Insulin Flashcards
Name the intermediate basal insulin
NPH
Name the 3 long acting basal insulins
- Glargine
- Detemir
- Delgludec
What is the insulin starting regimen for Type 1 DM
basal-bolus
What is the starting regimen for most Type II DM
Metformin (+/- GLP-1) and basal insulin
Which insulins come from an animal source (pork)?
Short acting: Humulin R, Novolin R
NPH: Humulin N, Novolin N
Rapid Acting Insulins: onset
15-30minutes
Short acting insulins: onset
30min-1 hour
Intermediate active insulins: onset:
2-4 hours
Long Acting insulins: onset
1, 2, 4-5 hours
How much will 1 unit of insulin cover?
15g of carbohydrates
Storing insulin opened versus unopened bottles
opened: keep at room temperature
unopened: refrigerate
How much will one unit of insulin lower blood sugar in Type II DM?
30 mg/dL
How much will one unit of insulin lower blood sugar in Type I DM?
50 mg/dL
When choosing to add Prandial insulin, when and how much should you add?
begin prandial insulin before largest meal
10% of basal dose, or 5 units
If post prandial glucose is consistently >140mg/dL how much should you increase prandial insulin dose?
1-2 units
How do you calculate Total Daily Dose of insulin?
TDD (units) = weight in pounds /4
or
0.55*Weight in Kilograms
If your patient’s blood sugar is >180mg/dL how much should you increase insulin dose?
increase by 20%
A. increase by 1 unit a day until FBS is between 80-120mg/dL
or
B. increase long acting by 1 unit every 2-3 days until FBS is at goal of 80-120mg/dL
What is the ideal fasting blood sugar?
100
What is the premeal ideal blood glucose?
<110
What is the post meal target for blood sugar?
20-40mg/dL rise
<140mg/dL (<180 according to ADA)
Bolus mealtime insulin is self-adjusted based on what?
carbs you are going to consume + correction of blood sugar higher than >110 premeal
What calculation can be used to determine bolus dose?
Rule of 500:
500/total daily insulin dose= # of carbs that 1 unit of insulin will cover
What is the correction factor used for?
Correction factor helps you determine how much 1 unit of short-acting insulin will lower the plasma glucose
Correction factor (“Rule of 1800”)/ Insulin Sensitivity Factor (ISF) calculation
1800/TDD = how much 1 unit of insulin will lower the BG
“Correction dose” for premeal high blood sugar
Actual BS - Target BS (110) / correction factor
Total Mealtime dose
Total Mealtime Dose = CHO insulin dose + high blood sugar correction insulin dose
(ex. 6 units for meal CHO + 3 units for premeal BS correction = 9 units)
IF your total daily insulin is 60 units how much is given in the morning?
2/3 or 40 units in this case
Traditional insulins: Of the 40 units in the morning dose what is the ratio of NPH (intermediate) to Regular?
2/3 is NPH and 1/3 is Regular
NPH = 26 units R= 13 units
If your patient’s blood sugars are all messed up - which blood sugar do you fix first?
Fasting blood sugar
What drug can be given for asymptomatic erratic gastric emptying?
Pramlintide (synthetic amylin)
