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Summer pharm exam 2 > Insulin management > Flashcards

Insulin management Flashcards

1
Q

What meds lower A1c the most

A

Metformin: 1.5-2%
GLP: 0.9-1.1%
SGLT2: 0.91-1.16%

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2
Q

Insulin is considered an

A

anabolic steroid- causes weight gain

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3
Q

What is your insulin starting point for T1DM

A

Basal-Bolus insulin (basal for fasting, bolus for mealtime)
+/- mealtime pramlintide w/ uncontrolled postprandial glycemia
+.- metformin, GLP1, or SGLT2

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4
Q

What is your insulin starting point for T2DM

A

Basal insulin + Metformin (+/- GLP-1)

Add bolus insulin if A1c target nt met and BG still increasing

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5
Q

What are the different insulins (time onset and by name)

A

Rapid (bolus): Humalog (lispro), Novolog (aspart), Apidra (glulisine)
Short (bolus): Humilin R, Novolin R
Intermediate (basal-NPH): Humilin N, Novolin N, Novolin 70/30
Long (basal): Lantus (glargine), Levemir (detemir), Tresiba (degludec)

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6
Q

When do you take different insulins

A

Rapid acting: Before each meal
Short acting: Before breakfast (also covers lunch), before dinner
Intermediate: AM and PM, or AM and evening meal
Long: once daily (HS)

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7
Q

What are common premixed insulin/GLP

A

Decludec/Liraglutide

Glargine/Lixisenatide

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8
Q

How should you store insulin

A

Open vials at room temp, discard opened vials after recommended interval
Unopened vials, refrigerate 36-46 F (expiration date still applies)
Durable pens and dosing devices: do NOT refrigerate after open

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9
Q

In T2DM, if A1c is not met and blood sugar is still rising, consider

A

Dosing insulin for basal and bolus coverage

start bolus with 1, 2, or 3 meals a day

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10
Q

Hyperglycemia can be due to

A

too little insulin

rebound from low glucose and over treatment with excess carbs

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11
Q

Where should all insulin injections be taken

A

in the abdomen- most consistent absorption

If unwilling to follow, do systemic site rotation BUT- always give insulin injection in same region at same time of day

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12
Q

If you are concerned about the patient not being able to afford their insulin, which should you prescribe

A

Traditional insulins- NPH (intermediate) and R (short)

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13
Q

What is TDD (total daily dose)

A

A way to calculate the total amount of insulin a patient needs per day

  1. 4 units/kg in normal patients
  2. 5 units/kg in overweight
    alternate: weight in lbs/4
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14
Q

PEARLS on how many carbs insulin covers

A

1 unit of insulin covers appx 15g carbs

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15
Q

PEARLS on how much insulin lowers blood glucose

A

T1DM: 1 unit lowers BG 50 mg
T2DM: 1 unit lowers BG 30 mg

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16
Q

What is “background” or “basal” insulin replacement

A

replacing insulin overnight when you are fasting between meals (40-50% of TDD)

17
Q

What is the “bolus insulin replacement”

A

The remaining 50-60% of TDD of insulin should be given to cover carbs and high blood sugar correction

18
Q

What is ideal basal:bolus ration

A

50:50
If it is not close to this, reassess
*Basal is further broken down into biggest dose (20%) at Bfast, then 15% at lunch and dinner

19
Q

How can you instruct a patient to titrate insulin

A

increase LONG acting 1 unit each day until FBS is 80-120
OR
increase LONG acting 1 unit q2-3 days until FBS is 80-120

20
Q

How can you tell a patient to relieve Sx of hypoglycemia

A

Eat 15 g of glucose (carbs)
Recheck your BG after 15 minutes
If still hypoglycemia, repeat until your BG normalizes
-If your next meal is >2 hrs away, eat a small snack after your blood glucose is normalized

21
Q

What are examples of “15g” of carbs

A 
glucose tablets, gel tube 
2 tbsp raisins 
4 oz (1/2 cup) of juice/regular soda (not diet) 
1 tbsp sugar, honey, or corn syrup 
8oz nonfat or 1% milk 
hard candies, jelly beans, gumdrops
22
Q

What are good resources for diet planning

A

ChooseMyPlate.gov

Carb Counting book

23
Q

What should bolus insulin be based on

A

amount of carbs to be consumed

-Pts can self adjust their dose of bolus insulin based on what they’ll be eating (insulin:carb ratio)

24
Q

Per her ppt (not her PEARLS), how do we calculate how many carbs insulin covers

A

500/TDD
If TDD is 76 units insulin, 500/76= 7g
1 unit insulin covers 7g carbs (but you should round to like 10)
Insulin:Carb= 1:10

25
Q

What is Correction Factor

A

The glucose lowering effect of 1 unit of rapid acting insulin
1700/TDD
so if TDD is 76 units, 1700/76= 22, round to 25
Each unit of insulin will lower BG 25mg
(for short acting insulin use 1500)

26
Q

What is the “rule of 1800”

A

The “insulin sensitivity factor” which basically uses 1800 as the correction factor number instead of 1500 or 1700??

27
Q

How do you calculate correction dose

A

Actual BG before meal (-) target BG (/) correction factor

Ex: 220 - 110 / 25 = appx 4 units

28
Q

How do you calculate total mealtime dose

A

CHO insulin dose (rule of 500) + high BG correction dose= total meal insulin dose
7 units + 4 units= 11 units of insulin should be given for this meal

29
Q

How should you instruct a patient to take NPH and Rapid acting dosing

A

Calculate TDD- give 2/3 in the morning (2/3 NPH, remainder R) and the 1/3 in the evening (2/3 NPH, remainder R)
Give 30 min before eating

30
Q

When making adjustments, which lab values do you fix first

A

Fix FBS first, then fix post prandial blood sugar

because, FBG represents the insulin given the night before!

31
Q

What is sliding scale insulin

A

You adjust the dose of insulin based on the normal amount of CHO the patient eats

32
Q

What is a relative contraindication to insulin therapy

A

Hypoglycemic unawareness- autonomic neuropathy or frequent episodes of hypoglycemia make it hard for the pt to recognize he is hypoglycemic

33
Q

What is asymptomatic erratic gastric emptying

A

a d/o that severely hinders the ability to match insulin to meals- must do gastric emptying study

34
Q

What effect does exercise have on BG

A

it can continue to lower BG for 6-8 hrs

so, tell pt to work out at a consistent time each day and avoid late night exercise until insulin doses are stable

35
Q

How does a patient adjust when they are sick

A

Kcal intake usually decreases, as well as insulin sensitivity= It takes more insulin to control BG
Try to maintain 120-150g CHO per day, and SBGM more frequently
Also test for ketones!

36
Q

What happens to insulin therapy after an islet cell or whole pancreas transplant

A

They usually can stop insulin

But, w/in 2 years of transplant they usually start some form of insulin therapy again

Summer pharm exam 2 (6 decks)

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