Insulin Treatment

Question 1

What is the origin for insulin biosynthesis?

Answer 1

Recombinant DNA

Question 2

Which is the only insulin used as an IV formulation?

Answer 2

Regular

Question 3

Why can NPH not be given as an IV?

Answer 3

It is a suspension

Question 4

Why can glargine not be given as an IV?

Answer 4

Clear solution but it precipitates at physiological pH and stings when injected

Question 5

Why can detemir not be given as an IV?

Answer 5

Clear solution but it binds albumin

Question 6

Why can degludec not be given as an IV?

Answer 6

Clear solution but it causes severe hypoglycemia when given IV

Question 7

Is insulin given in Type 1 or Type 2 diabetes?

Answer 7

BOTH
-especially Type 1

Question 8

What fasting glucose levels indicate that insulin should be started?

Answer 8

High levels >280-300 mg/dL

Question 9

What affect does insulin have on hyperkalemia?

Answer 9

Insulin pushes potassium back into cells
-this is used to treat hyperkalemia

Question 10

What is a disadvantage to using pre-mixed insulins?

Answer 10

Cannot adjust the dosing of just one of the ingredients
(decreased individuality of dosing)

Question 11

Arrange the routes of administration of insulin from fastest acting to slowest acting
(Include: IM, SQ, IV, Intranasal)

Answer 11

Intranasal > IV > IM > SQ

Question 12

What are the three sites for insulin injection and how fast is the insulin absorbed at the sites?

Answer 12

Fastest: Stomach
Slowest: Buttocks, Thigh

Question 13

How does temperature affect insulin absorption?

Answer 13

Heat increases insulin absorption and action

*do not want patient rubbing their injection site because it changes heat and blood flow

Question 14

How does exercise/ massage affect insulin absorption and action?

Answer 14

Increases absorption and action

*do not want patients exercising right after injecting insulin

Question 15

When making a mixture of insulin, which insulins should be drawn up first and second?

Answer 15

Short-acting should always be drawn up first

NPH should be drawn up second

(can make the insulin cloudy, contaminate it and lose the short-acting insulin effects if drawn up first)

Question 16

How does U-500 insulin compare to U-100 insulin?

Answer 16

U-500 insulin has:

-Delayed onset and peak
-Longer duration of action
-Smaller volume
-Increased absorption

Question 17

What affect does renal failure have on insulin action?

Answer 17

Renal failure decreases insulin clearance
**this INCREASES insulin action

Question 18

What percent of insulin metabolism occurs in the kidneys?

Answer 18

15-20%

Question 19

How does stress affect insulin clearance?

Answer 19

Increases clearance

Question 20

How long are insulin vials stable at room temperature?

Answer 20

28 days

Question 21

What is the one insulin that stays stable at room temperature longer than the others and how long does is stay stable?

Answer 21

Levemir

42 days

Question 22

When should OPENED insulin vials/pens be discarded?

Answer 22

After 28 days

Question 23

How long do prefilled insulin syringes that are being REFRIGERATED remain stable for?

Answer 23

28 days

Question 24

How long do prefilled insulin syringes that are at ROOM TEMPERATURE remain stable for?

Answer 24

10-28 days
**highly variable

Question 25

How long does the mixture of Regular/NPH insulin remain stable for?

Answer 25

7 days with refrigeration

Question 26

How long does the mixture of Aspart, Glulisine, or Lispro (ultra short-acting) with NPH remain stable for?

Answer 26

Hardly any time *GIVE IMMEDIATELY*

Question 27

Can you create a mixture with Degludec, Detemir, or Glargine (long-acting) with any other insulin?

Answer 27

NO

Question 28

Can excessive alcohol cause hypo or hyper glycemia?

Answer 28

Hypoglycemia

Question 29

What glucose level is considered Level 1 hypoglycemia?

Answer 29

<70 mg/dL

Question 30

What glucose level is considered Level 2 hypoglycemia?

Answer 30

<54 mg/dL

Question 31

What glucose level is considered Level 3 hypoglycemia?

Answer 31

Severe event with altered mental and/or physical functioning that requires another person for recovery

Question 32

What affect do beta blockers have on hypoglycemia?

Answer 32

Decrease responsiveness to hypoglycemia through blocking sympathetic warning symptoms

Question 33

What is the Rule of 15's used for?

Answer 33

Hypoglycemia treatment

Question 34

What is the rule of 15's?

Answer 34

When a person is hypoglycemic: 1. Start with 15 gm of fast-acting carbohydrates **Unless BS < 50mg/dL (then use 30gm) 2. Wait 15 minutes then check BS again 3.If BS is not >79 mg/dL repeat with another 15gm 4. Follow up with a complex carbohydrate (eat meal if it is within the hour OR eat a 30gm snack if meal is > 1 hour away) For level 2 or 3 patients: Use glucagon (Intranasal, SQ, IM, or IV)

Question 35

What are examples of 15 gm of fast-acting carbs that can be eaten during hypoglycemia?

Answer 35

4 oz OJ 6 oz Cola (not sugar free, not the whole can) 5-6 lifesavers 2 tsp sugar (real sugar) 1 tbs honey Glucose tablets (4-5 gm of carbs per tablet) Glucose gel (great if patient cannot chew)

Question 36

What blood sugar are we aiming to be above that signals the end of a hypoglycemic episode?

Answer 36

>79 mg/dL

Question 37

What affect does insulin have on weight?

Answer 37

Causes weight GAIN 5-10 pound gain is typical

Question 38

What causes lipohypertrophy?

Answer 38

Repeated injections of insulin to the same site

Question 39

What is/causes lipoatrophy?

Answer 39

Concavities caused by destruction of fat from antibodies or an allergic reaction to insulin -rare

Question 40

What are the advantages of Glulisine, Lispro, and Aspart insulin analogs?

Answer 40

-Decreases post-prandial hypoglycemia -Superior postprandial lowering of blood sugars *Less overall hypoglycemia -Flexibility

Question 41

What are the advantages of Glargine, Detemir, and Degludec insulins?

Answer 41

24+ hour coverage with constant absorption patterns and no pronounced peaks May benefit patients suffering from nocturnal hypoglycemic episodes

Question 42

The DEVOTE trial showed that which insulin (degludec or glargine) is MORE likely to cause hypoglycemia?

Answer 42

Glargine

Question 43

Which of the long-acting insulins is the shortest acting and may require BID dosing?

Answer 43

Detemir

Question 44

What are the side effects of Afrezza?

Answer 44

-Cough -Acute bronchospasm -Upper Respiratory Infection -Decreased pulmonary function -Lung Cancer -Throat pain/irritation -Hypersensitivity reactions