Insulin Initiation Flashcards
When should insulin therapy be initiated in patients with type 2 diabetes?
When A1C remains above target despite maximized oral therapy or injectable non-insulin therapies.
What is the starting dose of basal insulin in adults with type 2 diabetes?
Start with 10 units daily or 0.1-0.2 units/kg/day.
How often should basal insulin doses be titrated?
Adjust 2 units every 3 days to reach a fasting blood glucose (FBG) of 80-130 mg/dL.
What is the maximum recommended dose of basal insulin before adding prandial insulin?
0.5 units/kg/day.
What are the different types of insulin formulations used in type 2 diabetes management?
Basal insulin (long-acting, intermediate-acting), prandial insulin (rapid-acting), and mixed insulin formulations.
What are examples of basal insulins used in type 2 diabetes?
Glargine (Lantus®), Detemir (Levemir®), Degludec (Tresiba®), and NPH (Humulin N®).
What are examples of rapid-acting insulins used for prandial dosing?
Aspart (Novolog®), Lispro (Humalog®), and Glulisine (Apidra®).
What is the role of fixed-ratio combination (FRC) therapies in insulin management?
FRCs combine basal insulin with GLP-1 receptor agonists, such as Xultophy® and Soliqua®.
What are important factors to consider when administering insulin via pen or syringe?
Priming the pen, holding the pen for 5 seconds after injection, and rotating injection sites to prevent lipodystrophy.
Why should patients rotate insulin injection sites?
To avoid lipodystrophy and ensure consistent insulin absorption.
What is the ‘Rule of 5 Mississippis’ when injecting insulin?
Hold the pen for 5 seconds after injection to ensure full dose delivery.
When should prandial insulin be initiated?
When A1C remains above target with basal insulin or fasting glucose is on target but postprandial glucose is high.
What is the initial prandial insulin dose?
4 units before the largest meal or 10% of basal insulin dose.
How is prandial insulin titrated?
Increase by 1-2 units or 10-15% of the dose twice weekly based on SMBG.
What insulin therapy was initiated for Jane, a type 2 diabetes patient with A1C >9%?
Insulin glargine (Basaglar®) 10 units once daily, adjusted by 2 units every 3 days.
How was Jane’s prandial insulin introduced?
Lispro 4 units before supper, with a 2-unit reduction in her basal insulin dose.
How often should Jane follow up after starting insulin?
Follow up weekly for dose adjustments and every 3 months for A1C monitoring.
What is the first step in managing hypoglycemia in patients on insulin?
Identify the cause, such as missed meals, dosing errors, or excessive exercise.
What is the Rule of 15 for treating hypoglycemia?
Consume 15 grams of fast-acting carbohydrate, check glucose after 15 minutes, and repeat if needed.
What are some carbohydrate options for treating hypoglycemia?
Glucose tablets, fruit juice, regular soda, or hard candies.
How should insulin be adjusted if hypoglycemia occurs without a clear cause?
Reduce the insulin dose by 10-20%.
When should insulin doses be adjusted more frequently?
When patients are self-titrating or experiencing significant glucose fluctuations.
Which patients benefit from concentrated insulin formulations?
Patients requiring large doses of insulin, such as those taking >100 units/day.
What are examples of concentrated insulins?
U-200 insulin degludec (Tresiba®), U-300 insulin glargine (Toujeo®), and U-500 regular insulin.
What are the advantages of using long-acting insulins like glargine and detemir?
Fewer injections, reduced risk of hypoglycemia, and consistent 24-hour coverage.
What should be considered when switching patients to a concentrated insulin formulation?
Dosing adjustments, patient education, and proper injection technique.
How often should insulin titration be done in patients self-managing their doses?
Every 3-7 days depending on blood glucose patterns.
What factors should be considered when adjusting insulin doses?
Diet, physical activity, stress levels, and any other medications.
What is the recommended approach for adjusting insulin during illness or infection?
Increase insulin dose as needed since illness can cause insulin resistance.
What insulin regimens are recommended for hospitalized patients with type 2 diabetes?
Basal-bolus regimens are preferred over sliding-scale insulin alone.
How should insulin therapy be adjusted for patients undergoing surgery?
Basal insulin should be continued, while prandial insulin may be held based on the patient’s ability to eat.
What is lipohypertrophy and how can it be prevented?
It is the buildup of fat under the skin from repeated injections in the same site. Rotate injection sites to prevent it.
What are common signs of insulin allergies?
Localized itching, swelling, and redness at the injection site.
What is insulin resistance?
A condition where the body’s cells do not respond properly to insulin, requiring higher doses for glucose control.
How should insulin therapy be managed in elderly patients?
Start with lower doses to reduce the risk of hypoglycemia and adjust based on renal function.
What is the main concern with insulin use in patients with kidney disease?
Reduced renal clearance may lead to prolonged insulin action and increased hypoglycemia risk.
How should insulin therapy be adjusted in patients with liver disease?
Insulin doses may need to be reduced due to impaired hepatic glucose production.
What should be done if postprandial glucose levels are consistently elevated?
Increase prandial insulin by 1-2 units or 10-15% of the dose.
How should insulin be adjusted for patients with high fasting glucose levels?
Increase basal insulin by 2 units every 3 days until fasting glucose is within the target range.
What is the advantage of U-500 insulin for patients requiring large insulin doses?
It allows for fewer injections and smaller injection volumes for patients needing >200 units/day.
When should U-500 insulin be considered?
For patients with severe insulin resistance who require large daily doses of insulin.
What is the benefit of using premixed insulin regimens?
Convenience of fewer injections while providing both basal and prandial coverage.
What are examples of premixed insulin formulations?
70/30 (70% NPH, 30% regular), 75/25 (75% insulin lispro protamine, 25% insulin lispro).
What are the goals of prandial insulin therapy?
To manage postprandial glucose spikes and prevent post-meal hyperglycemia.
What should be considered when adjusting prandial insulin doses?
The carbohydrate content of meals, physical activity, and current blood glucose levels.
How is prandial insulin typically initiated?
Start with 4 units before the largest meal, and titrate based on glucose response.
What are the benefits of using insulin pens over syringes?
Improved convenience, more accurate dosing, and reduced risk of errors.
What is the proper technique for using an insulin pen?
Prime the pen with 2 units, inject at a 90-degree angle, and hold for 5 seconds after injection.
How should insulin pens be stored?
Unopened pens should be refrigerated, while opened pens can be stored at room temperature.
What are key points to cover during insulin initiation counseling?
Proper injection technique, rotating injection sites, and recognizing signs of hypoglycemia.
How can patients reduce the risk of hypoglycemia when starting insulin?
Monitor blood glucose regularly, adjust insulin doses carefully, and avoid skipping meals.
What is the importance of self-monitoring of blood glucose (SMBG) for insulin-treated patients?
It helps in dose adjustment and provides feedback on how insulin and lifestyle factors affect glucose levels.
What is the role of combining basal insulin with GLP-1 receptor agonists?
It provides better glucose control with less risk of hypoglycemia and weight gain.
How can insulin be combined with oral antidiabetic medications?
Insulin can be added to metformin or SGLT2 inhibitors for enhanced glucose control.
What is the impact of using continuous glucose monitoring (CGM) in insulin-treated patients?
CGM improves glycemic outcomes by providing real-time glucose data and trends, helping to optimize insulin dosing.
How should insulin therapy be managed during periods of increased physical activity?
Reduce prandial insulin doses or consume additional carbohydrates before exercise to prevent hypoglycemia.
