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Therapeutics 2 - Exam 3 > insulin treatment pg 1-12 > Flashcards

insulin treatment pg 1-12 Flashcards

kania pt 2

1
Q

what insulins are approved for IV use?

A

aspart, glulisine, lispro, and regular are all approved but only regular insulin is used due to cost and no clear advantage of the other three

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2
Q

what site of injection is the fastest?

A

abdomen
then buttocks then thigh as the slowest

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3
Q

what does heat do to insulin?

A

increases absorption and action

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4
Q

what does exercise/massage do to insulin?

A

increases absorption and action
effect may depend on inject site

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5
Q

how does renal function affect insulin action?

A

renal failure decreases insulin clearance thus increasing insulin action
leads to a greater risk of hypoglycemia
15-20% of insulin metabolism occurs in the kidney

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6
Q

what does stress do to insulin action?

A

increases insulin clearance

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7
Q

when mixing insulins, which one should you draw up first?

A

short-acting
stable in fridge for 7 days if regular/NPH
give immediately if aspart, glulisine, or lispro is mixed with NPH

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8
Q

what are some causes of hypoglycemia?

A

increased insulin dosage
decreased caloric intake
increased muscle utilization
excessive alcohol

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9
Q

how do b-blockers affect hypoglycemia?

A

they block the sympathetic warning symptoms
decreases responsiveness to hypoglycemia event

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10
Q

how would you treat a hypoglycemia episode?

A

check blood glucose level to confirm
rule of 15
repeat if necessary
if eating meal within an hour, no follow up
if meal is over an hour away, eat a 30 gram carbohydrate snack

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11
Q

what is the rule of 15?

A

after confirming hypoglycemia episode (BS less than 70), eat 15 gm of fasting acting carbohydrate
wait 15 minutes
check BS again
if not above 70mg/dL, repeat another 15 grams

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12
Q

what are some examples of 15 grams of fast-acting carbohydrates?

A

4-5oz of OJ
4-6oz of cola
5-6 lifesavers
4tsp of sugar
1 tbsp of honey
4 glucose tablets

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13
Q

what are some side effects of insulin therapy?

A

hypoglycemia
weight gain
lipohypertrophy
lipoatrophy

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14
Q

what is lipohypertrophy?

A

accumulation of fatty tissue caused by repeated injects into the same size

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15
Q

what is lipoatrophy?

A

concavities caused by destruction of fat from antibodies or allergic reactions

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16
Q

what are insulin analogs?

A

glulisine, lispro, or aspart insulin
more closely stimulates physiologic insulin secretion relative to meals

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17
Q

what are some advantages of using insulin analogs?

A

decreases post-prandial hypoglycemia and superior postprandial lowering of blood sugars
fewer overall occurrences of hypoglycemia (and less at night)
greater flexibility

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18
Q

what are some disadvantages of insulin analogs?

A

risk of hypoglycemia if no meal within 15 minutes of dose
will need to combine with a longer acting insulin for optimal blood sugar control
if mixed with another insulin –> give immediately
hyperglycemia/ketosis may occur more rapidly if insulin delivery is interrupted

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19
Q

what are some long-acting or ultra-long acting insulins?

A

glargine, degludec

20
Q

what are the advantages of using glargine/degludec?

A

provides 24+ hours coverage with a constant absorption patter (no pronounced peak)
may be beneficial in patients suffering from nocturnal hypoglycemia due to stabalization

21
Q

what are some disadvantages of glargine/degludec?

A

some european studies suggest risk of malignancy
cannot be mixed with any other insulins

22
Q

what is the DEVOTE trial?

A

studied CV risk in long-acting insulins used in patients with T2DM and either CVD or risk of CVD

23
Q

how would dose change when switching from daily NPH to glargine/degludec?

A

it wouldn’t
keep it the same

24
Q

how would dose change when switching from BID NPH to glargine/degludec?

A

it would decrease by 20%

25
Q

how would dose change when switching from BID NPH to U-300 glargine?

A

it would decrease by 20%

26
Q

what would have a conversion factor of 1:1?

A

daily glargine (lantus/basaglar) to daily glargine (toujeo)
basal insulin and u-200 degludec (tresiba)
lispro u-100 to u-200

27
Q

how would you determine what dose to change to when switching u-100 to u-500?

A

assess A1c
U-500 replaces both basal and bolus insulin types so depends on TDD

28
Q

how would dose change if the A1c is <8% when switching to U-500?

A

decrease TDD by 10-20%

29
Q

how would dose change if the A1c is between 8-10% when switching to U-500?

A

it would not change

30
Q

how would dose change if the A1c is >10% when switching to U-500?

A

increase TDD by 10-20%

31
Q

how would the dose schedule look for U-500 conversion when TDD is 150-300 units?

A

change to BID or TID dosing
if BID –> 60% before breakfast and 40% before dinner
if TID –> 40% before breakfast, 30% before lunch, and 30% before dinner

32
Q

how would the dose schedule look for U-500 conversion when TDD is 300-600 units?

A

TID dosing
40% before breakfast, 30% before lunch, and 30% before dinner
may consider a 10% dose at bedtime if concerned about nighttime spike and need 4th injection

33
Q

how would the dose schedule look for U-500 conversion when TDD is >600 units?

A

30% breakfast
30% lunch
30% dinner
10% bedtime

34
Q

what is the average TDD of T1DM patients?

A

0.4 to 1 units/kg/day (actual body weight)
use higher amounts during puberty, menses, and medical illness
use lower amounts in newly diagnosed pts (0.2-0.6)

35
Q

when should T1DM pts check their blood glucose levels?

A

4 times a day before meals and at bedtime
occasionally at 3am to assess insulin dosages

36
Q

what is typical T1DM basal dosing?

A

1-2 doses of glargine or degludec
1-2+ doses of NPH

37
Q

what is typical T1DM bolus (prandial) dosing?

A

provided by meal-time short acting or ultra shorting acting insulines (regular, lispro, glulisine, or aspart)

38
Q

what is the typical T1DM basal-bolus dosing?

A

50-70% is basal
30-50% is bolus
it’s all variable!

39
Q

how would a mixture of NPH and short-acting be utilized in T1DM?

A

two daily injections of mixture only breakfast and dinner
AM dose –> 40% NPH + 15% short acting
PM dose –> 30% NPH + 15% short acting

40
Q

what is the typical starting insulin type in T2DM?

A

long-acting (glargine/degludec) OR NPH in combination with non-insulin agents (some orals can be d/c when basal/bolus insulin is initiated)

41
Q

what is the ADA recommendation for T2DM starting basal insulin dose?

A

0.1-0.2 units/kg/day OR 10 units/day

42
Q

what is the AACE recommendation for T2DM starting basal insulin dose?

A

if A1c is <8%, start 0.1-0.2 units/kg/day
if A1c is >8%, start 0.2-0.3 units/kg/day

43
Q

what is the ADA recommendation for T2DM adjusting basal dose?

A

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

44
Q

what is the AACE recommendation for T2DM adjusting basal dose?

A

titrate every 2-3 days based on blood glucose levels
if over 180 –> add 20% of TDD
if 140-180 –> add 10% of TDD
if 110-139 –> add 1 unit
if under 70 –> decrease by 10-20% of TDD

45
Q

when should bolus be added in T2DM?

A

usually needs it eventually, but especially in pts who are on equal to or greater than 0.5 units/kg/day

46
Q

what is the procedure for adding bolus in T2DM?

A
  • start with 10% of basal dose or 4 units with largest meal
    -may start with one meal or all three based on pt preference
    -adjust dose by 10-15% every 3/4 days
47
Q

what is the average insulin dose for T2DM pts?

A

over 1 unit per kg

Therapeutics 2 - Exam 3 (10 decks)

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