Met 1: Insulin Therapy

Question 1

How many units of insulin are secreted by a normal pancreas each day?

Answer 1

About 30

Question 2

Is insulin only secreted in response to food?

Answer 2

No. There is a surge in response to food, but there is a base-line level of insulin released.

*This is why we give basal and bolus insulin

Question 3

__ T1D and __ T2D patients need insulin

Answer 3

All T1D and some T2D need insulin

Question 4

How can you determine if the insulin is exogenous or endogenous?

Answer 4

C-peptide!

C-peptide will be elevated only if it’s endogenous.

Question 5

What are the three rapid acting insulins?

Answer 5

no LAG

• Lispro
• Aspart
• Glulisine

Question 6

When are the rapid acting (no LAG) insulins given?

Answer 6

Just prior to a meal

Question 7

What is the name of the inhaled insulin?
Name 1 pro and 1 con

Answer 7

Afrezza

Pro: Very rapid acting (given just before a meal)

Con: Only available in pre-set doses (4, 8, 12, etc)

Question 8

Name the 2 “regular” insulins.

When are they given?

Answer 8

Humulin-R and Novolin-R

Given 30 minutes before meal

Question 9

What are the intermediate insulins?

When are they given?

Answer 9

NPH insulin (Humulin-N, Novolin-N)

Given twice daily for basal coverage

Question 10

Which insulin is CLOUDY?

Answer 10

NPH insulin

Question 11

Name the 3 long-acting insulins.

When are they given?

Answer 11

Glargine (1x/day), Degludec (1x/day), Detemir (2x/day)

*all for basal coverage

Question 12

Which insulins cannot be mixed in the same syringe with other insulins?

Answer 12

Long acting (glargine, degludec, detemir)

Question 13

What is pre-mixed insulin?

What is one pro and one con?

Answer 13

Combines intermediate and short-acting insulin

Pro: Inject only twice per day to cover both basal and bolus needs

Con: can’t adjust doses

Question 14

What is the purpose of basal insulin?

Answer 14

Suppress hepatic glucose production to maintain a normal fasting glucose

Question 15

Why does the extra-concentrated version of insulin exist?

Answer 15

• Insulin absorption decreases as the volume of injection increases.
• So, if you have to inject a large volume b/c you take 100 units of insulin, it won’t get absorbed well
• A more concentrated solution will allow you to inject same # units in less volume, improving absorption

Question 16

How much of total daily insulin should by basal?

Answer 16

50% basal

50% bolus

Question 17

What is correction insulin?

What is the danger of correction insulin?

Answer 17

Insulin added to a meal dose to correct for any pre-meal HYPERglycermia.

Pts should be careful not to give more insulin before their current insulin has had time to work (ie stacking). If they do, they’ll become hypoglycemic

Question 18

What is an appropriate insulin bolus?

Answer 18

All three meals should get bolus of

1/6*Total daily insulin dose + CF

Question 19

What is the correction factor in insulin dosing?

Interpret CF of 30

Answer 19

CF (added to meal boluses) is the number of points you expect someone’s sugar to fall per unit of insulin administered. Based on insulin sensitivity

ie. With a CF of 30, BG should decrease by 30 points for every 1 unit insulin given

Question 20

What is administered through an insulin pump?

Answer 20

Insulin pumps ONLY contain RAPID acting insulin

• Continuous infusion of rapid insulin given to create basal coverage
• You program how much to give before each meal

Question 21

What is the idea of an artificial pancreas?

Answer 21

A continuous glucose sensor detects your blood sugar and then the pump adjusts your insulin accordingly.

Currently, we only have versions that CANNOT account for meals

Question 22

Name 4 conditions for T2D that would require insulin therapy

Answer 22

1. Lifestyle changes and other meds don’t achieve target A1c
2. Contraindications to other medications (renal, liver dysf, CHF)
3. Signs of insulin deficiency (weight loss, really bad blood sugars)
4. Hospital admission for diabetes

Question 23

What is the target for:

fasting BG

2 hr post meal BG

A1c

Answer 23

• Fasting BG: 80-130
• 2 hr post meal BG: under 180
• HbA1C: less than 7

Question 24

Should you eliminate hypoglycemia or hyperglycemia first?

Answer 24

eliminate HYPOglycemia

b/c hypoglycemia causes rebound high BG

Question 25

How is inpatient hyperglycemia managed?

Answer 25

• Stop all non-insulin glucose-lowering medications
• IV insulin