Insulin prescribing Flashcards
Onset, peak and duration of rapid acting insulin analogues
Onset: 5 mins
Peak: 1 hour
Duration: 3-5 hours
Onset, peak and duration of short-acting insulin analogues
Onset: 30 mins
Peak: 3 hours
Duration: 6-8 hours
Onset, peak and duration of intermediate-acting acting insulin analogues
Onset: 2 hours
Peak: 5-8 hours
Duration: 12-18 hours
Onset, peak and duration of long-acting acting insulin analogues
Onset: 1-2 hours
Peak: Flat profile
Duration: Up to 24 hours
Examples of rapid acting insulin analogues
Novorapid (Aspart) Humalog (Lispro)
Apidra (Glulisine)
Examples of short acting insulin analogues
Actrapid
Humulin S
FRIl (only short-acting)
Given 15-30 minutes before meal
Examples of intermediate acting insulin analogues
Insulatard
Humulin I
Insuman basal
Given OD/BD or as part of a mix
Examples of long acting insulin analogues
Lantus (Glargine)
Levemir (Determir)
Tresiba (Degludec)
Given OD
Pre-mixed preparations: Novomix 30
Intermediate + Rapid (at start of breakfast and dinner)
30% insulin aspart (rapid-acting), 70% insulin aspart protamine
Pre-mixed preparations: Humalog Mix25/50
25%/50% rapid-acting (insulin lispro)
How to administer insulin
rotate injection sites to prevent lipodystrophy
What regimens of insulin exist?
Basal bolus regimen
BD pre-mixed regimen
OD intermediate morning/evening regimen
How many units of insulin in 1mL?
100 units
Biphasic insulin dose
0.5 - 0.8 UNITS / kg
2/3rds in the morning, 1/3rd in the evening
Rules for diabetics on insulin going for surgery
If glucose 4-12mmol/L = proceed with surgery
If glucose >12mmol/L, capillary blood ketones >3 or urine ketones +++ = delay surgery and give VRII
1 U = ~3mmol/L glucose drop
If patient is NBM, how should insulin be adjusted?
Continue basal insulin
Omit bolus insulin
In what situations should you increase insulin?
DKA/HHS, sepsis, steroids, missed doses, pancreatitis, dehydration
IE-asthma goes home with 5 days PO prednisolone → +10% to daily insulin
In what situations should you decrease insulin?
ETOH, reduced renal function, reduced calonies
How should you adjust basal/bolus regimens if high/low before breakfast/at night?
Increase/decrease evening long acting
How should you adjust basal/bolus regimens if high/low before lunch/dinner/bed?
Increase/decrease rapid acting in meal before
How should you adjust BD pre-mixed/intermediate regimens if high/low before bed AND before breakfast?
Increase/decrease evening insulin
How should you adjust BD pre-mixed/intermediate regimens if high/low before lunch AND before evening meal?
Increase/decrease morning insulin
VRII indications
NBM surgery patients, post FRII in DKA
VRII mix
50 UNITS Actrapid insulin (or Humulin S) in 50mL of 0.9% sodium chloride
IV glucose medical vs surgical
Medical: 1L 5% glucose + 0.30% K+ at 100mL/hour
Surgical: 1L 5% glucose + 0.30% K+ at 80mL/hour
Stopping a VRII checklist
E+D normally
Taken long-acting insulin (≥1 hour before)
Taken mixed/rapid insulin at usual mealtime (and wait 30 minutes before stopping VRII)
Monitor CBG QDS for ≥24 hours
BM <4
Conscious / able to swallow
Glucotabs (47) OR 150-200mL fruit juice OR 4 teaspoons sugar dissolved in water
2nd choice: IM glucagon OR glucose 20% 100mL IV over 10 mins
BM <4
Unconscious / no swallow
IM glucagon (community, no IV) OR Glucose 20%, 100mL, IV, over 10 mins
BM > 4
Conscious / able to swallow
Long-acting CHO
(two biscuits, one slice of bread, 200-300 mL of milk
