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PHR 938 Endocrine B1 > Insulin Initiation > Flashcards

Insulin Initiation Flashcards

1
Q

When should insulin therapy be initiated in patients with type 2 diabetes?

A

When A1C remains above target despite maximized oral therapy or injectable non-insulin therapies.

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2
Q

What is the starting dose of basal insulin in adults with type 2 diabetes?

A

Start with 10 units daily or 0.1-0.2 units/kg/day.

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3
Q

How often should basal insulin doses be titrated?

A

Adjust 2 units every 3 days to reach a fasting blood glucose (FBG) of 80-130 mg/dL.

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4
Q

What is the maximum recommended dose of basal insulin before adding prandial insulin?

A

0.5 units/kg/day.

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5
Q

What are the different types of insulin formulations used in type 2 diabetes management?

A

Basal insulin (long-acting, intermediate-acting), prandial insulin (rapid-acting), and mixed insulin formulations.

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6
Q

What are examples of basal insulins used in type 2 diabetes?

A

Glargine (Lantus®), Detemir (Levemir®), Degludec (Tresiba®), and NPH (Humulin N®).

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7
Q

What are examples of rapid-acting insulins used for prandial dosing?

A

Aspart (Novolog®), Lispro (Humalog®), and Glulisine (Apidra®).

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8
Q

What is the role of fixed-ratio combination (FRC) therapies in insulin management?

A

FRCs combine basal insulin with GLP-1 receptor agonists, such as Xultophy® and Soliqua®.

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9
Q

What are important factors to consider when administering insulin via pen or syringe?

A

Priming the pen, holding the pen for 5 seconds after injection, and rotating injection sites to prevent lipodystrophy.

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10
Q

Why should patients rotate insulin injection sites?

A

To avoid lipodystrophy and ensure consistent insulin absorption.

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11
Q

What is the ‘Rule of 5 Mississippis’ when injecting insulin?

A

Hold the pen for 5 seconds after injection to ensure full dose delivery.

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12
Q

When should prandial insulin be initiated?

A

When A1C remains above target with basal insulin or fasting glucose is on target but postprandial glucose is high.

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13
Q

What is the initial prandial insulin dose?

A

4 units before the largest meal or 10% of basal insulin dose.

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14
Q

How is prandial insulin titrated?

A

Increase by 1-2 units or 10-15% of the dose twice weekly based on SMBG.

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15
Q

What insulin therapy was initiated for Jane, a type 2 diabetes patient with A1C >9%?

A

Insulin glargine (Basaglar®) 10 units once daily, adjusted by 2 units every 3 days.

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16
Q

How was Jane’s prandial insulin introduced?

A

Lispro 4 units before supper, with a 2-unit reduction in her basal insulin dose.

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17
Q

How often should Jane follow up after starting insulin?

A

Follow up weekly for dose adjustments and every 3 months for A1C monitoring.

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18
Q

What is the first step in managing hypoglycemia in patients on insulin?

A

Identify the cause, such as missed meals, dosing errors, or excessive exercise.

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19
Q

What is the Rule of 15 for treating hypoglycemia?

A

Consume 15 grams of fast-acting carbohydrate, check glucose after 15 minutes, and repeat if needed.

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20
Q

What are some carbohydrate options for treating hypoglycemia?

A

Glucose tablets, fruit juice, regular soda, or hard candies.

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21
Q

How should insulin be adjusted if hypoglycemia occurs without a clear cause?

A

Reduce the insulin dose by 10-20%.

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22
Q

When should insulin doses be adjusted more frequently?

A

When patients are self-titrating or experiencing significant glucose fluctuations.

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23
Q

Which patients benefit from concentrated insulin formulations?

A

Patients requiring large doses of insulin, such as those taking >100 units/day.

24
Q

What are examples of concentrated insulins?

A

U-200 insulin degludec (Tresiba®), U-300 insulin glargine (Toujeo®), and U-500 regular insulin.

25
Q

What are the advantages of using long-acting insulins like glargine and detemir?

A

Fewer injections, reduced risk of hypoglycemia, and consistent 24-hour coverage.

26
Q

What should be considered when switching patients to a concentrated insulin formulation?

A

Dosing adjustments, patient education, and proper injection technique.

27
Q

How often should insulin titration be done in patients self-managing their doses?

A

Every 3-7 days depending on blood glucose patterns.

28
Q

What factors should be considered when adjusting insulin doses?

A

Diet, physical activity, stress levels, and any other medications.

29
Q

What is the recommended approach for adjusting insulin during illness or infection?

A

Increase insulin dose as needed since illness can cause insulin resistance.

30
Q

What insulin regimens are recommended for hospitalized patients with type 2 diabetes?

A

Basal-bolus regimens are preferred over sliding-scale insulin alone.

31
Q

How should insulin therapy be adjusted for patients undergoing surgery?

A

Basal insulin should be continued, while prandial insulin may be held based on the patient’s ability to eat.

32
Q

What is lipohypertrophy and how can it be prevented?

A

It is the buildup of fat under the skin from repeated injections in the same site. Rotate injection sites to prevent it.

33
Q

What are common signs of insulin allergies?

A

Localized itching, swelling, and redness at the injection site.

34
Q

What is insulin resistance?

A

A condition where the body’s cells do not respond properly to insulin, requiring higher doses for glucose control.

35
Q

How should insulin therapy be managed in elderly patients?

A

Start with lower doses to reduce the risk of hypoglycemia and adjust based on renal function.

36
Q

What is the main concern with insulin use in patients with kidney disease?

A

Reduced renal clearance may lead to prolonged insulin action and increased hypoglycemia risk.

37
Q

How should insulin therapy be adjusted in patients with liver disease?

A

Insulin doses may need to be reduced due to impaired hepatic glucose production.

38
Q

What should be done if postprandial glucose levels are consistently elevated?

A

Increase prandial insulin by 1-2 units or 10-15% of the dose.

39
Q

How should insulin be adjusted for patients with high fasting glucose levels?

A

Increase basal insulin by 2 units every 3 days until fasting glucose is within the target range.

40
Q

What is the advantage of U-500 insulin for patients requiring large insulin doses?

A

It allows for fewer injections and smaller injection volumes for patients needing >200 units/day.

41
Q

When should U-500 insulin be considered?

A

For patients with severe insulin resistance who require large daily doses of insulin.

42
Q

What is the benefit of using premixed insulin regimens?

A

Convenience of fewer injections while providing both basal and prandial coverage.

43
Q

What are examples of premixed insulin formulations?

A

70/30 (70% NPH, 30% regular), 75/25 (75% insulin lispro protamine, 25% insulin lispro).

44
Q

What are the goals of prandial insulin therapy?

A

To manage postprandial glucose spikes and prevent post-meal hyperglycemia.

45
Q

What should be considered when adjusting prandial insulin doses?

A

The carbohydrate content of meals, physical activity, and current blood glucose levels.

46
Q

How is prandial insulin typically initiated?

A

Start with 4 units before the largest meal, and titrate based on glucose response.

47
Q

What are the benefits of using insulin pens over syringes?

A

Improved convenience, more accurate dosing, and reduced risk of errors.

48
Q

What is the proper technique for using an insulin pen?

A

Prime the pen with 2 units, inject at a 90-degree angle, and hold for 5 seconds after injection.

49
Q

How should insulin pens be stored?

A

Unopened pens should be refrigerated, while opened pens can be stored at room temperature.

50
Q

What are key points to cover during insulin initiation counseling?

A

Proper injection technique, rotating injection sites, and recognizing signs of hypoglycemia.

51
Q

How can patients reduce the risk of hypoglycemia when starting insulin?

A

Monitor blood glucose regularly, adjust insulin doses carefully, and avoid skipping meals.

52
Q

What is the importance of self-monitoring of blood glucose (SMBG) for insulin-treated patients?

A

It helps in dose adjustment and provides feedback on how insulin and lifestyle factors affect glucose levels.

53
Q

What is the role of combining basal insulin with GLP-1 receptor agonists?

A

It provides better glucose control with less risk of hypoglycemia and weight gain.

54
Q

How can insulin be combined with oral antidiabetic medications?

A

Insulin can be added to metformin or SGLT2 inhibitors for enhanced glucose control.

55
Q

What is the impact of using continuous glucose monitoring (CGM) in insulin-treated patients?

A

CGM improves glycemic outcomes by providing real-time glucose data and trends, helping to optimize insulin dosing.

56
Q

How should insulin therapy be managed during periods of increased physical activity?

A

Reduce prandial insulin doses or consume additional carbohydrates before exercise to prevent hypoglycemia.

PHR 938 Endocrine B1 (13 decks)

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