Subcutaneous insulin management

Question 1

What are the 2 common errors identified in the administration of insulin by clinical staff?

Answer 1

1. The inappropriate use of non-insulin syringes, which are marked in millilitres and not in insulin units
2. 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

Question 2

When is insulin replacement therapy used ?

Answer 2

When there is no endogenous insulin, significant insulin deficiency, or when other diabetes medication has been ineffective in controlling blood glucose levels

Question 3

Insulin is constantly secreted at a low basal rate - how much of total insulin produced does this account for ?

Answer 3

Around 50%

Question 4

What is post-prandial insulin ?

Answer 4

It is insulin secreted after meals

Question 5

Outside of hospital patients may have different glucose targets whcih may be lower than the targets in hospital - T/F?

Answer 5

True

Question 6

What are the 3 main groups(there are others but these are the main ones) of insulin given ?

Answer 6

Quick acting

Intermediate to long-acting insulin

Question 7

What must quick acting insulins always be given with ?

Answer 7

Carbohydrates

Question 8

What are quick acting insulins used for ?

Answer 8

Mealtimes and snacks due to their fast action

Question 9

What are the 2 different types of quick acting insulin and describe there action profiles

Answer 9

1. Rapid acting analogue - immediate effect, peaks at 2hrs after administered then has stopped working by 4hrs
2. Short-acting (soluble) - 30mins to take effect, peaks at 4hrs after administered then has stopped working by 8hrs

Question 10

Which of these are rapid-acting insulin analogue and which are short-acting (soluble)?

• Humalog
• Humulin S
• Insuman rapid
• Novorapid
• Apidra
• Actarapid
  *

Answer 10

Rapid-acting analogue:

• Humalog
• Novorapid
• Apidra

Short-acting (soluble):

• Actrapid
• Humulin S
• Insuman rapid

Question 11

How often is long acting insulin given in the majority of patients?

Answer 11

once daily at the same time each day sometimes twice daily with 12hrs apart from each dose

Question 12

Give 2 examples of long-acting insulin and describe their action profiles

Answer 12

Isophane -

Question 13

What are the principles of insulin dose adjustment ?

Answer 13

• 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

Question 14

Which of these are intermediate acting (isophane) and which are long acting insulin?

• Insulatard
• Lantus
• Levemir
• Humulin I
• Insuman basal

Answer 14

Long acting analogue:

• Lantus
• Levemir

Intermediate acting (isophane):

• Insulatard
• Humulin I
• Insuman basal

Question 15

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

Answer 15

Rapid-actting analogue intermediate mixture:

• Humalog Mix 25 and 50
• Novomix 30

Short-acting intermediate mixture:

• Humulin M3
• Insuman 15,25,50

Question 16

If a patient is on fixed mix insulin (e.g. short-acting intermediate mixture), how often are they given it and when ?

Answer 16

Usuaully 2 per day before breakfast and dinner

Question 17

What does the number in a

Question 18

What is a basal bolus regime ?

Answer 18

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

Question 19

What is the basic adjustment guidelines for twice daily insulin regimes ?

Answer 19

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

Question 20

What is the basic guideline for insulin adjustment for multipledaily injection regimes ?

Answer 20

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