OnlineMedEd: Endocrinology - "Insulin Management"

Question 1

Why do you give a basal insulin rate?

Answer 1

Physiologically the body has a static amount of insulin. The basal rate replaces that.

Question 2

You’re supposed to give the rapid-acting insulin ____________.

Answer 2

before meals

Question 3

The long-acting insulins both start with _____.

Answer 3

L (at least the trade names do)

Levemir
Lantus

Question 4

What’s the difference between Humalin and Humalog?

Answer 4

Humalog is rapid-acting insulin. Humalin is a mixture of rapid-acting and long-acting (usually written as 70/30 or 50/50).

Same applies to Novolog/Novolin.

Question 5

It’s recommended that diabetics use the long-acting insulin when?

Answer 5

Before bed

Question 6

How should you add insulin to a type II diabetic’s medication regimen?

Answer 6

• First, start with 0.1 U/kg of long-acting
• Second, if their A1c is not in the desired range, then add a bolus for the biggest meal of the day.
• Third/fourth, if the A1c is still not less than 7%, then add boluses for lunch and breakfast.

Question 7

Go through the recommendation for how patients should check their blood glucose, give insulin, and eat.

Answer 7

• First, they should check their blood glucose.
• Second, they should bolus insulin.
• Last, they should eat.

If they don’t eat they should not give insulin!!

Note: the blood glucose is a reflection of what they last ate and how effective the previous dose of insulin was at controlling their blood glucose.

Question 8

What is the formula for doing total daily insulin (TDI) in the hospital?

Answer 8

• First, calculate total requirements in 0.5 U/kg
• Second, give half as basal QHS.
• Third, give half as a bolus, divided into three before each meal.

Question 9

Describe sliding scale.

Answer 9

Sliding scale is the method of checking blood glucose and then giving insulin based on how high it is. It’s not ideal because it’s reactive rather than proactive.