Insulin

Question 1

Who needs insulin therapy?

Answer 1

• Type 1 diabetics

- Type 2 diabetics if glycaemic targets are not met with diet and non-insulin therapies

Question 2

What are the insulin prescribing standards to minimize error?

Answer 2

• Right person
• Right time
• Right strength
• Right device
• Right insulin
• Right dose

Question 3

What is the 25-50 rule?

Answer 3

Question any dose of:

• Rapid acting insulin over 25 units
• Longer acting insulin over 50 units

Question 4

When should a patient self adjust their dose of insulin?

Answer 4

• Exercise
• Depending on fingerprick glucose
• Calorie intake
• Carbohydrate counting

Question 5

What should a patient on insulin avoid?

Answer 5

• Binge drinking (risk of delayed hypoglycaemia)

Question 6

Name some rapid acting insulins?
When are they given?
What time is the onset?

Answer 6

• Novorapid, insulin aspart
• Inject at start of meal, or just after a meal
• Onset within 30-40 mins, duration 3-5hrs

Question 7

How is insulin given?

Answer 7

Subcutaneously

Question 8

Name some short acting insulins?

How long do they work for?

Answer 8

Humulin S, actrapid

Onset within 30-60 mins, peak at 2-5hrs

Question 9

Name some intermediate acting insulins?

How long do they work for?

Answer 9

Isophane insulin (NPH)
Onset within 60-120mins, peak at 4-12hrs

Question 10

Name some long acting insulins?

How long do they work for?

Answer 10

Insulin glargine

Onset in 60-90 mins, last 20-24hrs

Question 11

If a patient is on steroids, what happens to their insulin dose?

Answer 11

Increase it!!

Question 12

Name some side effects of insulin therapy

Answer 12

Hypoglycaemia (esp if renal impairment), lipohypertrophy, lipoatrophy

Question 13

What is a biphasic insulin regimen?

Answer 13

Twice daily premixed insulin (novomix)

Question 14

What is a QDS insulin regimen?

Answer 14

Before meals ultrafast insulin and bedtime long acting insulin. Gives good flexibility.

Question 15

What is a once daily insulin regimen?

Answer 15

Once before bed long acting insulin. A good regimen when switching from tablets in T2DM.

Question 16

What advice should you give during acute illnesses for a patient on insulin?

Answer 16

• Avoid stopping insulin during acute illness
• Illness increases insulin requirements despite eating less
• Check blood glucose >4 times a day and look for ketonuria. Increase insulin if glucose rises.
• Maintain calorie intake
• Admit if vomiting, ketotic, a child or pregnant

Question 17

When should you consider a patient for insulin pumps?

Answer 17

• Attempts to reach target HbA1C have failed despite regular insulin injections
• Multiple injections have lead to disabling hypoglycaemia when trying to reach HbA1C target