Devices, Daily Management and Acute Complications

Question 1

Patient on NPH switching to Lantus

Answer 1

One time daily NPH = equivalent dose

Twice daily NPH: 80% of NPH dose

Question 2

Administration options

Answer 2

Insulin pens
SQ insulin infusion pumps
V-go (pump-like-patch)
SQ ports
Continuous glucose monitors

Question 3

What is an insulin pump?

Answer 3

A computerized device that allows for both continuous and non-continuous doses of insulin to be delivered to the body
SQ administration
Replaces insulin injections
Uses short acting insulin

Question 4

Insulin Pumps Usage

Answer 4

Cartridge is filled with insulin
Inserted into pump and readied
Tubing is primed
Attached to site
Release drops of insulin every few minutes to achieve a programmed units/hr rate
Additional boluses can be manually released

Question 5

Insulin Pump Advantages

Answer 5

Allows individualization of therapy
Helps adjust for variables (meals, exercise, hormones)
Allows for tracking of adherence

Question 6

Insulin Pump Disadvantages

Answer 6

More complex
Requires greater diligence and adherence by patient
Cost

Question 7

What are insulin pens?

Answer 7

An insulin injection system
Can be prefilled/disposable or durable/refillable
Available for most single insulin types
Always prime the pen
Keep pressing the button for 5-10 sec before removing

Question 8

Advantages of insulin pens

Answer 8

Improved patient acceptability and compliance
Increased convenience and lifestyle flexibility
Greater reliability and accuracy of dosing
Simplification of insulin administration
Reduced injection pain
Cost

Question 9

Disadvantages of insulin pens

Answer 9

Malfunction/greater complexity
Partial loss of dose due to early removal
Patient can not see dose going in
Limited availability of 1/2 unit dosing
Potential increased risk of needle sticks in hospital and nursing home setting

Question 10

Hyperglycemia Cause and Symptoms

Answer 10

Less insulin being used or available

Increased thirst, urination, mood changes/agitation, hunger, vision changes, headache

Question 11

Hyperglycemia management

Answer 11

Take insulin when/if appropriate
Increase fluid intake
Monitor for ketones (T1)

Question 12

Hypoglycemia Cause and Symptoms

Answer 12

More insulin being released than needed

Confusion, dizziness, shakiness, headache, sleepiness, sudden hunger, sweating, seizure

Question 13

Hypoglycemia Management

Answer 13

Fast acting sugar
Rate of 15
Glucagon, Dextrose IV

Question 14

Rate of 15

Answer 14

15 grams of fast acting sugar
Test in 15 mins
Repeat until blood glucose increasing

Question 15

Standard supplies to always have on them

Answer 15

ID
Monitoring: monitor, lancing device, lancet, antiseptic, strips
Hypoglycemic treatment: fast sugar, protein, glycagon

Question 16

Standard supplies to have reasonable access

Answer 16

Meds: insulin, orals, syringes, pens, pump supplies

Hyperglycemic management: ketone testing, fluids

Question 17

Insulin container

Answer 17

10 mL vial of U-100 insulin (100 u/mL)

Question 18

Insulin storage

Answer 18

Unopened vials: refrigerator until expired
Opened vials: 28 days at room temperature (detemir: 42 days)
Rapid acting: 28 days
Pre-mixed/NPH: 10-14

Question 19

Fixed Insulin Combination

Answer 19

70/30 (aspart protamine and aspart or NPH and regular)
75/25 (lispro protamine and lispro)
50/50 (NPH and regular)