Insulin Flashcards by Morgan LaRoque

What Insulin therapy MUST you being in Type 1 DM?

Basal-Bolus Insulin

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What does basal-bolus insulin therapy include?

Basal Insulin: For fasting and post-absorptive control

2. Rapid Acting Bolus Insulin: For mealtime

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What Insulin Therapy are you going to begin with in Type 2 DM?

Background/Basal Insulin + Metformin (usually)

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List the Rapid-Acting Insulins

Aspart
Lispro
Glulisine

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Onset of Rapid Acting Insulins

15-30 minutes

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Peaks onset of Rapid Acting Insulin

1-2 hrs

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Duration Rapid Acting Insulin

3-6 hrs

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List the Short-Acting Insulin

Regular

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When do you administer Regular? What meals does it cover?

Before AM

Covers: 1st, noon, and PM meals

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Onset of Regular (short acting)

30 min-1 hr

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Peak onset of Regular (short acting)

2-3 hrs

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Duration of Regular (short acting)

4-8 hrs

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List the Intermediate Acting Insulin

NPH

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Onset of NPH (Intermediate)

2-4 hrs

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Peak onset of NPH (Intermediate)

4-8 hrs

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Duration of NPH (Intermediate)

8-18 hrs

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What meals does NPH (intermediate) cover?

AM and PM meals

List the Long-Acting Insulin

Detemir
Glargine
Degludec

Duration of Long-Acting Insulin

24 hrs

Administer once daily

List the NON-ANALOG insulins

NPH Regular Combinations:Humili 70/30, Novolin 70/30

2. Inhaled Insulin: Afrezza

what should NOT be refrigerated once in use?

Durable Pens

2. Dosing Devices

What should UNOPENED vials be refrigerated at?

36-46 deg. F

What temperature do you keep OPEN vials at?

Room temp

In DM Type 2, how many grams of CHO does 1 unit of bolus insulin cover?

15 g

In DM Type 2, how much does 1 unit of bolus insulin decrease blood sugar by?

30 mg/dL

In DM Type 1, how much does 1 unit of bolus insulin decrease blood sugar by?

50 mg/dL

What injection site/location has the most consistent absorption?

Abdomen

What can Hyperglycemia be d/t?

1. Too little insulin | 2. "Rebound" from low glucose and overcorrection with CHO

How much should you increase the basal (long acting) insulin to reach glycemic control?

2 Units every 2-3 days

What is the IDEAL FBS?

100

What target blood sugar is often used?

110-120

What is the rise in BS post meal?

20-40

What is a relative CI to continued intensive insulin therapy?

Loss of hypoglycemia warning signs

What can Hypoglycemia unawareness results from?

1. Autonomic neuropathy | 2. Frequent episodes of hypoglycemia

How can you restore Hypoglycemia awareness

Reduce/adjust insulin dose

Asx erratic gastric emptying tx

Pramlinitide

How long can exercise continue to decrease blood sugars?

up to 6-8 hrs

Exercise recommendations

1. Exercise @ consistent time | 2. Avoid late evening exercise until insulin dose is stable

Minor surgery recommendations in both Type 1 and 2 DM

1. No Insulin day of operation (Type 2), D/c Pump night before + 24 hr basal insulin (type 1) 2. 5% Dextrose infusion 3. Monitor blood glucose 4. SubQ short acting insulin q. 4-6 hrs

Mjr surgery recommendations in both Type 1

1. Insulin infusion morning of procedure | 2. Transition back to regimen when eating

What is the recommended CHO intake on sick days?

120-150 g CHO

How many years following pancreas transplants do 80% of patients need to reinitiate insulin therapy?

2 years