Insulin delivery devices and use

Question 1

How are disposable insulin syringes chosen?

Answer 1

According to dose of insulin that needs to be injected

0.25 mL for doses <25 units, 0.3 mL for doses <30 units, 0.5 mL for doses <50 units and 1 mL for doses 50-100 units

Question 2

True or false: A “short needle” (6-8 mm is appropriate for all pt’s with DM regardless of BMI

Answer 2

True

Question 3

True or false: In most situations, pt’s with DM may safely reuse syringes and needles during a single day

Answer 3

True; however, reuse may carry increased risk of infection for some pt’s

Advise those who choose to reuse that markings on syringe may rub off and needle becomes dull w/ repeated use

Question 4

Sharps containers that are ____ full should be closed and discarded according to community guidelines

Answer 4

three quarters

Question 5

Insulin pump therapy is is a continuous basal amount of insulin usually given at ___ to ___ units per hour administered in addition to bolus doses given prior to meals

Answer 5

0.5-1.0 units per hours

Question 6

What is a jet injector?

Answer 6

Needle free system that delivers insulin transcutaneously; they release a fine stream of insulin at high speed under high pressure to penetrate skin

Question 7

What are the downsides to a jet injector?

Answer 7

expense, injection site pain, and required weekly maintainance

Question 8

What is a pen device for insulin delivery?

Answer 8

Combine insulin container and syringe into single modular unit that allows for convenient insulin delivery

pens are available for almost all branded insulin products in a variety of types and styles. They are either reusable or prefilled, and both types hold cartridges of insulin

Question 9

Where should unopended insulin be stored?

Answer 9

In the refrigerator

Question 10

In general, in use insulin pens and vials may be stored at room temp for up to ____

Answer 10

28 days; however, providers should check specific product labeling

Question 11

True or false: Afreeza adversely affects lung function

Answer 11

True; contains black box warning of acute bronchospasm in pt’s with DM w/ asthma and COPD. Need for ongoing spirometry and concerns about adverse lung function limits acceptance of inhaled insulin

Question 12

Which test is useful to determine endogenous insulin production and type of DM?

Answer 12

C peptide levels

Question 13

what is C peptide?

Answer 13

A substance made in the pancreas, along with insulin

Question 14

Why is the initial measurement of c peptide useful?

Answer 14

To confirm dx of DM in person w/out a clear presentation and when absolute need for exogenous insulin is uncertain

Question 15

What are common causes of hypoglycemia for pt’s who use insulin?

Answer 15

Excessive dose, delayed, missed, or insufficient food intake, too much unplanned physical activity

Question 16

How is hypertrophy best prevented in patients that take insulin?

Answer 16

rotating injection sites

Question 17

What should be done if a systemic reaction occurs to insulin?

Answer 17

Attending MD should be encouraged to contact insulin manufacturer for desensitization kit and procedure to follow

Question 18

True or false: As a general rule, both insulin products to be mixed should be of the same brand

Answer 18

True

Question 19

When mixing insulin, which type of insulin is usually drawn up first?

Answer 19

Rapid acting/regular followed by intermediate (limits potential for contamination, which may result in dose variance)

Question 20

Manually prefilled syringes of either single formulations or mixtures of insulins are to be refrigerated and used within how many days?

Answer 20

21 to 30

Question 21

Where may insulin be injected?

Answer 21

Subq tissue of upper arm, anterior and lateral aspect of the thigh, buttocks, and abdomen (with exception of 2 in inch radius around the navel)

Question 22

When taking insulin, pt’s with DM should be instructed to count to what to ensure adequate insulin absorption/distribution under the skin?

Answer 22

5 (low dose)

10 (high doses)

Question 23

Due to an acidic pH, which insulin may cause a mild burning when injected?

Answer 23

Glargine

Other insulin products retain a normal pH in solution

Question 24

True or false: Rotating injection sites w/in a single area is not recommended

Answer 24

false; rotating w/in a single area is recommended rather than rotating to different area to decrease variability in absorption from day to day

Question 25

Which techniques/situations may induce most rapid absorption of insulin?

Answer 25

Abd injection (not as much with glargine), deeper IM injection, exercise or massage of injection site

Question 26

Per the ADA, what is the definition of severe hypoglycemia?

Answer 26

NOT a number; characterized by inability to self treat d/t mental confusion/lethargy/unconsciousness

Question 27

Per the ADA, what is documented symptomatic hypoglycemia?

Answer 27

BG <70 w/ symptoms such as sweating, trembling, difficulty concentrating, lightheadedness, lack of coordination

usually alleviated quickly by drinking beverages or foods with CHO

Question 28

Per the ADA, what is the definition of documented asymptomatic hypoglycemia?

Answer 28

BG <70 without symptoms