Subcutaneous insulin management Flashcards
What are the 2 common errors identified in the administration of insulin by clinical staff?
- The inappropriate use of non-insulin syringes, which are marked in millilitres and not in insulin units
- The use of abbreviations such as ‘U’ or ‘IU’ for units. When abbreviations are added to the intended dose, the dose may be misread. For example, 10 units may be read as 100 units
When is insulin replacement therapy used ?
When there is no endogenous insulin, significant insulin deficiency, or when other diabetes medication has been ineffective in controlling blood glucose levels
Insulin is constantly secreted at a low basal rate - how much of total insulin produced does this account for ?
Around 50%
What is post-prandial insulin ?
It is insulin secreted after meals
Outside of hospital patients may have different glucose targets whcih may be lower than the targets in hospital - T/F?
True
What are the 3 main groups(there are others but these are the main ones) of insulin given ?
Quick acting
Intermediate to long-acting insulin
What must quick acting insulins always be given with ?
Carbohydrates
What are quick acting insulins used for ?
Mealtimes and snacks due to their fast action
What are the 2 different types of quick acting insulin and describe there action profiles
- Rapid acting analogue - immediate effect, peaks at 2hrs after administered then has stopped working by 4hrs
- Short-acting (soluble) - 30mins to take effect, peaks at 4hrs after administered then has stopped working by 8hrs
Which of these are rapid-acting insulin analogue and which are short-acting (soluble)?
- Humalog
- Humulin S
- Insuman rapid
- Novorapid
- Apidra
- Actarapid
*
Rapid-acting analogue:
- Humalog
- Novorapid
- Apidra
Short-acting (soluble):
- Actrapid
- Humulin S
- Insuman rapid
How often is long acting insulin given in the majority of patients?
once daily at the same time each day sometimes twice daily with 12hrs apart from each dose
Give 2 examples of long-acting insulin and describe their action profiles
Isophane -
What are the principles of insulin dose adjustment ?
- Review glycaemic control routinely and adjust it to optimise control
- Avoid extra doses of short-acting insulin to correct hyperglycaemia (may precipitate hypoglycaemia)
- Do not omit insulin if hypoglycaemic. Treat hypoglycaemia and administer insulin as usual (provided patient is eating), while considering an appropriate dose reduction
- If hypoglycaemia occurs whilst on insulin, undertake a medication and dose review to prevent recurrent episodes
Which of these are intermediate acting (isophane) and which are long acting insulin?
- Insulatard
- Lantus
- Levemir
- Humulin I
- Insuman basal
Long acting analogue:
- Lantus
- Levemir
Intermediate acting (isophane):
- Insulatard
- Humulin I
- Insuman basal
Which of these are rapid-acting analogue intermediate mixture and which are short-acting intermediate mixture ?
- Humalog Mix 25
- Humulin M3
- Insuman comb 15,25,50
- Novomix 30
- Humalog Mix 50
Rapid-actting analogue intermediate mixture:
- Humalog Mix 25 and 50
- Novomix 30
Short-acting intermediate mixture:
- Humulin M3
- Insuman 15,25,50
If a patient is on fixed mix insulin (e.g. short-acting intermediate mixture), how often are they given it and when ?
Usuaully 2 per day before breakfast and dinner
What does the number in a
What is a basal bolus regime ?
It is when the patient takes a long acting and then short acting for each meal which contains carbs as if they take for a meal with almost no carbs then it could result in hypoglycaemia
What is the basic adjustment guidelines for twice daily insulin regimes ?
You should review blood glucose levels over previous 48hrs:
If the blood guclose levels are low (<6mmol/L):
- low before lunch and tea then reduce breakfast insulin dose
- low before bed and before breakfast then reduce teatime insulin dose
- A decrease of 10% to the dose of insulin if lowering it is generally recommended
If blood glucose if higher than target:
- High before lunch and tea then increase breakfast insulin dose
- High before bed and before dinner then increase teatime insulin dose
- An increase of 10% to the dose of insulin if increasing it is generally recommended
What is the basic guideline for insulin adjustment for multipledaily injection regimes ?
If blood glucose is above target:
- At lunchtime then increase breakfast dose
- At teatime then increase lunchtime dose
- At suppertime then increase teatime dose
- At breakfast then consider increasing basal insulin dose
- If increasing an increase of 10% to insulin dose is generally recommended
If blood glucose is below 6mmol/L:
- At lunchtime then decrease breakfast dose
- At teatime then decrease lunchtime dose
- At suppertime then decrease teatime dose
- At breakfast then consider decreasing basal insulin dose
- If decreasing, a decrease of 10% to insulin dose is generally recommended
