Insulin

Question 1

Name the intermediate basal insulin

Answer 1

NPH

Question 2

Name the 3 long acting basal insulins

Answer 2

1. Glargine
2. Detemir
3. Delgludec

Question 3

What is the insulin starting regimen for Type 1 DM

Answer 3

basal-bolus

Question 4

What is the starting regimen for most Type II DM

Answer 4

Metformin (+/- GLP-1) and basal insulin

Question 5

Which insulins come from an animal source (pork)?

Answer 5

Short acting: Humulin R, Novolin R

NPH: Humulin N, Novolin N

Question 6

Rapid Acting Insulins: onset

Answer 6

15-30minutes

Question 7

Short acting insulins: onset

Answer 7

30min-1 hour

Question 8

Intermediate active insulins: onset:

Answer 8

2-4 hours

Question 9

Long Acting insulins: onset

Answer 9

1, 2, 4-5 hours

Question 10

How much will 1 unit of insulin cover?

Answer 10

15g of carbohydrates

Question 11

Storing insulin opened versus unopened bottles

Answer 11

opened: keep at room temperature
unopened: refrigerate

Question 12

How much will one unit of insulin lower blood sugar in Type II DM?

Answer 12

30 mg/dL

Question 13

How much will one unit of insulin lower blood sugar in Type I DM?

Answer 13

50 mg/dL

Question 14

When choosing to add Prandial insulin, when and how much should you add?

Answer 14

begin prandial insulin before largest meal

10% of basal dose, or 5 units

Question 15

If post prandial glucose is consistently >140mg/dL how much should you increase prandial insulin dose?

Answer 15

1-2 units

Question 16

How do you calculate Total Daily Dose of insulin?

Answer 16

TDD (units) = weight in pounds /4

or

0.55*Weight in Kilograms

Question 17

If your patient’s blood sugar is >180mg/dL how much should you increase insulin dose?

Answer 17

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

Question 18

What is the ideal fasting blood sugar?

Answer 18

100

Question 19

What is the premeal ideal blood glucose?

Answer 19

<110

Question 20

What is the post meal target for blood sugar?

Answer 20

20-40mg/dL rise

<140mg/dL (<180 according to ADA)

Question 21

Bolus mealtime insulin is self-adjusted based on what?

Answer 21

carbs you are going to consume + correction of blood sugar higher than >110 premeal

Question 22

What calculation can be used to determine bolus dose?

Answer 22

Rule of 500:

500/total daily insulin dose= # of carbs that 1 unit of insulin will cover

Question 23

What is the correction factor used for?

Answer 23

Correction factor helps you determine how much 1 unit of short-acting insulin will lower the plasma glucose

Question 24

Correction factor (“Rule of 1800”)/ Insulin Sensitivity Factor (ISF) calculation

Answer 24

1800/TDD = how much 1 unit of insulin will lower the BG

Question 25

"Correction dose" for premeal high blood sugar

Answer 25

Actual BS - Target BS (110) / correction factor

Question 26

Total Mealtime dose

Answer 26

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)

Question 27

IF your total daily insulin is 60 units how much is given in the morning?

Answer 27

2/3 or 40 units in this case

Question 28

Traditional insulins: Of the 40 units in the morning dose what is the ratio of NPH (intermediate) to Regular?

Answer 28

2/3 is NPH and 1/3 is Regular ``` NPH = 26 units R= 13 units ```

Question 29

If your patient's blood sugars are all messed up - which blood sugar do you fix first?

Answer 29

Fasting blood sugar

Question 30

What drug can be given for asymptomatic erratic gastric emptying?

Answer 30

Pramlintide (synthetic amylin)