Insulin Needles + Continuous/flash monitoring Flashcards
What was the outcome of optimizing insulin injection technique and its effect on BG control study? A1C? FBG? TDD?
As effective as which drug?
A1C lowering of 0.58%
FBG lowered by 0.77 mmol/L
TDD lowered by 2 units
- almost as effective as a DPP-IV inhibitor
How often should you be checking their injection technique?
chronically checking
T/F insulin therapy causes complications such as blindness, amputations, or the need for dialysis
False
How long should make sure patients are consistently testing blood sugars before initiating insulin?
One month
What questions are important to ask a patient before counselling
Prime questions
HAMS
Patient’s understanding of insulin
Define trypanophobia
Extreme fear of needles/pointed objects, or fear of any type of injection
What does a true phobia of needles consist of?
A vasovagal response
- increase in HR and BP followed by a rapid drop
- rare but exists
What are the 4 types of phobias? Explain them
Associative phobia
- eg. knowing someone who had a bad experience
Resistant phobia
- history of being held down or forced to get injections
Hyperalgesia
- Extreme pain with injection
Vicarious phobia
- just seeing the needles
What are strategies for:
Resistant phobia
Hyperalgesia phobia
Vicarious phobia
Resistant phobia
- let patients self-inject and gain control
Hyperalgesia phobia
- use EMLA cream or topical lidocaine to help numb the area
Vicarious phobia
- use small needles
- use injection tools that can shield needle from view
Define gauge
Diameter or thickness of the needle
What is the trend of increasing gauge #
Thinner/thicker needle
the thinner the needle
If you are administer larger insulin doses, do you need a small or larger gauge needle
Need a smaller gauge.
- thicker needle to allow for a larger volume of insulin
What is the common length of needles used in most body types for insulin?
4-5mm
What is the average human skin thickness?
2mm
Can we accommodate a 4mm length to reach SC tissue without penetrating muscle tissue?
Or do we need to pinch
We can accomodate
Which is more painful, BG testing with lancets OR injections using 4-5mm needles? Why?
BG testing with lancets are more painful
- longer than 4-5mm
What is a good point to tell patients to reduce their fears on needles
Fine needles are the width of 2 human hairs
Why are needles only for one-time use? If patient’s cannot afford and need to re-use, what is the max?
They are coated with a one-time SILICONE LUBRICANT for smoother insertion
Money problems
- use only 3x
Most needles have universality with pens and a “screw-on thread type” except which needle? Which pens can they be used on and what type are the needles?
NOVOTWIST needles
- “twist & click”
only on Novo Nordisk pens
What is the thin-walled technology of needles allow for?
- less thumb force
- less painful injections
- easier to insert
- can give full dose in less time
- allows for 31% higher insulin flow
What is the use of bevel shaped needles? Which pen needles have 5 vs standard 3
Increased # of bevels = more easily enter into skin and reduce pain for patients
BD pen needles
What are most needle compositions made of?
Nickel covered in silicone
What do flat injection base needle allow for? How to minimize bruising here?
Allows for more comfortable injection
- to minimize bruising: do not push the top “hub” into the injection site
What is most likely the cause of insulin allergies? Which insulins don’t have this?
Preservatives (cresol and metacresol)
- GLP-1 agonists don’t have this
Which pen is easier to push the button for patients with arthritis?
Novo Naordisk Flextouch
Which refillable pen has the most features such as a memory function and half unit dosing?
Eli lilly
- HumaPen Memoir/Novo Nordisk Echo
What type of pen is ozempic?
Disposable pen + attachable needle device
Where should insulin be stored?
If not used = in fridge 2-8 degrees
If using
- can leave room temp for approx 1 month for less painful injections (depends on insulin type)
Which part of the needle cap do you save for safe needle disposal
Big outer needle cap
How often do you prime an insulin pen? GLP-1 agonist?
Insulin pen
- prior to each insulin dose
GLP-1 agonist
- only prime with opening the box first-time
What kind of delivery system is a pen?
Hydraulic delivery system
Why is holding the pen 6-10 seconds vital?
Injection process is much slower with a pen
- guaranteed to under-dose themselves
- pressing the plunger only begins the delivery
How to prime NPH or mixed insulins
Suspensions - need to mix it
- roll 10x and tip 10x and check for consistent and milky appearance
If the insulin is a solution, what should you check for?
Clear and colourless
What does it mean when the display stops at a certain number
Cartridge coming to an end
When should you split insulin doses? Why? (5)
Dose of 50 units+
- larger doses may delay absorption
- better BG control
- easier use of pen
- less irritation with injection
- less force required
Can use the same needle for the 2 injections
Which injection sites have the slowest absorption?
Buttocks and outer thighs
If patients do get bruising and bleeding in the injection site, what is it associated with?
Injection technique
NOT needle length or injection site
T/F you need to clean sites with alcohol wipes or swabs
False
- makes it more painful
What is the preferred area of injection for pregnant women?
Abdomen
Define lipohypertrophy
a thickened area of tissue that can grow and develop over time where REPEATED injections of insulin are given
What are consequences of lipohypertrophy? (3)
- associated with repeated unexplained hypoglycemia
- reduce absorption of insulin by 40%
- Use more insulin units
When do you give glucagon
- the patient is unconscious
- the patient is unable to orally take sugar
- patient is having a seizure
- repeated oral sugar not working
What does the glucagon injection contain?
un-reconstituted glucagon powder and syringe
- need to mix content before giving
Glucagon nasal spray
can use if patient has cold?
Can you give a second spray?
Can use if patient has cold?
- Yes
Can you give a second spray?
- Yes
What are the 2 types of continuous glucose monitoring systems
Real time (personal)
- provides BG info directly to user
- has alarm notifications
Blinded (professional)
- does not display BG readings
- downloaded onto computer for analysis with HCP
What are benefits of CGM
- increased glucose testing
- A1C reduction
- less variability in glycemic levels
- more confidence to prevent hypoglycemia
- less time in hypoglycemia
- increased patient engagement and QOL
How often are glucose data transmitted in Dexcom G7?
Is it in real-time?
every 5 minutes
Real-time
Define flash BG monitoring.
real time?
Patient must scan the sensor in order to “pull” data forward to be seen
- not in real time, 10-15 minute delay
Who should NOT use freestyle libre? (5)
- critically ill patients (may be inaccurate)
- Pregnant women
- dialysis patients
- patients on pacemakers
- Severe deyhdration or excessive water loss during times of illness (do CBGM)
What are interfering substances to freestyle libre? how does it effect BG reading? (2)
- Ascorbic avid
- falsely elevate it - Salicylic acid
- may slightly lower it
- ASA 81mg is OK
Can you wear the libre during MRI and CT
No
How often do the libre sensors measure BG readings and store it?
What happens when it is scanned?
Sensor measures glucose levels every minute
- stores readings every 15 minutes
When you scan
- transmits data from the last minute, even if that data has not yet been stored
Where can the sensors be placed
ONLY on back of arm
What to do if you perform intense exercise and sensor loosens due to sweat?
Can use
- tegaderm
- skintac
- large bandaids
Does NOT affect accuracy
How long does the sensor have the memory ability for?
can show results for the past 8 hours
What do you have to do in the first 24 hours of the sensor?
Tends to run lower
- need to perform CBGM as needed
What does the arrow in the top right of the meter tell you?
The direction of where your BG levels are going
What does it mean when LO & HI appear on the meter?
LO
- <2.2 mmol/L
HI
- over 27 mmol/L
What does the freestyle libre ambulatory glucose profile AGP display?
Collapses data from several days/weeks as if they occurred in a 24 hour period
- good to see data as they will see info that they have never seen before
What does the glucose management indicator tell you on the meter?
Approx what the patient’s A1C level is likely to be
What is the acronym for reviewing the CGM data?
DATAA
D download the data
A Assess safety
T time in range
A areas for improvement
A action plan
