Treatment of Diabetes – Insulin

Question 1

How many units of insulin does the pancreas secrete normally?

Answer 1

30 units per day

Question 2

Type 2 diabetics typically lose which phase of insulin secretion?

Answer 2

Phase 1

Question 3

Which glucose channel is constitutively expressed in beta cells?

Answer 3

GLUT2

Question 4

What percent of T2 diabetics are using insulin?

Answer 4

50 percent

Question 5

What are the brand names of the three fast-acting insulins?

Answer 5

Humalog (lispro)
Novolog (aspart)
Apidra (glulisine)

Question 6

What are the three long-acting insulins and their brand names?

Answer 6

Detemir (Levemir)
Glargine (Lantus)
Degludec (Tresiba)

Question 7

The ______________ have no peak.

Answer 7

long-acting insulins

Question 8

What is MDI?

Answer 8

Multiple daily injections (also called basal-bolus or intensive insulin therapy)

Question 9

In a non-diabetic, meals should raise blood glucose by _______________.

Answer 9

30 to 50

Question 10

Detemir needs to be given __________ daily, while glargine needs to be given __________ daily.

Answer 10

twice; once

Question 11

Insulin pumps secrete ______________.

Answer 11

rapid-acting insulin as a basal insulin

Question 12

What stimulates second-phase insulin secretion?

Answer 12

Glucose that remains high after the initial rise

Question 13

What concentrations are typically given in injectable insulin?

Answer 13

100 U/mL, 300 U/mL, or 500 U/mL

Question 14

What are the peak times of fast-acting and intermediate-acting insulin?

Answer 14

Fast-acting: 1.5 hours

Intermediate-acting: 3-5 hours

Question 15

How (chemically) does detemir last so long in the circulation?

Answer 15

It has an added fatty acid, so it binds to albumin.

Question 16

Which insulin is dispensed as a cloudy solution?

Answer 16

Neutral protamine Hagedorn (think Hagedorn = Hazy)

Question 17

What formula is used to estimate basal insulin needs per day?

Answer 17

0.2 U/kg/day (so a 70 kg person needs 14 U daily for basal levels)

Question 18

What is the typical range for carbohydrate-to-insulin ratios?

Answer 18

8:1 to 20:1 (meaning an insulin-resistant person might need 1 unit of insulin for every 8 grams of carbohydrates, while an insulin-sensitive person might need 1 unit of insulin for every 20 grams of carbohydrates)

Question 19

By how much does 1 unit of fast-acting insulin typically lower a person’s blood glucose?

Answer 19

20 mg/dL to 50 mg/dL

Question 20

What is the “dawn phenomenon”?

Answer 20

Growth hormone typically rises between 4 am and 8 am, thus inducing hyperglycemia; patients with T1DM usually need more insulin during this time.

Question 21

_____________ channels are blocked in beta-cells to stimulate secretion of insulin.

Answer 21

ATP-sensitive potassium

Question 22

What are some signs that a type-2 diabetic might need insulin?

Answer 22

• Random glucose greater than 300
• Fasting glucose greater than 250
• Weight loss
• HbA1c greater than 10%
• Hospital admission for DKA or hyperosmolar syndrome

Question 23

What are lab goals for diabetics receiving insulin?

Answer 23

• A1c less than 7.5% in children and 7.0% in adults
• Fasting glucose 70 - 130
• Two hours post-meal less than 180

Question 24

If a diabetic is admitted to the hospital, stop _______________.

Answer 24

all non-insulin glucose-lowering agents