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Pharm 229 Professional practice 4 Midterm > Insulin Needles + Continuous/flash monitoring > Flashcards

Insulin Needles + Continuous/flash monitoring Flashcards

1
Q

What was the outcome of optimizing insulin injection technique and its effect on BG control study? A1C? FBG? TDD?
As effective as which drug?

A

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

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2
Q

How often should you be checking their injection technique?

A

chronically checking

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3
Q

T/F insulin therapy causes complications such as blindness, amputations, or the need for dialysis

A

False

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4
Q

How long should make sure patients are consistently testing blood sugars before initiating insulin?

A

One month

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5
Q

What questions are important to ask a patient before counselling

A

Prime questions
HAMS
Patient’s understanding of insulin

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6
Q

Define trypanophobia

A

Extreme fear of needles/pointed objects, or fear of any type of injection

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7
Q

What does a true phobia of needles consist of?

A

A vasovagal response
- increase in HR and BP followed by a rapid drop
- rare but exists

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8
Q

What are the 4 types of phobias? Explain them

A

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

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9
Q

What are strategies for:
Resistant phobia
Hyperalgesia phobia
Vicarious phobia

A

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

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10
Q

Define gauge

A

Diameter or thickness of the needle

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11
Q

What is the trend of increasing gauge #
Thinner/thicker needle

A

the thinner the needle

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12
Q

If you are administer larger insulin doses, do you need a small or larger gauge needle

A

Need a smaller gauge.
- thicker needle to allow for a larger volume of insulin

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13
Q

What is the common length of needles used in most body types for insulin?

A

4-5mm

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14
Q

What is the average human skin thickness?

A

2mm

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15
Q

Can we accommodate a 4mm length to reach SC tissue without penetrating muscle tissue?
Or do we need to pinch

A

We can accomodate

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16
Q

Which is more painful, BG testing with lancets OR injections using 4-5mm needles? Why?

A

BG testing with lancets are more painful
- longer than 4-5mm

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17
Q

What is a good point to tell patients to reduce their fears on needles

A

Fine needles are the width of 2 human hairs

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18
Q

Why are needles only for one-time use? If patient’s cannot afford and need to re-use, what is the max?

A

They are coated with a one-time SILICONE LUBRICANT for smoother insertion

Money problems
- use only 3x

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19
Q

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?

A

NOVOTWIST needles
- “twist & click”

only on Novo Nordisk pens

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20
Q

What is the thin-walled technology of needles allow for?

A
  • less thumb force
  • less painful injections
  • easier to insert
  • can give full dose in less time
  • allows for 31% higher insulin flow
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21
Q

What is the use of bevel shaped needles? Which pen needles have 5 vs standard 3

A

Increased # of bevels = more easily enter into skin and reduce pain for patients

BD pen needles

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22
Q

What are most needle compositions made of?

A

Nickel covered in silicone

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22
Q

What do flat injection base needle allow for? How to minimize bruising here?

A

Allows for more comfortable injection
- to minimize bruising: do not push the top “hub” into the injection site

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23
Q

What is most likely the cause of insulin allergies? Which insulins don’t have this?

A

Preservatives (cresol and metacresol)
- GLP-1 agonists don’t have this

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24
Q

Which pen is easier to push the button for patients with arthritis?

A

Novo Naordisk Flextouch

25
Q

Which refillable pen has the most features such as a memory function and half unit dosing?

A

Eli lilly
- HumaPen Memoir/Novo Nordisk Echo

26
Q

What type of pen is ozempic?

A

Disposable pen + attachable needle device

27
Q

Where should insulin be stored?

A

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)

28
Q

Which part of the needle cap do you save for safe needle disposal

A

Big outer needle cap

29
Q

How often do you prime an insulin pen? GLP-1 agonist?

A

Insulin pen
- prior to each insulin dose

GLP-1 agonist
- only prime with opening the box first-time

30
Q

What kind of delivery system is a pen?

A

Hydraulic delivery system

31
Q

Why is holding the pen 6-10 seconds vital?

A

Injection process is much slower with a pen
- guaranteed to under-dose themselves
- pressing the plunger only begins the delivery

32
Q

How to prime NPH or mixed insulins

A

Suspensions - need to mix it
- roll 10x and tip 10x and check for consistent and milky appearance

33
Q

If the insulin is a solution, what should you check for?

A

Clear and colourless

34
Q

What does it mean when the display stops at a certain number

A

Cartridge coming to an end

35
Q

When should you split insulin doses? Why? (5)

A

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

36
Q

Which injection sites have the slowest absorption?

A

Buttocks and outer thighs

37
Q

If patients do get bruising and bleeding in the injection site, what is it associated with?

A

Injection technique
NOT needle length or injection site

38
Q

T/F you need to clean sites with alcohol wipes or swabs

A

False
- makes it more painful

39
Q

What is the preferred area of injection for pregnant women?

A

Abdomen

40
Q

Define lipohypertrophy

A

a thickened area of tissue that can grow and develop over time where REPEATED injections of insulin are given

41
Q

What are consequences of lipohypertrophy? (3)

A
  • associated with repeated unexplained hypoglycemia
  • reduce absorption of insulin by 40%
  • Use more insulin units
42
Q

When do you give glucagon

A
  • the patient is unconscious
  • the patient is unable to orally take sugar
  • patient is having a seizure
  • repeated oral sugar not working
43
Q

What does the glucagon injection contain?

A

un-reconstituted glucagon powder and syringe
- need to mix content before giving

44
Q

Glucagon nasal spray
can use if patient has cold?
Can you give a second spray?

A

Can use if patient has cold?
- Yes

Can you give a second spray?
- Yes

45
Q

What are the 2 types of continuous glucose monitoring systems

A

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

46
Q

What are benefits of CGM

A
  • increased glucose testing
  • A1C reduction
  • less variability in glycemic levels
  • more confidence to prevent hypoglycemia
  • less time in hypoglycemia
  • increased patient engagement and QOL
47
Q

How often are glucose data transmitted in Dexcom G7?
Is it in real-time?

A

every 5 minutes
Real-time

48
Q

Define flash BG monitoring.
real time?

A

Patient must scan the sensor in order to “pull” data forward to be seen

  • not in real time, 10-15 minute delay
49
Q

Who should NOT use freestyle libre? (5)

A
  • 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)
50
Q

What are interfering substances to freestyle libre? how does it effect BG reading? (2)

A
  1. Ascorbic avid
    - falsely elevate it
  2. Salicylic acid
    - may slightly lower it
    - ASA 81mg is OK
51
Q

Can you wear the libre during MRI and CT

A

No

52
Q

How often do the libre sensors measure BG readings and store it?
What happens when it is scanned?

A

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

53
Q

Where can the sensors be placed

A

ONLY on back of arm

54
Q

What to do if you perform intense exercise and sensor loosens due to sweat?

A

Can use
- tegaderm
- skintac
- large bandaids

Does NOT affect accuracy

55
Q

How long does the sensor have the memory ability for?

A

can show results for the past 8 hours

56
Q

What do you have to do in the first 24 hours of the sensor?

A

Tends to run lower
- need to perform CBGM as needed

57
Q

What does the arrow in the top right of the meter tell you?

A

The direction of where your BG levels are going

58
Q

What does it mean when LO & HI appear on the meter?

A

LO
- <2.2 mmol/L

HI
- over 27 mmol/L

59
Q

What does the freestyle libre ambulatory glucose profile AGP display?

A

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

60
Q

What does the glucose management indicator tell you on the meter?

A

Approx what the patient’s A1C level is likely to be

61
Q

What is the acronym for reviewing the CGM data?

A

DATAA

D download the data
A Assess safety
T time in range
A areas for improvement
A action plan

Pharm 229 Professional practice 4 Midterm (4 decks)

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