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PR - ENDOCRINE > INSULIN REGIMEN (T1) > Flashcards

INSULIN REGIMEN (T1) Flashcards

1
Q

When is insulin used?

A
  • Type 1
  • Type 2 if oral antidiabetic medication fails
  • Surgery
  • Hospitalisation for illness e.g. DKA
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2
Q

T1DM - first line treatment

A

Basal bolus regime
- Insulin determir bd
- Insulin aspart before meals

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3
Q

Types of insulin regimens

A

1.Basal-bolus insulin regimens
2. Biphasic regimen
3. Continuous subcutaneous insulin infusion (insulin pump)

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4
Q

Multiple daily injection basal-bolus insulin regimens (FIRST LINE)

A
  • 3 bolus injections of rapid acting insulin for meals
  • Once-twice daily background long acting insulin
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5
Q

Basal

A

Long/ intermediate acting insulin
OD or BD

  1. detemir BD
  2. second line = glargine OD
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6
Q

Examples of long acting

A

Detemir (Levemir)
Glargine (Abasglar, Lantus)
Degludec (Tresiba)

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7
Q

Bolus

A

Short/rapid acting before meals

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8
Q

Biphasic mixture

A

Short-acting mixed with intermediate injection
1-3 times a day

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9
Q

Which insulin regimens should NOT be recommended to patients newly
diagnosed with type 1 diabetes?

A

Non-basal-bolus regimens:
- Biphasic
- Basal-only
- Bolus-only

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10
Q

Continuous subcutaneous insulin infusion (insulin pump)

A

Regular or continuous amount of insulin (usually rapid acting insulin analogue or soluble insulin) delivered by a programmed pump and insulin storage reservoir via SC needle or cannula

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11
Q

When would you give continuous subcutaneous insulin infusion (insulin pump)

A
  • Disabling hypoglycaemia
  • Glycaemic control >8.5% despite optimised MIR
  • Children over 12 (MIR is impractical) BUT they must undergo MIR trial between 12-18
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12
Q

What factors require pt to increase insulin administration?

A

Infection
Stress
Trauma

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13
Q

What factors require pt to decrease insulin administration?

A

Physical activity
Intercurrent illness
Reduced food intake
Impaired renal function
Certain endocrine disorders (thyroid, coeliac, Addison’s)

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14
Q

Why is insulin give s/c

A

It is a protein which would be digested very quickly and inactivated by GI enzymes

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15
Q

Where is insulin administrated?

A

Injected into a body area with plenty of subcutaneous fat
- abdomen (fastest absorption rate)
- outer thighs/buttocks (slower absorption rate)

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16
Q

Why should you rotate the injection site?

A

Lipohypertrophy can occur due to repeated injection into the same area
leads to erratic absorption of insulin

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17
Q

What are the types of short acting insulin?

A

Soluble (short-acting) insulin
Rapid-acting insulin

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18
Q

Examples of soluble (short-acting insulin)

A

Animal: Hypurin porcine neutral
Human: Actrapid, Humulin S, Insuman Rapid

19
Q

Soluble (short-acting) insulin

A

Inject: 15-30 mins before meals
Onset: 30-60 mins
Peak action: 1-4 hours
Duration: up to 9 hours

20
Q

Soluble (short-acting) insulin counselling points

A

Must consume food within 30mins of injecting to avoid hypo
Can be given in diabetic emergencies + surgery

21
Q

Soluble (short-acting) insulin: side effects

A
  • Increased risk of hypo
  • Local reaction and fat hypertrophy at injection site can occur
22
Q

Rapid-acting insulin

A

Inject: immediately before meal
Onset: < 15 mins
Duration: 2-5 hours

Lower risk of hypo than soluble (short acting)
Alternative to soluble in emergency

23
Q

Examples of rapid-acting insulin

A

Lispro (Humalog)
Aspart (NovoRapid)
Glulisine (Apidra)
LAG - doesn’t lag

24
Q

Examples of Intermediate-acting insulin

A

Biphasic isophane, biphasic aspart / lispro (isophane insulin mixed with SA insulin)
Animal: Porcine isophane
Human: Insulatard, Humulin I, Insuman Basal

25
Q

Intermediate-acting insulin

A

Onset: 1-2 hours
Peak affect of 3-12 hours
Duration: 11-24 hours
Given in conjunction with short acting

26
Q

intermediate-acting insulin counselling points

A

Roll in hands before administration to resuspend zinc-insulin particulate
Never use IV (may block capillary; thrombosis)

27
Q

intermediate-acting insulin side effects

A
  • Never use IV (may block capillary; thrombosis)
  • Protamine may cause allergic reactions
  • Local reaction and fat hypertrophy at injection site can occur
28
Q

Why should some insulins never be given IV

A

Particulate matter in suspension may lodge in the capillary beds of the lungs and the brain, leading to thrombus development

29
Q

Examples of Long-acting insulin

A

Detemir (Levemir)
Degludec (Tresiba)
Glargine (Lantus, Abasaglar)

30
Q

Long-acting insulin

A

Inject: OD (Detemir = BD)
Onset: 2-4 days to reach steady state
Duration: 36 hours

31
Q

What patients are long-acting insulins better for

A

Insulin determir or insuline glargine is recommended for those:
- require assitance injecting insulin
- lifestyle if significantly restricted by recurrent symptomatic hypoglycaemia
- would otherwise need BD basal insulin injection in combo with oral anti diabetic drugs
- who cannot use device needed to inject isoprene insulin

32
Q

Long-acting insulin counselling points

A
  • Roll in hands before administration to resuspend zinc-insulin particulate
  • Never use IV (may block capillary; thrombosis)
  • Dont mix with soluble insulin
  • Use same time each day - to provide cover for 24H period
  • Clear liquids - potential for confusion with quick acting insulins
33
Q

Long-acting insulin: side effects

A
  • Local reaction and fat hypertrophy at injection site can occur
34
Q

Biphasic insulin

A
  • 1, 2 or 3 insulin injections per day of short acting MIXED with intermediate acting insulin
  • Preps may be mixed by pt or pre-mixed
  • More convenient
  • Less control as proportions are fixed
35
Q

Examples of Biphasic insulin

A

NovoMix 30
30% insulin aspart,
70% insulin aspart protamine

Humalog Mix 25
25% insulin lispro,
75% insulin lispro protamine

Humulin M3
30% soluble human,
70% isophane human

Insuman Comb 50
50% soluble human,
50% isophane

36
Q

Benefits of biphasic insulins

A

Pt don’t have to inject short- and long-acting insulins separately, good for poor dexterity and/or difficulty in measuring the insulins

37
Q

Bisphasic insulin: side effects

A
  • Protamine may cause allergic reactions.
  • Local reactions and fat hypertrophy at injection site can occur.
38
Q

Acutely ill patients on biphasic insulins

A
  • Can’t use these biphasic mixtures to boost their insulin levels
  • Should ideally have short or rapid-acting insulins to use to manage their insulin requirement whilst being ill.
39
Q

When do insulin requirements increase?

A
  • Infections or intercurrent illness
  • Stress
  • accidental surgical trauma
  • Puberty
  • Pregnancy - 2nd/3rd trimester
40
Q

When do insulin requirements decrease?

A
  • Endocrine disorders
    e.g. Addisons disease, hypopituitarism
  • Coeliac disease (gluten intolerance)
  • Exercise
  • Reduced food intake
  • Impaired RF
  • Immediately after birth
41
Q

Counselling - food

A

MIR
- Adjust dose according to carbohydrate intake
Biphasic
- Regulate and distribute carbohydrate intake throughout day to match regimen

42
Q

Interactions -HYPOglycaemia

A

Oral antidiabetics
ACEi
MAOIs
Salicylates
Beta blockers (masks symptoms)
Alcohol

43
Q

Interactions - HYPERglycaemia

A

Corticosteroids
Diuretics
Sympathomimetics (epinephrine, salbutamol, terbutaline)
Thyroid hormones
Oral contraceptives (oestrogen, progesterone)

44
Q

Warning

A

Recurrent hypoglycaemic episodes
- Sweating
- Palpitations
- Confusion
- Drowsiness
DKA
- N + v
- Drowsiness
- Hepatotoxicity
- Ulceration of foot tissue

PR - ENDOCRINE (25 decks)

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