Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Diabetes > Insulin Treatment > Flashcards

Insulin Treatment Flashcards

1
Q

What is the insulin used as the IV formulation?

A

Regular insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Do not give the following as IV:

A

NPH - is a suspension
Glargine - precipitates at physiologic pH
Detemir - binds to albumin through it FA chain
Degludec - may cause severe hypoglycemia if given IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Uses of insulin

A

Type 1 and 2 diabetes: high fasting glucose levels > 280-300 mg/dL; patients with ketoacidosis; gestational diabetes; when deemed appropriate by clinician + patient
Hyperkalemia
Type 2 diabetes in combo with various non-insulin agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe the onset, peak, duration of action, and adverse effects of each of the insulin preparations available.

A

Ultra Short-Acting
Short-Acting
Intermediate
Long-Acting
Ultra Long-Acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ultra-Short Acting

A

Aspart (Novolog)
Lispro (Humalog)
Glulisine (Apidra)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Aspart (Novolog)

A

Onset: 10-20 min
Peak: 30-90 min
Duration: 3-5 hours
Compatible when mixed with: NPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Lispro (Humalog)

A

Onset: 10-20 min
Peak: 30-90 min
Duration: 3-5 hours
Compatible when mixed with: NPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Glulisine (Apidra)

A

Onset: 10-20 min
Peak: 30-90 min
Duration: 3-5 hours
Compatible when mixed with: NPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Short-Acting

A

Regular (Humulin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Regular (Humulin)

A

Onset: 30-60 min
Peak: 2-4 hours
Duration: 5-8 hours
Compatible when mixed with: NPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Intermediate

A

NPH (Humulin N, Novolin N)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

NPH (Humulin N, Novolin N)

A

Onset: 2-4 hours
Peak: 4-10 hours
Duration: 8-12 hours
Compatible when mixed with Regular, Lispro, Aspart, Glulisine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Long-Acting

A

Glargine (Lantus, Basaglar, Semglee)
Detemir (Levemir)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Glargine (Lantus, Basaglar, Semglee)

A

Onset: 2-4 hours
Peak: no peak
Duration: 20-24 hours
Not compatible when mixed with others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Detemir (Levemir)

A

Onset: 1.5-4 hours
Peak: 6-14 hours
Duration: 16-20 hours
Not compatible when mixed with others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ultra Long-Acting

A

Degludec (Tresiba)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Degludec (Tresiba)

A

Onset: 1 hour
Peak: no peak
Duration: over 24 hours (~ 42)
Not compatible when mixed with others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Insulin Pre-mixtures

A

Reduce the # of injections
Problem: can’t individually adjust them
NPH/Regular mixture 70/30
75% neutral protamine lispro/25% lispro
50% neutral protamine lispro/50% lispro
70% aspart protamine suspension/30% aspart
Degludec U-100/aspart U-100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Concentrated insulins

A

Humulin-R U500
Degludec U200 (Tresiba)
Glargine U300 (Toujeo)
Glargine U 300 (Toujeo Max)
Lispro U200 (Humalog Kwikpen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Humulin-R U500

A

DOA: 6-10 hours
Greatest A1C reduction T2DM
Most weight gain
Most expensive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Degludec U200 (Tresiba)

A

DOA: 42 hours
Second greatest A1C reduction T2DM
Least weight gain
2nd most expensive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Glargine U300 (Toujeo)

A

DOA: > 30 hours
3rd greatest A1C reduction
3rd most weight gain
2nd to least expensive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Glargine U 300 (Toujeo Max)

A

DOA: > 30 hours
3rd greatest A1C reduction
3rd most weight gain
3rd most expensive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Lispro U200 (Humalog Kwikpen)

A

only bolus insulin that is concentrated
DOA: 3-5 hours
Least amount of A1C reduction
2nd most weight gain
Cheapest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Factors altering insulin action

A

Route of administration
Site of injection
Temperature
Exercise/massage
Preparation/mixtures
Dose
Patient compliance
Patient errors
Irregular diet/exercise
Renal function
Stress
Drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Route of administration of insulin

A

IV > IM > SQ
intranasal may even be faster

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Site of injection

A

Stomach is fastest
Butt and thigh slowest
Want to keep same site for same time of day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Temperature

A

heat increases absorption and action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Exercise and massage

A

increase absorption and action

30
Q

Preparations/mixtures

A

always draw short-acting insulins 1st
short-acting effect of insulins may be lost if mixed incorrectly
smaller volume (more concentrated) allows for overall increased absorption

31
Q

Dose

A

lower dose is absorbed more rapidly (less volume)

32
Q

Renal function

A

renal failure decreases insulin clearance, thereby increasing insulin action (risk of hypoglycemia)

33
Q

Stress

A

increases insulin clearance (increases BS)

34
Q

Insulin vials stable at room temp for

A

28 days
42 days with levemir
refrigerate vials/pens not in use , do not freeze

35
Q

Insulin you prefill in syringes is stable for

A

28 days with refrigeration, as long as not mixed
10-28 days at room temp

36
Q

Mixture stability

A

Regular/NPH: stable for 7 days in fridge
Aspart, Glulisine, or Lispro with NPH: give immediately
Degludec, Detemir, and Glargine with any other insulin: ??

37
Q

Hypoglycemia Causes

A

increased insulin dosage
decreased caloric intake
increased muscle utilization
excessive alcohol

38
Q

Hypoglycemia Classification

A

level 1: glucose < 70 mg/dL
level 2: glucose < 54 mg/dL
level 3: severe event with altered mental state

39
Q

Hypoglycemia Signs/Symptoms

A

tremore, diaphoresis, anxiety, dizziness, hunger, tachycardia, blurred vision, weakness/drowsiness, headache, irritability, confusion, slurred speech
beta-blockers can decrease responsiveness to hypoglycemia due to blocking sympathetic warning symptoms

40
Q

Hypoglycemia Treatment

A

rule of 15’s: start with 15 gm of FAST-ACTING carb unless BS < 50 mg/dl (then use 30 gm) - 4 oz OJ, 6 oz cola, 5-6 lifesavers, 2 tsp sugar, 1 T honey, 4-5 glucose tabs/gel
wait for 15 min, check BS again, if not > 79 mg/dL, repeat iwth another 15 gm
follow with complex carb - eat your meal if within the hour, eat 30 gm CHO snack if meal > 1 hour away
glucagon for level 2/3 patients: 3 mg intranasal Baqsimi, 1 mg SQ, IV, IM glucagon, 0.6 mg SQ dasiglucaogon

41
Q

Complications of insulin therapy

A

hypoglycemia
weight gain
lipohypertrophy - repeated injections into same site, tumerous like fat pads
lipoatrophy - concavities caused by destruction of fat from antibodies or allergic reactions
allergic reactions

42
Q

Glulisine, Lispro, or Aspart Insulin Advantages

A

decreases post-prandial hypoglycemia and superior post-prandial lowering of BS
fewer overall occurrences of hypoglycemia, less noctural hypoglycemia
greater flexibility (can take right after eating)

43
Q

Glulisine, Lispro, or Aspart Insulin Disadvantages

A

risk of hypoglycemia if no meal within 15 min of dose
need to combine with longer acting insulin for optimal BS control
if mixed with another insulin, give immediately after mixing
hyperglycemia/ketosis may occur more rapidly if insulin delivery is interrupted

44
Q

Glargine, Detemir, or Degludec Advantages

A

provides 24+ hour coverage with a constant absorption pattern and no pronounced peak (detemir may require BID dosing in order to acheive 24 hr coverage)
may be beneficial in pts suffering from nocturnal hypoglycemic episodes

45
Q

Glargine, Detemir, or Degludec Disadvantages

A

risk of malignancy
can NOT be mixed with any other insulin

46
Q

DEVOTE trial

A

glargine vs degludec
T2DM with either CVD or risk factors for CVD
CVD risk was basically the same for each
degludec has much less hypoglycemia

47
Q

Changing between U-100 therapies

A

pts change from daily NPH to glargine/detemir/degludec, keep dose the same
pts change from BID NPH to glargine/detemir/degludec, decrease dose by 20%

48
Q

Changing U-100 to a concentrated insulin therapy

A

pts change from BID NPH to U-300 glargine, decrease dose by 20%
1:1 conversion between daily glargine (lantus, basaglar, semglee) or daily detemir (levemir) to daily glargine (toujeo or toujeo max) but pts may need an increased dose of toujeo or toujeo max
1:1 conversion between basal insulin and U-200 insulin degludec
1:1 conversion between lispro U-100 to U-200

49
Q

U-100 basal-bolus regimen to U-500 regimen

A

U-500 replaces both basal and bolus insulin types
if A1C > 8%, consider 1:1 conversion
if A1C </= 8%, use a 20% dosage reduction

50
Q

Type 1 pts average daily dose

A

0.5-0.6 U/kg/day
use lower dosages in newly diagnosed pt: 0.1-0.4 U/kg/day

51
Q

Basal is provided by

A

either 1-2 doses of glargine, detemir, or degludec or 1-2 doses of NPH

52
Q

Bolus dosing is provided by

A

meal-time short-acting or ultra-short acting insulins (regular, lispro, glulisine, aspart)

53
Q

50-70% of the insulin requirements are given as

A

basal insulin
other 30-50% is divided among the meal as bolus insulin

54
Q

Prandial doses can be adjusted based on

A

carbohydrate content of meals
1 unit for every 15 gm of CHO (1:15 insulin: CHO ratio)

55
Q

Insulin pumps

A

rapid acting insulin used to cover both basal and prandial insulin needs
basal rate throughout the day
bolus dose calculator to determine bolus doses bases on glucose levels, carb intake, and insulin on board

56
Q

Type 2 patients start insulin if

A

A1C >/= 10%
usually long-acting or intermediate insulin is started in combo with non-insulin agents
bedtime insulin usually added to previous non-insulin therapies

57
Q

Starting dose of insulin in T2DM

A

0.1-0.2 U/kg/day or 10 U/day

58
Q

Adjusting dose in T2DM

A

increase dose by 2 units every 3 days to reach FBS goal

59
Q

Basal in T2DM

A

basal provided by either 1-2 doses of glargine, detemir, or degludec or 1-2 doses of NPH

60
Q

Eventually, many T2D pts will need

A

bolus insulin
consider addition of bolus, especially for pts on >/= 0.5 U/kg/day
usually can start with 10% of basal dose or 4-5 units of ultra-short or short-acting insulin with largest meal

61
Q

General dosing principles

A

for all diabetic pts on insulin, increase/decrease dose every 2-4 days until goals are met
target FBS, then PPG - with A1C > 10%, 70% of the problem involves FBS, with A1C < 7.5%, 70% of the problem involves PPG

62
Q

Insulin to Carb ratio

A

1 unit:10-15 gm CHO for adults
1 unit:20-30 gm for children
calculating insulin:carb ratio - divide # of grams of CHO for a meal by amount of bolus insulin given
rule of 500: take 500/total daily insulin dose and this will equal the # gm of CHO for 1 unit of insulin

63
Q

Correction factor

A

guidance for fixing high BS
rule of 1800: 1800/total daily dose of insulin = # of mg/dL blood glucose will drop for every 1 unit of insulin

64
Q

If you use a CF dose before bedtime

A

consider only giving 50% of the dose

65
Q

Use 1500 if the pt is

A

on regular insulin

66
Q

For many T1 pts, an increased insulin dose by ~2 units decreases the BS by

A

~50 mg/dL

67
Q

For many T2 pts, an increased insulin dose by ~4 units decreases the BS by

A

~50 mg/dL

68
Q

Somogyi effect

A

nocturnal hypoglycemia with rebound hyperglycemia
signs/sx: wake up sweaty, serious/scary dreams
add a bedtime snack; move NPH from dinner to bedtime or decrease long-acting dose at bedtime

69
Q

Concentrated insulins were developed in order to

A

provide sustained glucose-lowering effect with less risk of hypoglycemia, lower intra-individual variability, fewer injections, better adherence, less pain, less frequent pen changes
consider when TDD = 200-300 U/day

70
Q

Afrezza

A

inhaled insulin
adverse rxs: hypoglycemia, cough, acute bronchospasm, URI, decline in pulmonary function, lung cancer, throat/irritation, hypersensitivity rxns

Diabetes (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions