Pharm2 2 Insulins pt2 Flashcards
Explain split-mixed insulin dosing. What’s it a mix of? When throughout the day are they administered?
And in what ratio??
utilize a mixture of rapid- and intermediate-acting insulins administered before breakfast (2/3) and before dinner (1/3)
split-mixed insulin dosing (in any administration ratio) contains what ratios of insulin?
Two-thirds of each injection comprises intermediate-acting insulin and one-third short-acting insulin (Rule of thirds)
Who is a split-mixed insulin dosing regiment meant for?
Only used in patients with fixed/regimented lives
Doing this means you have to do everything the same. Same meal, exercise, regiments
NURSING HOME PATIENTS. They get the same food regiment every single day.
Split-mixed Insulin Dosing
if a patient needs 90 units, how is it administered?
2/3 in morning: 60 units – 2/3 of this is intermediate-acting – 40 units; 1/3 is short acting: 20
1/3 at dinner: 30 units – 2/3 of this is intermediate acting – 20; 1/3 is short-acting: 10
All these numbers: 40, 20, 20, 10 add up to the 90 units they take.
Split-mixed insulin dosing for a 220 pound patient
220 pound patient = 100 kg
How many units of insulin should they have? 50-100 units (can start anywhere in this range)
If you choose 60 units: 2/3 (40 units immediately before breakfast) are given in morning, 1/3 (20 units immediately before dinner) given in evening.
Insulin glargine may be combined with short-acting insulin, but not in the same syringe. How do you teach a patient to use Insulin glargine?
First time you show them: They will do that day’s dose in front of you (that day’s dose) with 10 units. Tell them, “I want to take your glucose 2 hours after you eat dinner in your log. Tomorrow morning, do fingerstick again before you eat and write it down again. Don’t eat or drink anything before you check it in the morning.” if your sugar in the morning is >100 units, tomorrow evening inject 1 extra additional unit of insulin. So that night instead of injecting 10, inject 11 units. Repeat checking after dinner/morning. If it’s still >100, inject 12 units this time. Keep doing this until it’s no longer >100.
The first time you fall below 100, you stay at this dose.
the average individual needs somewhere between - units of Insulin Glargine to control their Diabetes and get their morning glucose below 100.
45-50 units
After finally finding your dose of insulin glargine, if the number one day is >100 again, what do you do?
you do one more unit that day, but don’t maintain this higher dose every day until you talk to provider.
What is insulin’s effect on weight?
Insulin can lead to weight gain (b/c sugar is going into cell).
If a patient truly wants to avoid insulin b/c of probable weight gain, what will you recommend instead? Why? What are its risks?
insulin-memic (GLP-1) and they’ll lose some weight in their first week. If they want to do this instead, talk to them about the cost, safety with this drug (pancreatitis)
Add 1 unit glargine every night until your AM FBS = 100 method is called what?
“KISS” Method
Basal Insulin titration
Which insulin therapy gives: Improved glycemic control Greater lifestyle flexibility Weight control Reducing hypoglycemia Improved quality of life Empowered patient
Basal/Bolus Therapy
If you were on split/mixed and wanted to go running. What would you have to do?
You’d have to eat something to keep glucose levels consistent. unpractical and counterproductive
*A mix of what 2 types of drugs gives the highest risk for hypoglycemia?
Sulfonylureas + Insulin = highest risk for hypoglycemia. If I start you on insulin, either take you off SU entirely, or at least cut it by half.
What route of insulin administration Most closely mimics the pancreas?
Insulin pumps
