Sisson Insulin Flashcards
What came out of the LANMET trial?
Glargine or NPH along with dual metformin therapy did not produce different profiles
What did Fritsche et. al find with glargine?
They found that dosing glargine in the morning lowered A1c better than bedtime NPH or glargine.
Also found that morning dosings lead to lower events of nocturnal hypoglycemia
Which insulin formulation binds to albumin?
Levemir
Which insulin formulation should not be mixed with other insulins before administering?
Glargine because it is soluble at pH 4 while other insulin formulations will degrade in acidic environments
Why is Levemir considered an intermediate - long acting insulin?
The more you give, the more it will act like a long-acting insulin
As A1c increases, which parameter (FPG or PPG) is responsible for the rise?
Fasting plasma glucose (FPG) becomes a larger contributor when A1c increases instead of post prandial glucose.
What did the 4T trial establish?
Glargine is a good basal insulin to start on and then add on prandial insulin.
Also, long term use of glargine is better than biphasic
What did the LAPTOP and INITIATE trials establish?
Glargine is better than biphasic insulin in terms of having less hypoglycemic events
What happens to insulin when given in high amounts? Give an example
Administering U-500 regular insulin will promote aggregation in bloodstream
What is U 500 insulin equivalent to?
greater than 0.12mL of NPH (at least 60units)
TDM1
Initial Insulin dosing:
Mealtime bolus:
Insulin Sensivity Factor:
TDM1
Initial Insulin basal dosing: 0.5 x Pt wt = TDD
Mealtime bolus: Rule of 500 (500/TDD) = unit/carbohydrates
Insulin Sensivity Factor: Rule of 1800 (unit/amount of glucose lowering)
- USE 1500 if regular insulin
TDM2
Initial Insulin dosing:
Mealtime bolus:
Insulin Sensivity Factor:
TDM2
Initial Insulin basal dosing: 0.2 x Pt wt = TDD (or 0.25 for obese)
- Give metformin with or without SU
Mealtime bolus: Rule of 500 (500/TDD) = unit/carbohydrates
Insulin Sensivity Factor: Rule of 1800 (unit/amount of glucose lowering)
- USE 1500 if regular insulin
