Subcutaneous Insulin management

Question 1

what is the target range of insulin for hospital patients

Answer 1

6-12mmol/L

Question 2

when is insulin replacement therapy used

Answer 2

when no endogenous insulin, for insulin deficiency or when other diabetes medication ineffective

Question 3

when is basal insulin produced and how much of endogenous insulin does this make up

Answer 3

all the time, makes up just under 50% of insulin

Question 4

when is post-prandial insulin produced and in response to what

Answer 4

at meal times, in response to increased blood glucose

Question 5

what is the standard conc. of subcutaneous insulin

Answer 5

100 units/ml

Question 6

what are 2 common errors made in the administration of subcutaneous insulin

Answer 6

inappropriate use of non-insulin syringes, marked in ml instead of units
use of abbreviations such as U instead of units, can be misread and wrong dose given

Question 7

what must always be given with quick acting insulins

Answer 7

carbohydrate

Question 8

when are quick acting insulins used

Answer 8

for insulin cover at meal times with carbs or when high carb snacks

Question 9

describe the action of rapid-acting analogue insulin and give an example

Answer 9

immediate action, peak at around 2 hours after given

example = Humalog

Question 10

describe the action and give an example of a short-acting(soluble) insulin

Answer 10

30 min to take affect, peak action at 4 hours

example = Humulin S

Question 11

when are long acting insulins usually given to patients

Answer 11

once daily, at same time each day

sometimes 2 daily, 12hrs apart

Question 12

what is the benefit of analogue long acting insulin

Answer 12

longer duration of action(around 24hours)

Question 13

what is needed in conjunction with long acting insulin and why

Answer 13

short-acting insulin at meal times as long-acting provides basal rate with no increase at meal times when glucose increases

Question 14

what is fixed mix insulin and when is it given

Answer 14

either rapid-acting analogue-intermediate mixture
OR short acting-intermediate mixture
usually given twice daily before breakfast and dinner

Question 15

what is an example of a long acting insulin

Answer 15

Insulatard or Humulin I(analogue)

Question 16

for basic insulin adjustment how often should blood glucose be checked in patients on twice daily dose

Answer 16

review blood glucose pattern over previous 48hours

Question 17

how is basic insulin dose adjusted in those on 2 daily doses with blood glucose higher than target

Answer 17

if higher before lunch + tea, increase at breakfast
if higher before breakfast + lunch, increase at tea
(usually increase by 10%)

Question 18

how is basic insulin dose adjusted in those on 2 daily doses, with blood glucose lower than 6mmol/L

Answer 18

if lower before lunch + tea, reduce breakfast insulin dose
if lower before breakfast + lunch, reduce tea time insulin dose
(usually 10% decrease)

Question 19

how is the basic insulin dose adjusted in those on multiple daily doses, with blood glucose higher than target

Answer 19

if > at lunch, increase breakfast dose
if > at teatime, increase lunch dose
if > at suppertime, increase evening meal dose
if > breakfast, increase basal insulin dose

Question 20

how is the basic insulin dose adjusted in those on multiple daily doses, with blood glucose lower than 6mmol/L

Answer 20

if < at lunchtime, reduce breakfast dose
if < at teatime, reduce lunchtime dose
if < at suppertime, reduce evening meal dose
if < at breakfast, reduce basal insulin dose