Insulin Complications

Question 1

Signs and symptoms of hypoglycemia

Answer 1

Tremors, diaphoresis, anxiety, dizziness, hunger, tachycardia, blurred vision, weakness/drowsiness, headache l, irritability, confusion, slurred speech

Question 2

Why can’t we take beta blockers for hypoglycemia

Answer 2

It decreases the responsiveness to hypoglycemia because it blocks the sympathetic warning symptoms

Question 3

Treatment of hypoglycemia

Answer 3

Start with 15 grams of fast acting carbon hydrate. Wait for 15 minutes then check blood sugar. If it is less than 70 then repeat with another round of 15 grams of fast acting carbohydrate. Follow this with a complex carbon hydrate or with a meal. Take 30 grams of complex carb if meal is more than an hour away

Question 4

Examples of 15 g of fast acting carb

Answer 4

4 ounces of orange juice, 5-6 lifesavers, 2 tsp of sugar(white or brown only), 6 ounces of cola, and 3 or 4 glucose tablets/gels

Question 5

Examples of complex carbohydrates

Answer 5

Granola bars, peanut butter sandwich, crackers with peanut butter or cheese

Question 6

Drugs to give level 2 or 3 hypoglycemic patients

Answer 6

3 mg of Baqsimi intranasal. 0.6 mg SQ dasiglucagon(zegalogue). 1mg SQ, IM, or IV gvoke hypopen or Glucapen

Question 7

List complications of insulin

Answer 7

Hypoglycemia, weight gain, lipohypertrophy, Lipoatrophy

Question 8

Advantages of short acting insulins

Answer 8

Decreases post prandial hyperglycemia. Has superior post prandial ability of reducing blood sugars. Has lesser nocturnal hypoglycemia. Fewer occurrence of hypoglycemia. Greater flexibility

Question 9

Disadvantages of short acting insulins

Answer 9

Risk of hypoglycemia if you don’t eat a meal within 15 minutes of dose. Need to combine with a longer acting insulin for optimal control of blood sugar . More expensive compared to regular insulins Hyperglycemia/ ketosis May occur rapidly if insulin delivery is interrupted. If you mix with another insulin you will need to give immediately

Question 10

Advantages of long acting insulins

Answer 10

Beneficial for patients who may be experiencing nocturnal hypoglycemia. Provides 24 hours coverage with no pronounced peak

Question 11

Disadvantages of long acting insulins

Answer 11

Increased breast, colon and pancreatic cancer in patients with glargine compared to the other types of insulins. Cannot be mixed with other insulins. More expensive compared to NPH

Question 12

What did the devote trial show

Answer 12

Glargine had a higher risk of non fatal MI and strokes compared to Degludec. Glargine had a higher risk of hypoglycemia compared to Degludec l

Question 13

Dosing principle of changing U-100 NPH to a long acting insulin U-100

Answer 13

The dose stays the same

Question 14

Dosing principle of changing U-100 BID NPH to U-100 long acting insulins

Answer 14

Decrease long acting insulin dose by 20%

Question 15

Dosing principles for U-100 to a more concentrated therapy for BID NPH to U-300 glargine

Answer 15

Reduce dose by 20 percent

Question 16

If you are changing from daily glargine to Toujeo how should you adjust the dose

Answer 16

The dose stays the same

Question 17

How do you adjust the dose of basal insulins(long acting) when you change them out o U-200 Degludec insulin

Answer 17

Keep the same dose

Question 18

How do you adjust the dose when you convert U-100 lispro to U-200 lispro

Answer 18

Keep the same dose

Question 19

If A1C is less than or equal to 8%, how should you adjust the dose when you change from U-100 basal-bolus to U-500

Answer 19

You use a 20% dosage reduction

Question 20

If A1C is greater than 8%, how would you adjust the dose when you go from a U-100 basal-bolus to a U-500

Answer 20

You do a 1:1 conversion and keep the same dose

Question 21

U-500 insulin BID schedule

Answer 21

60% breakfast and 40% lunch

Question 22

U-500 TID schedule

Answer 22

40% breakfast, 40% lunch and 20% dinner OR 40% breakfast, 30% lunch and 30% dinner

Question 23

How do you dose for T1DM who was recently diagnosed

Answer 23

0.1-0.4 units/kg/ day

Question 24

How do you dose for a regular T1DM

Answer 24

0.5 to 0.6 units/kg/day

Question 25

How do you adjust the prandial doses for insulin

Answer 25

Do 15 grams carbs for every 1 unit of insulin

Question 26

If a patient was to inject two daily NPH plus an additional bolus how should he divide it up

Answer 26

2/3 in the morning and 1/3 in the evening. With 2/3rd of each dose being NPH and 1/3rd of each dose being bolus insulin

Question 27

Starting dose for basal insulin for T2DM

Answer 27

0.1 to 0.2 units/kg/day. Or 10 units/ day