Insulin

Question 1

Principles

Answer 1

Ensure pt. education about
Self-adjustment ̄c exercise and calories
Titrate dose
Family member can abort hypo ̄c sugary drinks
or GlucoGel
Pre-prandial BM don’t tell you who much glucose is
needed
Fasting BM before meal informs re long-acting insulin
dose.
Finger-prick BM after meal informs re short-acting
insulin dose (for that last meal)

Question 2

BD Biphasic regime - Mixed regime

Answer 2

BD insulin mixture 30min before breakfast and dinner Rapid-acting: e.g. novorapid
Intermediate- / long-acting: e.g. insulatard
T2 or T1 DM ̄c regular lifestyle: children, older pts.
Assoc, ̄c fasting hyperglycaemia

Question 3

Basal-bolus regime

Answer 3

Bedtime long-acting (e.g. glargine) + short acting before each meal (e.g. lispro)
  Adjust dose according to meal size
  ~50% of insulin given as long-acting
  T1DM allowing flexible lifestyle
  Best outcome

Question 4

During illness - change in management

Answer 4

Insulin requirements usually ↑ (even if food intake ↓)
  Maintain calories (e.g. milk)
  Check BMs ≥4hrly and test for ketonuria
  ↑ insulin dose if glucose rising

Question 5

Hypoglycaemia

Answer 5

At risk: EtOH binge, β-B (mask symptoms), elderly

Need to admit sulfonylurea-induced hypo

Question 6

Lipohypertrophy

Answer 6

Rotate injection site: abdomen, thighs

Question 7

Wt. gain in T2DM

Answer 7

↓ wt. gain if insulin given ̄c metformin

Question 8

Name rapid acting

Answer 8

Homolog, Novorapid, Apidra

Question 9

Name short acting

Answer 9

Humulin S, Actrapid, Inhuman Rapid

Question 10

Name intermediate acting

Answer 10

Insulatard, Humulin I, Insuman Basal

Question 11

Long acting

Answer 11

Lantus, Levemir

Question 12

Ultra long acting

Answer 12

Tresiba

Question 13

Rapid acting analogue intermediate mixture

Answer 13

Homolog Mix 25, Homolog Mix 50, Novomix 30

Question 14

Short acting intermediate mixture

Answer 14

Humulin M3, Inhuman Comb 15, 25, 50

Question 15

Short acting intermediate mixture

Answer 15

Humulin M3, Inhuman Comb 15, 25, 50

Question 16

Inpatient diabetic level

Answer 16

4-11 mmol/L

Question 17

How many ml in 1 unit?

Answer 17

0.01ml

Question 18

How much does mmol/L decrease by with 1 unit?

Answer 18

2.8mmol/L