DM- Management Part 2 - Exam 4 Flashcards
What is the MOA of insulin? How is it classified?
mimics the effect of regular insulin.
Classified by time of onset and duration of action
Which type of insulin is considered to have less ideal timing and is less expensive
Non-analog insulins (regular, NPH)
What are common SE of insulin? What is the major one?
hypoglycemia**- MC
weight gain
inflammation
fibrosis
pain
lipohypertrophy
lipoatrophy
How are insulin pens dosed? What effect does alcohol have?
dosed in units
Alcohol - often causes hypoglycemia in insulin-dependent patients!
What are the 3 rapid acting insulins?
Insulin lispro (Humalog) / Insulin lispro-aabc (Lyumjev) - U100, U200
Insulin aspart (Novolog) / Insulin faster aspart (Fiasp)
Insulin glulisine (Apidra)
What is the rapid acting inhaled insulin?
Technosphere insulin (Afrezza)
______ is the short acting insulin
Human regular (Humulin R, Novolin R) - U100, U500
_____ is the intermediate acting insulin
Human NPH (Humulin N, Novolin N)
What are the 4 long acting insulin? Which 2 are ultra long?
Insulin detemir (Levemir)
Insulin glargine U100 (Lantus)
Ultra long:
Insulin glargine U300 (Toujeo) - ultra-long
Insulin degludec (Tresiba) - U100, U200 - ultra-long
**When is inhaled insulin CI? What are the major SE? What are the monitor requirements?
not for use in smokers or pts with chronic lung conditions
cough; possible increased risk of lung cancer
requires periodic PFTs - baseline, 6 mo, then yearly
What is the major advantages of premixed insulin?
advantage: fewer injections
disadvantage: less ability to adjust dose. NPH insulin can be harder to predict
Where are some common insulin injections site? What is the pt education?
arms, abdomen and thighs
need to rotate within each site but need to keep it within the site due to how the body metabolizes it to keep the dose steady
If the pt is carb counting, what is the recommended carb intake for males and females? meals and snack
What is the insulin recommendation?
Males - 60 g per meal, 30 g per snack
Females - 45 g per meal, 15 g per snack
1 U per 15 g of carbohydrate, PLUS
1 U for every 50 mg/dL of BG at pre-meal screening above a set goal (i.e., 120 mg/dL)
What is the dawn phenomenon? How do you correct it?
hyperglycemia in the morning
Nocturnal release of counterregulatory hormones (glucagon, epinephrine, cortisol) leads to increased glucose levels
Inadequate levels of insulin to balance increased glucose leads to AM hyperglycemia
“Down Insulin” -> need to increase insulin
What is the Somogyi Effect? How do you correct it?
due to excess amounts of exogenous insulin with evening dose
pt becomes hypoglycemic while sleeping and the body releases counterregulatory hormones
increased glucose levels in the AM leads to rebound hyperglycemia
“so much insulin”-> need to decrease insulin
Which cause of hyperglycemia in the morning, leads to the sugar bottoming out in the middle of the night?
somogyi effect
How do you tell the difference between the dawn phenomenon and somogyi effect? What do you expect for each?
Have patient wake up a few nights in a row to check his/her sugar at 3 am
Low readings - Somogyi Effect
Medium-high readings - Dawn Phenomenon
What is the Professor Jensen way to tell the difference between dawn phenomenon and somogyi effect? What do you expect for each?
try decreasing evening/bedtime dose of insulin
Hyperglycemia improves - Somogyi Effect
Hyperglycemia persists or worsens - Dawn Phenomenon
**If you are unsure if its the dawn phenomenon and somogyi effect, what should you NOT do?
If you aren’t sure - don’t increase insulin dose!
What are the general guidelines for a T1DM insulin dosing schedule?
Starting calculation of 0.5 U/kg - divided into two portions
50% - basal (long-acting) insulin dose
50% - bolus (rapid-acting or short-acting) - divided into 3 equal parts
Requires 4 injections/day (3 rapid-acting or short-acting, 1 long-acting) should also check BS 3-4 times a day
What are the recommendations to adjust your bolus insulin?
If BS is under 80 need to subtract 2 units from the injection prior
80-130 keep insulin the same.
BS over 130, add to units to your previous insulin injection
Which is considered the better choice, long acting insulin or NPH? Why?
long acting is better because it has better predictable absorption and LESS hypoglycemia,
long acting is dosed QD
NPH is dosed BID
Is rapid acting or regular insulin preferred? Why?
rapid acting is preferred because it has more predictable absorption
Shorter duration of action - less “leftover” hypoglycemia
regular: has less predictable absorption
but can give IV
more hypoglycemia
How many injections is premix dosing? How many BS checks?
BID
2-3 BG check a day