Level 1 - Insulin Therapy & Pattern Mgmt (Class 4) Flashcards
DiabetesEd
What are some problem-solving tips for more comfortable injections?
1) Short, fine needles hurt less
2) Inject subQ, not into the muscle
3) If they are thin, inject at an angle
4) Avoid areas with scar tissue
5) Use needle once and toss in sharps
6) To avoid leakage, wait 5-10 seconds before withdrawing needle
7) Use pen needles and injectors
A participant tells you she doesn’t want to start on insulin. What is your best response?
A. The needles are so small, you won’t feel a thing.
B. If you don’t start on insulin, your risk of complications will increase.
C. Tell me why.
D. Gently tell them there is a doctor’s order to start insulin.
C.
What is the best response for someone who does not want to start on insulin, because:
“it will make gain weight.”
Yes, you may gain a few pounds, but that is a sign that your body is healing
If they keep gaining weight, that is a sign that they are on too much insulin
What is the best response for someone who does not want to start on insulin, because:
“injecting insulin will hurt.”
Most people are surprised that they barely feel the injections
What is the best response for someone who does not want to start on insulin, because:
“people who need insulin are really sick.”
It only means that your pancreas can’t make enough insulin, so you can help it by injecting it
What are 5 devices to inject insulin?
1) Syringe
2) Pen
3) Injector (uses high pressure air)
4) Pump
5) Inhaled (dried powder form; only available as bolus insulin, so they would still need to inject their basal insulin)
What medication is inhaled insulin?
Afrezza
List some items that should be kept together in an ‘insulin toolkit.’
1) Alcohol wipes
2) Insulin vials
3) Syringes
4) Insulin pens
5) Insulin pump supplies
6) Meter
7) Strips
8) Log book
9) Carb snacks
10) Glucagon emergency kit
(TRUE or FALSE)
If you are reusing your insulin needle, you can clean it using an alcohol wipe.
FALSE
There is a silicon coating on the needle that makes it easy to go into the skin. So if reusing, just recap the needle CAREFULLY.
(TRUE or FALSE)
Fat can delay the absorption of the carbohydrates.
TRUE
On CGM reading, you will see two spikes after the mealtime
What best describes the role of bolus insulin?
A. Covers carbs at meals and hyperglycemia.
B. Helps to lower FBG
C. Keeps overnight blood glucose on target
D. Used during hypoglycemic episodes
A.
Aspart and lispro-aabc are:
A. Very rapid acting
B. Rapid acting
C. Intermediate
D. Long-acting
A. Very rapid acting
Aspart, Lispro, Ademelog, Glulisine, Afrezza are:
A. Very rapid acting
B. Rapid acting
C. Intermediate
D. Long-acting
B. rapid acting
NPH is:
A. Very rapid acting
B. Rapid acting
C. Intermediate
D. Long-acting
C. intermediate
Glargine (Lantus, Basaglar, Semglee, Rezvoglar) and Degludec (Tresiba) are:
A. Very rapid acting
B. Rapid acting
C. Intermediate
D. Long-acting
Long-acting
(TRUE or FALSE)
You cannot use the term ‘generic’ for large molecule biologicals because they are manufactured in living organisms (bacteria and yeast).
TRUE
Includes Lispro (Ademelog) - bolus & Glargine (Basaglar/Semglee/Rezvoglar) - basal
(TRUE or FALSE)
Semglee/Rezvolgar cannot be switched without provider preapproval.
FALSE
It can, when lantus is denied.
How soon does rapid insulin start working?
15-30 minutes
How long does the bolus insulin last?
3-6 hours, average 4 hours
*Wait at least 4 hours before next bolus insulin injection
JR has T1DM for 30 years. They inject aspart (Novolog) before meals and glargine (Basaglar) at night. When you ask if they brought a log book says “I can just tell you how much insulin I need.” What is your best response?
A. Checking your BG is important to prevent hypoglycemia.
B. Usually insulin dosing is based on blood sugar levels?
C. Sounds like you know how you feel.
D. How has this strategy worked so far?
D. Engage with curiosity
How much bolus insulin will cover 15 grams of carb?
1 unit = 10-15g carbs
Lowers BG by 30-50 mg/dL (insulin sensitivity) depending on body weight
How is the effectiveness of bolus insulin determined?
2-hour post meal (if you can get it)
*Before next meal BG (used MORE often; target 80-130 mg/dL)
What is the glucose goal for 1-2 hours after meals?*
< 180 mg/dL
What is the glucose goal for before meals?*
80 - 130 mg/dL
(TRUE or FALSE)
You can take bolus insulin after dinner.
FALSE
It is not recommended to take bolus insulin at nighttime, when they are not under observation due to the risk for hypos
What is the peak action time for NPH?
Intermediate = 4 to 10 hours
What is the duration for NPH?
10 to 16 hours duration
What is the peak action for long-acting insulin?
There is no peak
What is the duration for long-acting insulin?
24 hours for Glargine (lantus)
24 hours for Glargine (Basaglar)
42 hours for Degludec (Tresiba)
What best reflects the efficacy of basal insulin?
FBG
In how long does basal insulin start working?
2-4 hours
(TRUE or FALSE)
At least 42 factors affect glucose.
TRUE
Within the categories of: food, meds, activity, biological, environmental, and behavioral and decision making
When looking at glucose patterns, which problem do you fix first?
A. Hyperglycemia
B. Hypoglycemia
C. Non-compliance
D. Legible writing
B.
**Non-compliance = we do not use this term anymore! Rather, we look at where are they succeeding?
Which classes of medications cause hypoglycemia?
Insulin
Sulfonylureas
Meglitinides
Are we most concerned about hyperglycemia or hypoglycemia, first?
Hypos
If a PWD is having hypos, what should we do?
If possible, decrease the medication dose!*
Look at timing of meals, exercise, medications
Temporarily increase the BG targets: 100-130 mg/dL for FBG for a while
If a PWD is having hyperglycemia, before increasing insulin, what should be addressed first?
Make sure we aren’t missing carbs, exercise, omission
In general, what are the storage guidelines for insulin?
Once opened, store at room temperature. It is a lot more comfortable to inject warm insulin, rather than cold insulin, but it does have a shelf life.
We do not need to keep it on ice, since we don’t want it to freeze. Using cooling devices are OK.
See pocketcard for expiration when opened for insulin
(TRUE or FALSE)
Insulin can be stored at room temperature, up to 90F.
FALSE
86F
If a PWD is on insulin and they start a GLP-1, what should we recommend?
With addition of GLP-1, reduce basal insulin by ~10 units
This to create a big safety net. Since the GLP-1’s are so effective at reducing post-meal hyperglycemia (remember, they tell the pancreas to make insulin with meals).
JR is on 3 different diabetes oral medications and 100 units of glargine insulin. A1c is 8.9% and JR weighs 100 kg. What best describes this clinical picture?
A. Overbasalization
B. Non-compliance
C. Fear of hypoglycemia
D. Clinical inaction
A. He is exceeding 0.5 units/kg/day
When do we consider insulin first?
A1c > 10%, or
BG levels > 300 mg/dL, or
T1DM is a possibility
What are the two insulin combination medications?
1) IDegLira = Insulin degluec (IDeg or Tresiba) + Liraglutide (Victoza)
2) iGlarLixi = Insulin glargine (lantus) + Lixisenatide (Adiyxin) - GLP-1
These are very easy for people to take, just once daily injections
How do you take 70/30 insulin?
-Gently roll and invert between hands to mix*
-Prime pens = given 2 units ‘air shot’ to make sure pen and needle are functional
-After injecting insulin, count to 5 before pulling needle out
-Use new needle with each injection
When is 70/30 usually taken?
Before breakfast and before dinner; BID
When is 70/30 a good option?
For those who need bolus and basal coverage, but cannot do 4 injections daily
(TRUE or FALSE)
70/30 needs to be reconstituted before injecting.
TRUE
Gently roll and invert in hands
What are the two methods for converting someone to 70/30 from bolus/basal?
1) Based on their current insulin dose
2) Based on their body weight
How do you convert someone to 70/30 by using their current insulin dose?
1) Reduce current dose by 20%
2) Give 2/3 in AM; 1/3 in PM
How do you convert someone to 70/30 by using their body weight?
- Multiple their weight (kg) by 0.5 units/kg
- Give 2/3 in AM; 1/3 in PM
Which of the following are suggested insulin teaching keys?
A. Poke, Inject, Eat (PIE)
B. Abdomen is preferred injection site
C. Use a sharps container to dispose of needles and lancets
D. Always have treatment for hypos available.
E. All of the above.
E
(TRUE or FALSE)
The abdomen is the preferred site for insulin injections.
TRUE because it has the most subQ fat
Its their second insulin injection of the day, how far away from their first site, should they inject?
1 inch away
(TRUE or FALSE)
Keep unopened insulin in the refrigerator.
TRUE
Lipodystrophy
A condition where repeated insulin injections in the same area cause abnormal changes in the subQ fat
Lipohypertrophy
A condition where repeated insulin injections in the same area cause abnormal changes in the subQ fat, that leads to a LOCALIZED BUILDUP OF FAT
Which can affect insulin absorption
What is the 50/50 rule in regards to insulin dosing strategies?
0.5 - 1.0 units/kg per day
50% of total insulin needs come from BASAL
50% of other insulin needs come from BOLUS (divided into 3 meals)
At what point would someone be appropriate for concentrated insulin?
Taking more than 200 units per day may benefit from switching to U-500 insulin
What best describes U-500 regular insulin?
A. Regular insulin delivered in 5x the volume of U-100.
B. High potency inhaled insulin
C. Regular insulin that is 5x the concentration of U-100
D. Insulin that is given 5 times per day
C
How many units of insulin are in U-100?
100 units insulin per mL
How many units of insulin are in U-500?
500 units per mL
How many U-500 units come in a vial?
20 mL
500 units per mL = 10,000 units per vial
(TRUE or FALSE)
There is now a dedicated U-500 insulin syringe.
TRUE
It goes up to 250 mL, in increments of 5 mL
See pocketcard for concentrated and inhaled insulin
Which of the following is true about all concentrated insulins?
A. Need to convert to get correct dose.
B. Delivers the same amount of insulin in more volume.
C. Delivers the correct dose in less volume.
D. No calculations or conversion is required.
E. C & D
E.
(TRUE or FALSE)
Never withdraw concentrated insulin from a pen into a syringe.
TRUE
