Diabetes (Slide Deck 3)

Question 1

Which cells secrete insulin?

Answer 1

B Cells

Question 2

What is cleaved to produce insulin + C-peptide?

Answer 2

Proinsulin

Question 3

What are the three ways one could take insulin?

Answer 3

• Syringes
• Pen needles
• Continuous subcutaneous insulin infusion (CSII)

Question 4

What are the two types of pancreatic functions that’s release insulin?

Answer 4

Basal (Long term)
Bolus (Fast term)

Question 5

What is the Onset of Insulin Aspart (NovoRapid) or biosimilars: Trurapi®Kirsty®)

Answer 5

9-20 minutes

Question 6

What is the onset of insulin glulisine (s)

Answer 6

9-20 minutes

Question 7

What is the onset of Insulin lispro (Humalog® U-100 & U-200 and biosimilar: Admelog® U- 100)

Answer 7

10-15 minutes

Question 8

What is the onset of Faster-acting insulin aspart (Fiasp®)

Answer 8

4 minutes

Question 9

What is the onset of insulin regular (humulin-R Novolin ge Toronto)

Answer 9

30 minutes

Question 10

What is the onset of Insulin regular U-500 (Entuzity® (U-500)

Answer 10

15 minutes

Question 11

When should Insulin regular (Humulin®-R, Novolin® ge Toronto, Hypurin R) be administered?

Answer 11

30-45 minutes prior to meal time to cover glucose excursions

Question 12

When are the RAIA administered?

Answer 12

0-15 minutes prior to meals.

Question 13

What is an advantage of RAIA vs short acting insulins?

Answer 13

More closely mimic endogenous insulin release

Question 14

What are the advantages of RAIA’s?

Answer 14

• Fasteronset
• Quickerpeak
• Shorter duration of action

Convenience and decrease hypoglycemia risk

Question 15

What is the importance of the Insulin Lispro as compared to other products?

Answer 15

Has a higher concentration of insulin, but the units that you are injecting on the dose knob will be the same as the 100 units/ml and 200 units/ml (The injections quantities will be different, but the concentration be the same)

Question 16

Who should use and what is Insulin regular U-500 (Entuzity® (U-500)?

Answer 16

Contains 500u/mL of insulin and is for those who require >200U/D

Question 17

What is the onset and duration of Intermediate-acting (cloudy) *Insulin neutral protamine Hagedorn (Humulin® N, Novolin® ge NPH)

Answer 17

1-3 hours and 18 hours

Question 18

What is the onset of, Insulin detemir U-100 (Levemir®), Insulin glargine U-100 (Lantus®); biosimilars: (Basaglar® Semglee®), Insulin glargine U-300 (Toujeo®), Insulin degludec U-100, U-200 (Tresiba®)

Answer 18

90 minutes

Question 19

What is the duration of U-100 glargine insulin?

Answer 19

24 hours

Question 20

What is the duration of detemir?

Answer 20

16-24 hours

Question 21

What is the duration of U-300 glargine

Answer 21

> 30 hours

Question 22

What is the duration of degludec

Answer 22

42 hours

Question 23

Which insulins do we need to hand roll and invert prior to injection?

Answer 23

Humulin N, Novolin NPG, Hypurin NPH

Question 24

Which insulin is dose dependant based off of weight?

Answer 24

Insulin Detemir

Question 25

How often is insulin Glargine U100 given?

Answer 25

OD or BID

Question 26

How often is Insulin NPH given?.

Answer 26

BID

Question 27

Which method of insulin injection is the least expensive?

Answer 27

Syringes and vials.

Question 28

What are two of the main adverse effects of insulin?

Answer 28

Hypoglycemia, weight gain

Question 29

What is a side effect that can occur when first starting Insulin?

Answer 29

Blurry Vision

Question 30

What are the 7 factors affecting absorption of insulin?

Answer 30

Exercise of injected area Massage Temp Lipohypertrophy (Fat) Dose Renal function Depth of injection

Question 31

Which insulins can be mixed and stored together?

Answer 31

R + NPH

Question 32

Which insulins can be mixed but must be administered immediately?

Answer 32

RAIA + NPH

Question 33

Which insulin cannot be mixed together?

Answer 33

LAIA

Question 34

How much will 1U of insulin decrease BG by?

Answer 34

2-3mmol over the next 2-4 hours

Question 35

When adjusting insulin what is the general rule of thumb?

Answer 35

Fix the lows first and then go from there

Question 36

If glucose is <4mmol/l overnight and is high in the morning this suggests?

Answer 36

Somogyi effect

Question 37

If glucose >4mmol/l in the morning, this suggests the

Answer 37

dawn phenomenon

Question 38

Somogyi Effect define

Answer 38

*Unrecognized nocturnal hypoglycemia that patient sleeps through; as a result the body ↑’s prod’n of counter-regulatory hormones & see rebound hyperglycemia Morning glucose less then 4mmol