Insulin Needles + Continuous/flash monitoring Flashcards by Pierre Wadeie

What was the outcome of optimizing insulin injection technique and its effect on BG control study? A1C? FBG? TDD?
As effective as which drug?

A1C lowering of 0.58%
FBG lowered by 0.77 mmol/L
TDD lowered by 2 units
- almost as effective as a DPP-IV inhibitor

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How often should you be checking their injection technique?

chronically checking

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T/F insulin therapy causes complications such as blindness, amputations, or the need for dialysis

False

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How long should make sure patients are consistently testing blood sugars before initiating insulin?

One month

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What questions are important to ask a patient before counselling

Prime questions
HAMS
Patient’s understanding of insulin

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Define trypanophobia

Extreme fear of needles/pointed objects, or fear of any type of injection

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What does a true phobia of needles consist of?

A vasovagal response
- increase in HR and BP followed by a rapid drop
- rare but exists

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What are the 4 types of phobias? Explain them

Associative phobia
- eg. knowing someone who had a bad experience

Resistant phobia
- history of being held down or forced to get injections

Hyperalgesia
- Extreme pain with injection

Vicarious phobia
- just seeing the needles

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What are strategies for:
Resistant phobia
Hyperalgesia phobia
Vicarious phobia

Resistant phobia
- let patients self-inject and gain control

Hyperalgesia phobia
- use EMLA cream or topical lidocaine to help numb the area

Vicarious phobia
- use small needles
- use injection tools that can shield needle from view

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Define gauge

Diameter or thickness of the needle

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What is the trend of increasing gauge #
Thinner/thicker needle

the thinner the needle

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If you are administer larger insulin doses, do you need a small or larger gauge needle

Need a smaller gauge.
- thicker needle to allow for a larger volume of insulin

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What is the common length of needles used in most body types for insulin?

4-5mm

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What is the average human skin thickness?

2mm

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Can we accommodate a 4mm length to reach SC tissue without penetrating muscle tissue?
Or do we need to pinch

We can accomodate

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Which is more painful, BG testing with lancets OR injections using 4-5mm needles? Why?

BG testing with lancets are more painful
- longer than 4-5mm

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What is a good point to tell patients to reduce their fears on needles

Fine needles are the width of 2 human hairs

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Why are needles only for one-time use? If patient’s cannot afford and need to re-use, what is the max?

They are coated with a one-time SILICONE LUBRICANT for smoother insertion

Money problems
- use only 3x

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Most needles have universality with pens and a “screw-on thread type” except which needle? Which pens can they be used on and what type are the needles?

NOVOTWIST needles
- “twist & click”

only on Novo Nordisk pens

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What is the thin-walled technology of needles allow for?

less thumb force
less painful injections
easier to insert
can give full dose in less time
allows for 31% higher insulin flow

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What is the use of bevel shaped needles? Which pen needles have 5 vs standard 3

Increased # of bevels = more easily enter into skin and reduce pain for patients

BD pen needles

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What are most needle compositions made of?

Nickel covered in silicone

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What do flat injection base needle allow for? How to minimize bruising here?

Allows for more comfortable injection
- to minimize bruising: do not push the top “hub” into the injection site

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What is most likely the cause of insulin allergies? Which insulins don’t have this?

Preservatives (cresol and metacresol)
- GLP-1 agonists don’t have this

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Which pen is easier to push the button for patients with arthritis?

Novo Naordisk Flextouch

Which refillable pen has the most features such as a memory function and half unit dosing?

Eli lilly - HumaPen Memoir/Novo Nordisk Echo

What type of pen is ozempic?

Disposable pen + attachable needle device

Where should insulin be stored?

If not used = in fridge 2-8 degrees If using - can leave room temp for approx 1 month for less painful injections (depends on insulin type)

Which part of the needle cap do you save for safe needle disposal

Big outer needle cap

How often do you prime an insulin pen? GLP-1 agonist?

Insulin pen - prior to each insulin dose GLP-1 agonist - only prime with opening the box first-time

What kind of delivery system is a pen?

Hydraulic delivery system

Why is holding the pen 6-10 seconds vital?

Injection process is much slower with a pen - guaranteed to under-dose themselves - pressing the plunger only begins the delivery

How to prime NPH or mixed insulins

Suspensions - need to mix it - roll 10x and tip 10x and check for consistent and milky appearance

If the insulin is a solution, what should you check for?

Clear and colourless

What does it mean when the display stops at a certain number

Cartridge coming to an end

When should you split insulin doses? Why? (5)

Dose of 50 units+ - larger doses may delay absorption - better BG control - easier use of pen - less irritation with injection - less force required Can use the same needle for the 2 injections

Which injection sites have the slowest absorption?

Buttocks and outer thighs

If patients do get bruising and bleeding in the injection site, what is it associated with?

Injection technique NOT needle length or injection site

T/F you need to clean sites with alcohol wipes or swabs

False - makes it more painful

What is the preferred area of injection for pregnant women?

Abdomen

Define lipohypertrophy

a thickened area of tissue that can grow and develop over time where REPEATED injections of insulin are given

What are consequences of lipohypertrophy? (3)

- associated with repeated unexplained hypoglycemia - reduce absorption of insulin by 40% - Use more insulin units

When do you give glucagon

- the patient is unconscious - the patient is unable to orally take sugar - patient is having a seizure - repeated oral sugar not working

What does the glucagon injection contain?

un-reconstituted glucagon powder and syringe - need to mix content before giving

Glucagon nasal spray can use if patient has cold? Can you give a second spray?

Can use if patient has cold? - Yes Can you give a second spray? - Yes

What are the 2 types of continuous glucose monitoring systems

Real time (personal) - provides BG info directly to user - has alarm notifications Blinded (professional) - does not display BG readings - downloaded onto computer for analysis with HCP

What are benefits of CGM

- increased glucose testing - A1C reduction - less variability in glycemic levels - more confidence to prevent hypoglycemia - less time in hypoglycemia - increased patient engagement and QOL

How often are glucose data transmitted in Dexcom G7? Is it in real-time?

every 5 minutes Real-time

Define flash BG monitoring. real time?

Patient must scan the sensor in order to "pull" data forward to be seen - not in real time, 10-15 minute delay

Who should NOT use freestyle libre? (5)

- critically ill patients (may be inaccurate) - Pregnant women - dialysis patients - patients on pacemakers - Severe deyhdration or excessive water loss during times of illness (do CBGM)

What are interfering substances to freestyle libre? how does it effect BG reading? (2)

1. Ascorbic avid - falsely elevate it 2. Salicylic acid - may slightly lower it - ASA 81mg is OK

Can you wear the libre during MRI and CT

How often do the libre sensors measure BG readings and store it? What happens when it is scanned?

Sensor measures glucose levels every minute - stores readings every 15 minutes When you scan - transmits data from the last minute, even if that data has not yet been stored

Where can the sensors be placed

ONLY on back of arm

What to do if you perform intense exercise and sensor loosens due to sweat?

Can use - tegaderm - skintac - large bandaids Does NOT affect accuracy

How long does the sensor have the memory ability for?

can show results for the past 8 hours

What do you have to do in the first 24 hours of the sensor?

Tends to run lower - need to perform CBGM as needed

What does the arrow in the top right of the meter tell you?

The direction of where your BG levels are going

What does it mean when LO & HI appear on the meter?

LO - <2.2 mmol/L HI - over 27 mmol/L

What does the freestyle libre ambulatory glucose profile AGP display?

Collapses data from several days/weeks as if they occurred in a 24 hour period - good to see data as they will see info that they have never seen before

What does the glucose management indicator tell you on the meter?

Approx what the patient's A1C level is likely to be

What is the acronym for reviewing the CGM data?

DATAA D download the data A Assess safety T time in range A areas for improvement A action plan

Insulin Needles + Continuous/flash monitoring Flashcards

(62 cards)