apply pressure for 5-8 seconds. Do NOT rub the site
24
True or false: air bubbles should be removed from the filled syringe. Why?
True, to ensure proper insulin dosage
25
Starting dose of insulin for Type 1
0.5-1 units per kilogram of body weight
26
Honeymoon phase insulin requirements
0.2-0.6 units per kg body weight
27
Starting Basal insulin in Type 2
Single dose basal: 10-20 units
| Body weight: 0.7-2.5 units/kg body weight daily
28
True or false: Single daily injections are contraindicated for Type 1
True
29
Daily dosage limit for single daily insulin injection
30 units/day
30
Why do insulin at HS?
To suppress nocturnal glucose production by the liver
31
Typical daily dose breakdown for Two injection of insulin
2/3 in AM and 1/3 in evening
32
Two injection options
2 doses of intermediate or long acting only
Or
Mixed intermediate and rapid or short at one/both of the times
33
What type of insulin is used for pump?
Rapid acting (lispro/Humalog or aspart/Novolog)
34
Technical malfunction of the pump can cause interruptions of insulin delivery and may result in __________.
Ketosis
35
Pump site and tubing should be changed every ___ days to minimize infection and also prevent tube clogging.
3
36
Tube and reservoir changes should be done at what time of day to avoid undetected malfunction during sleep?
Early in the day
37
Why rotate insertion sites for pump users?
Reduce risk of lipodystrophy and maintain good insulin absorption
38
When should the pump be removed?
X-rays, CT, MRI, radiation therapy (keep device away as well)
39
True or false: Meglitinide doses do not need titration.
True, initial and maintenance dose is 120 mg before meals.
40
TZD doses should be adjusted at what interval to allow for optimal benefit to be realized?
8-12 weeks
41
AGI (alpha glucosidase inhibitors) are started at what dose?
25 mg with one meal per day, increased to patient tolerance
42
True or False: DPP-4 inhibitors have a once daily dosing that does not require titration
True. Dosing adjustments are made for renal impairment, however.
43
What is the 1700 rule?
Determines how many mg/dl the blood glucose is lowered by 1 unit of insulin.
44
What does the 1700 rule assume?
Rapid acting is only used as bolus to correct high blood sugar.
45
When to use 1500 rule?
When regular insulin is used to correct high blood sugar.
46
How does the 1700 rule work?
1. add up total insulin daily dose.
2. Divide 1700 by the total daily insulin dose.
3. Determine the required correction dose based on: 1) how many points the patient is from goal blood glucose and 2) the calculated dose required
47
Medications that raise blood glucose
1. Gluococorticoids (eg. prednisone)
2. Thiazides (eg. HCTZ)
3. Phenytoin
4. Estrogen compounds
5. Antipsychotics (eg. clozapine, olanzapine, risperidone)
48
Medications that LOWER blood glucose
1. Antibiotics (eg. clarithromycin, levofloxacin)
2. salicylates (high dose)
3. Alcohol (ethanol), especially without food
49
Medications that raise blood pressure
1. Anti-inflammatories
2. Glucocorticoids
3. OTC nasal decongestants
4. OC's
5. Tricyclic antidepressants (eg. nortriptyline)
50
Which class of medications masks hypoglycemia?
Beta blockers (eg. propranolol)
51
Herbs that may lower blood glucose include:
fenugeek, ginseng, prickly pear/cactus
52
Herbs that raise blood pressure
Ma Huang, licorice
53
Herbs that cause liver damage
chaparral, sassafras, comfrey
54
ADA criteria to deem an alternative therapy as safe and effective
Approved by the FDA and supported by 2 studies published in a peer-reviewed journal.
55
Examples of potentially useful herbs:
1. Omega-3 and 6 fatty acids for lipids.
2. Alpha lipoic acid and capsaicin for neuropathy
3. Fenugeek seeds, chromium picolinate and psyllioum to lower blood glucose.
56
What is endogenous insulin and where is it made?
Hormone secreted by the beta cells of the Islets of Langerhans in pancreas
57
What are the actions of insulin?
```
Augment protein synthesis (amino acids into cells)
Utilize glucose (stimulate its entry into cells)
Enhance storage of unused glucose at glycogen (into muscles and liver cells)
Enhance fat storage and prevent fat breakdown for energy
Impede glygogenolysis (making of glucose from glycogen in muscle and liver cells)
Impede glucose formation from amino acids/non-carb sources
```
58
Which hormones counteract insulin effects?
```
Glucagon
Epinephrine
Norepinephrine
Growth hormone
Cortisol
```
59
Rapid insulin examples
Lispro (Humalog)
| Aspart (Novolog)
60
Short acting insulin examples
Regular
Novolin R
Humulin R
61
Intermediate insulin examples
NPH
Novolin N
Humulin N
62
Long acting insulin examples
Glargine (Lantus)
| Detemir (Levemir)
63
Rapid acting insulin onset of action and typical dosing relative to meals
Onset in 5-15 minutes, given as bolus doses prior to meal.
64
What type of insulin is used in a pump?
Rapid-acting
65
Peak action for rapid acting insulin and duration of action
30-90 minutes (1-2 hours) and 5 hours
66
What site injection has been shown to shorten the duration of rapid acting insulins?
Aspart into the abdominal sub-Q tissue
67
What percentage of the daily insulin requirement is given with long-acting?
50%
68
Long acting insulin dosing options
QD or BID, if QD give at bedtime. May also use mealtime insulin to cover meals
69
Risks of nocturnal hypoglycemia and weight gain are less with _____ compared to ______.
Long Acting compared to NPH
70
Which insulin type cannot be mixed with other types?
Long acting (Lantus or Levemir)
71
What is the daily requirements for insulin in a Type 1 patient?
0.5-1 units per kg body weight daily
72
What is the daily insulin requirement for Type 1 during honeymoon phase?
0.2-0.6 units per kg body weight daily
73
Common insulin starting dose for Type 2 (in units).
10-20 units. Due to insulin resistance, the need is usually higher with Type 2 at 0.7-2.5 units per kg body weight daily
74
When 2 injection insulin regimen is used, what is the breakdown of morning and evening daily dose?
2/3 AM and 1/3 PM
75
Intensive insulin is ____ injections or more per day
3
76
When intermediate-acting insulin is given in the morning, should bolus insulin be given at lunch? Why or why not?
NO, because peak time for both will coincide and cause hypoglycemia
77
Basal insulin is also called _________.
Background insulin, secreted in steady state (no peaks).
78
Basal bolus insulin therapy is designed to mimic _______________.
Normal patterns of insulin secretion. It is made of basal and bolus insulin.
79
Bolus insulin is ________.
Bursts of insulin in response to increased blood glucose.
80
What is CSII?
Continous subcutaneous insulin infusion AKA Insulin pump
81
What is the preferred choice for insulin therapy in Type 1?
Basal bolus, because they don't secrete any insulin themselves.
82
Is 70/30 premix a good choice?
It doesn not allow for as much flexibility in timing of eating or exercise. Not the best control of blood glucose.
83
How should insulin be adjusted when glucose is high or low before breakfast?
Adjust bedtime intermediate (NPH) or long-acting (glargine, detemir)
84
How should insulin be adjusted when glucose is high after breakfast?
Adjust pre-breakfast rapid-acting
85
How should insulin be adjusted when glucose is high after lunch?
Adjust pre-lunch rapid-acting
86
How should insulin be adjusted when glucose is high after dinner?
Adjust pre-dinner rapid-acting
87
True or false: those on insulin pump or multiple daily injections that are on bolus insulin regimens, they will count carbs and inject rapid acting according to the carb/insulin ratio
True
88
True or False: Diabetics on fixed insulin doses and oral glucose lowering medications should maintain consistent carbohydrate consumption.
True
89
True or false, diabetics using oral insulin secretagogues may need to lower daily dose when they have ongoing increased physical activity
True
90
Steps for counting carbs:
1. determine serving size
2. Look at total carb value (may need to ignore sugar on the label, as that is may be included in the total carbs).
3. Check for Fiber content and subtract the amount from total if there is more than 5 grams of fiber per serving.
