Diabetes Products and Accessories

Question 1

List activities of each insulin type and understand the needles/syringe measure marking, needle length and gauge

Answer 1

Pen needles:
needle gauge: 28-32 (higher #, thicker the needle)
needle length: 5/32” (4mm) - 1/2” (12.7mm)
disposable/one time use
sterile
1 mL = 100 units; 1/2 mL = 50 units; 3/10 mL = 30 units
choosing needle length & gauge: subcutaneous thickness, insulin dose, injection technique

Question 2

U-500 syringes

Answer 2

doses up to 250 units
each line measures 5 units of insulin

Question 3

U-100 insulin products

Answer 3

pen, vial, and cartridge concentration: 100 units/mL
pen and cartridge capacity: 1 pen or cartridge = 300 units
vial capacity: 1 vial = 1000 units

Question 4

Explain general storage guidelines for insulin

Answer 4

unused: store in fridge, good until expiration date
in use: store at room temp, good for ~1 month

Question 5

Insulin pen storage

Answer 5

rapid acting - 28 days
short and intermediate acting - all 28 days except for humulin N kwikpen (14 days)
rapid and short intermediate mixes - novolin 70/30 flexpen & relion (28 days); novolog mix 70/30 flexpen, insulin aspart protamine and insulin aspart 70/30 pen injector (14 days); humalog mix 75/25 kwikpen, insulin lispro protamine and insulin lispro 75/25 pen injector, humalog mix 50/50 kwikpen, humulin 70/30 kwikpen (10 days)
long acting: all 28 days except levemir flextouch and both toujeo (42 days)
ultra long acting: all 56 days

Question 6

Insulin cartridge storage

Answer 6

unused cartridges must be kept refrigerated
in use cartridges should NOT be refrigerated
rapid acting good for 28 days

Question 7

Insulin vial storage

Answer 7

rapid acting and rapid intermediate mixes: 28 days
short acting, intermediate acting, and short intermediate mixes: humulin R U-100, humulin 70/30, humulin N (31 days); humulin R U-500 (40 days); novolin 70/30, novolin R, novolin N and relion (42 days)
long acting: levemir (42 days); lantus, semgless, insulin glargine (28 days)
ultra long acting: tresiba (56 days)

Question 8

Insulin administration devices

Answer 8

disposable or reusable insulin pens
syringe and needles
inhalation powder
continuous SQ insulin infusion pumps
V-Go

Question 9

Provide appropriate patient counseling info about insulin, insulin pens, needles/syringes, and injection devices

Answer 9

factors to consider: increase convenience = increase compliance = increase glycemic control

Question 10

Insulin pen use: priming

Answer 10

prime with 2 units before every administration, EXCEPT when using: humulin R U-500 KwikPen - prime with 5 units; toujeo max solostar U-300: prime with 4 units; toujeo solostar U-300: prime with 3 units

Question 11

Insulin cartridges for reusable insulin pens

Answer 11

rapid-acting: novolg penfill
insulin aspart cartridge
fiasp penfill
lyumjev cartridge

Question 12

Reusable insulin pens

Answer 12

NovoPen echo - dosed in half unit increments
InPen - dosed in half unit increments

Question 13

Disposable smart pen and system

Answer 13

Tempo

Question 14

Provide product aid solutions to patients’ barriers with injections

Answer 14

insulin measurement devices for visual impairment: count-a-dose
devices to overcome fear of needles: tickleFLEX, novofine autocover pen needles, autoshield duo
organization and safety devices: safe-clip (clips end of needle off); insulcheck (starts countdown when you take off cap, counts down when you last took a dose); diasecure (stores pen and needles)
indwelling catheter injection ports to minimizes sticks: i-Port advance, insuflon
educational tools for kids: jerry the bear, tartoos
pain relief for kids: buzzy, shotblocker

Question 15

Inhaled insulin

Answer 15

afrezza
delivers rapid-acting insulin
onset: ~ 12 min
max effect: ~ 53 min
DOA: ~ 160 min

Question 16

Identify contraindications for use of inhaled insulin and non-insulin injectables

Answer 16

afrezza
GLP-1 agonists
GIP/GLP-1 agonists
amylinomimetic
GLP-1 agonist and insulin combos

Question 17

Afrezza contraindications

Answer 17

chronic lung disease (asthma, COPD)
not recommended in pts who smoke or those with active lung cancer
adverse rxns: hypoglycemia, cough, throat pain/irritation

Question 18

GLP-1 agonists contraindications

Answer 18

T1D, history of thryoid tumors, history of pancreatitis

Question 19

GLP-1 agonists with cardiovascular benefit

Answer 19

victoza (liraglutide)
ozempic (semaglutide)
trulicity (dulaglutide)

Question 20

Amylinomimetic

Answer 20

symlinpen (pramlintide)

Question 21

GLP-1 agonist and insulin combos

Answer 21

soliqua
xultophy

Question 22

Define barriers that prevent a pt from using proper glucose monitoring

Answer 22

pts should self monitor to: get immediate feedback, prevent/detect highs and lows, adjust therapy in response to lifestyle changes, adjust insulin dosages, enhance understanding of disease and factors that affect blood glucose levels
barriers to monitoring: discomfort/fear of fingersticks, elevated readings, reminder of disease, cost, inconvenience, social stigma, lack of understanding

Question 23

Provide appropriate pt counseling info for non-insulin injectables, pen needles, and blood glucose testing supplies

Answer 23

auto-injector: trulicity, bydureon, mounjaro
pen needles included: ozempic
require pts to obtain pen needles separately: byetta, victoza, symlinpen, soliqua, xultophy

Question 24

Storage and expirations

Answer 24

afrezza opened: 3 days, unopened: 10 days
trulicity: 14 days
xultophy, mounjaro: 21 days
bydureon, soliqua: 28 days
symlin, victoza, byetta: 30 days
ozempic: 56 days

Question 25

Given a pt case, choose an appropriate meter, CGM system, or app and develop appropriate pt counseling info

Answer 25

CGM monitors BG every 1-5 minutes; four different types of CGM - real-time, intermittently scanned, professional, unblinded

Question 26

Stand-alone CGM

Answer 26

abbott freestyle libre 2 system
abbott freestyle libre 3 system
dexcom G6
dexcom G7
medtronic guardian connect
eversense E3

Question 27

Freestyle libre 2 system

Answer 27

placement: upper arm
fingerstick NOT needed for calibration
1-hour warm up period
sensor life: 14 days
approved for 4 years and older
user has to scan the sensor to see current reading; smartphone connectivity
interfering substance: vitamin C

Question 28

Freestyle libre 3 system

Answer 28

placement: upper arm
fingerstick NOT needed for calibration
1-hour warm up period
sensor life: 14 days
approved for 4 years and older
no scanning required; smartphone connectivity, no reader available; interfering substance: vitamin C

Question 29

Dexcom G6

Answer 29

placement: abdomen or butt
fingerstick NOT needed for calibration
2-hour warm up period
sensor life: 10 days
approved for 2 years and older
no scanning required; smartphone connectivity; includes sensors, wireless transmitter, and a receiver; interfering substance: hydroxyurea

Question 30

Dexcom G7

Answer 30

placement: back of upper arm or butt (2-6 yrs)
fingerstick NOT needed for calibration
30-min warm up period
sensor life: 10 days
approved for 2 years and older
no scanning required; smartphone connectivity; includes sensors and a receiver; receiver can be set up in another language
interfering substance: hydroxyurea

Question 31

Medtronic Guardian Connect

Answer 31

placement: abdomen and arm
calibration required every 12 hours
2-hour warm up period
sensor life: 7 days
approved for 14-75 year olds
no scanning required; smartphone connectivity; intended to compliment, not replace info obtained from standard blood glucose monitoring devices
interfering substance: acetaminophen

Question 32

Eversense E3 CGM system

Answer 32

placement: under the skin of the upper arm
four calibrations required during first 6-36 hours, two calibrations required per day for first 21 days, followed by either one or two calibrations per day
24-hour warm up period
sensor life: 6 months
approved for 18 years and older
removable and rechargeable transmitter sits on top of skin
interfering substance: tetracycline, mannitol

Question 33

Given a pt logbook, determine problem areas and possible causes for high/low readings

Answer 33

log book = pt’s reference book
always fix lows first

Question 34

Describe the importance of A1C monitoring, the info the A1C value provides, and the frequency of testing

Answer 34

A1c gives a picture of a pt’s avg BG control over past 3 months
frequency of testing: every 3 months - therapy change, not meeting glycemic goals; every 6 months - meeting treatment goals, stable glycemic control
A1c goals: AACE - </= 6.5% for most pts, ADA - <7% for most nonpregnant pts

Question 35

Explain the steps to get out of a low event

Answer 35

Hypoglycemia: level 1 - glucose < 70 mg/dL and >/=54 mg/dL; level 2 - glucose < 54 mg/dL; level 3 - altered mental status
getting out of a low: step 1 - check BG first to confirm hypoglycemia; step 2 - rule of 15, consume 1 serving (15 gm) of fast acting carbs, wait at least 15 min; step 3 - recheck BG; step 4 - analyze reading and determine additional action: <70 mg/dL, repeat process; >70mg/dL and greater than 1 hour until next meal, consume long acting carb snack/protein (30 gm); >70mg/dL and eating a meal within the hour, no further action

Question 36

Describe pt types who are candidates for continuous SQ injection pumps

Answer 36

mulitple daily injections
poor glycemic control despite basal-bolus therapy
comfortable self-managing insulin dosage
comfortable with technology
maintains regular appointments/checks
financially capable/insured benefit

Question 37

Identify insulins appropriate for pump delivery

Answer 37

rapid acting insulin only

Question 38

Describe the components of insulin pump systems

Answer 38

insulin pump: controls how much insulin is administered
insulin: rapid acting insulin only
reservoir: inserts into the pump to hold the insulin
infusion set: delivers the insulin from the reservoir to the body
correction factors - can program pump to know pt-specific factors
glucose targets - can suggest bolus insulin dosage
carb ratios - provides guidance for bolus dosing
extended bolus intervals: square wave bolus - delivers normal bolus over longer period of time (use for snacking); traditional bolus (at meal times); dual wave bolus - delivers initial normal bolus followed by a square wave

Question 39

Types of insulin delivery

Answer 39

open loop system: have to tell pump what reading is; blood glucose level –> sensing (finger, stick CGM) –> insulin delivery
hybrid closed-loop system: insulin glucose level –> sensing (CGM) –> modulation (control algorithm) –> insulin delivery; manual mode - basal rates are pre-programmed, bolus for food + corrections, may be used w/ w/o CGM; auto mode - basal is automatically adjusted every 5 min, bolusing for food is necessary, CGM required

Question 40

Given a pt’s insulin pump data, identify their total daily insulin dose