Insulin

Question 1

What % is metformin expected to drop A1c?

Answer 1

1.5-2.0%

Question 2

What % are GLP1 agonists expected to drop A1c?

Answer 2

0.9-1.1%

Question 3

What % is canagliflozin (SGLT2 inhibitor) expected to drop A1c?

Answer 3

0.91-1.16%

Question 4

Which GLP1 agonist is not indicated if CrCl < 30?

Answer 4

Exenatide

Question 5

Metformin contraindication

Answer 5

GFR < 30

Question 6

Besides hypoglycemia, injection reactions, & wt gain, insulin has a risk of…

Answer 6

CHF

Question 7

What is a contraindication of SGLT2 inhibitors?

Answer 7

GFR < 45

Question 8

List diabetic med classes in order of hierarchy

Answer 8

Metformin > GLP1 agonists > SGLT2 inhibitors > DPP4 inhibitors > TZDs

Question 9

What are 3 long acting basal insulins?

Answer 9

Glargine
Aspart
Delgludec

Question 10

What is the name of a rapid acting mealtime insulin?

Answer 10

Apidra

Question 11

How do you initiate prandial insulin?

Answer 11

10% of basal dose

Take before largest meal

Question 12

What 2 types of insulin are NOT available in analog form?

Answer 12

NPH (intermediate acting)

Short acting insulin (Humulin, Novolin)

Question 13

What type of insulin can be prescribed if economics is a factor?

Answer 13

NPH & R (traditional insulins)

• 2/3 of dose = NPH, 1/3 of dose = R
• Requires 3 meals in a day & consistent carb intake

Question 14

What are 2 causes of hyperglycemia?

Answer 14

Too little insulin

“rebound” from low glucose & over-treatment w/ excessive carbs

Question 15

What part of the body has the most consistent absorption of insulin?

Answer 15

Abdomen

Question 16

What is the calculation for total daily insulin requirement?

Answer 16

Weight in Pounds ÷ 4

Question 17

What is the ALTERNATIVE calculation for total daily insulin requirement?

Answer 17

0.55 X total weight in kilograms

Question 18

What % of the total daily insulin dose is used to replace insulin overnight?

Answer 18

40-50%

This is called background or basal insulin replacement

Question 19

What % of the total daily insulin dose is used for carb coverage & high BS correction?

Answer 19

50-60%

This is called bolus insulin replacement

Question 20

If average BS values are > 180, how should you adjust insulin?

Answer 20

Increase by 20%

Question 21

What are 2 PEARLS regarding insulin written instructions?

Answer 21

Increase long-acting by 1 unit each day until FBS btwn 80-120

Increase long-acting by 1 unit every 2-3 days until FBS btwn 80-120

Question 22

What are BS goals pre-meal vs post-meal?

Answer 22

Pre-meal: < 110

Post-meal: < 140

Question 23

What are ADA recommendations regarding BS?

What is ideal FBS?

Answer 23

< 180

100

Question 24

What tool is effective for determining the amount of rapid acting insulin that should be injected for each meal?

Answer 24

CHO counting

Question 25

How do you calculate the “insulin to carb ratio” ?

Answer 25

500 ÷ total daily dose of insulin

Question 26

How do you calculate the CHO insulin dose?

Answer 26

Total grams of carbs ÷ grams of carbs disposed by 1 unit of insulin

Question 27

How do you calculate a patient’s correct factor for regular insulin?

Answer 27

1500 ÷ total daily insulin dose

For rapid-acting: use 1700 or 1800 instead

Question 28

Generally, 1 unit of insulin is needed to drop blood glucose by ______ in type 2 DM & _______ in type 1 DM.

Answer 28

30 mg/dL

50 mg/dL

Question 29

How do you calculate pre-meal high BS correction dose?

Answer 29

( Actual BS - target BS ) ÷ correction factor

*Target BS = btwn 110-120

Question 30

How do you calculate total mealtime dose?

Answer 30

CHO insulin dose + high BS correction dose

Question 31

Who may benefit from addition of the amylinomimetic pramlintide?

Answer 31

Type 1 DM patients who continue to have erratic postprandial glycemic control

Question 32

What are possible signs of ketosis?

Answer 32

2 consecutive plasma glucose readings > 250, or if vomiting occurs