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PR - ENDOCRINE > INSULIN REGIMEN (T1) > Flashcards

INSULIN REGIMEN (T1) Flashcards

1
Q

When is insulin used?

A
  • Type 1
  • Type 2 if oral antidiabetic medication fails
  • Surgery
  • Hospitalisation for illness e.g. DKA
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2
Q

T1DM - first line treatment

A

Basal bolus regime
- Insulin determir bd
- Insulin aspart before meals

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3
Q

Types of insulin regimens

A

1.Basal-bolus insulin regimens
2. Biphasic regimen
3. Continuous subcutaneous insulin infusion (insulin pump)

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4
Q

Multiple daily injection basal-bolus insulin regimens (FIRST LINE)

A
  • 3 bolus injections of rapid acting insulin for meals
  • Once-twice daily background long acting insulin
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5
Q

Basal

A

Long/ intermediate acting insulin
OD or BD

  1. detemir BD
  2. second line = glargine OD
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6
Q

Examples of long acting

A

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

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7
Q

Bolus

A

Short/rapid acting before meals

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8
Q

Biphasic mixture

A

Short-acting mixed with intermediate injection
1-3 times a day

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9
Q

Which insulin regimens should NOT be recommended to patients newly
diagnosed with type 1 diabetes?

A

Non-basal-bolus regimens:
- Biphasic
- Basal-only
- Bolus-only

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10
Q

Continuous subcutaneous insulin infusion (insulin pump)

A

Regular or continuous amount of insulin (usually rapid acting insulin analogue or soluble insulin) delivered by a programmed pump and insulin storage reservoir via SC needle or cannula

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11
Q

When would you give continuous subcutaneous insulin infusion (insulin pump)

A
  • Disabling hypoglycaemia
  • Glycaemic control >8.5% despite optimised MIR
  • Children over 12 (MIR is impractical) BUT they must undergo MIR trial between 12-18
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12
Q

What factors require pt to increase insulin administration?

A

Infection
Stress
Trauma

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13
Q

What factors require pt to decrease insulin administration?

A

Physical activity
Intercurrent illness
Reduced food intake
Impaired renal function
Certain endocrine disorders (thyroid, coeliac, Addison’s)

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14
Q

Why is insulin give s/c

A

It is a protein which would be digested very quickly and inactivated by GI enzymes

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15
Q

Where is insulin administrated?

A

Injected into a body area with plenty of subcutaneous fat
- abdomen (fastest absorption rate)
- outer thighs/buttocks (slower absorption rate)

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16
Q

Why should you rotate the injection site?

A

Lipohypertrophy can occur due to repeated injection into the same area
leads to erratic absorption of insulin

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17
Q

What are the types of short acting insulin?

A

Soluble (short-acting) insulin
Rapid-acting insulin

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18
Q

Examples of soluble (short-acting insulin)

A

Animal: Hypurin porcine neutral
Human: Actrapid, Humulin S, Insuman Rapid

19
Q

Soluble (short-acting) insulin

A

Inject: 15-30 mins before meals
Onset: 30-60 mins
Peak action: 1-4 hours
Duration: up to 9 hours

20
Q

Soluble (short-acting) insulin counselling points

A

Must consume food within 30mins of injecting to avoid hypo
Can be given in diabetic emergencies + surgery

21
Q

Soluble (short-acting) insulin: side effects

A
  • Increased risk of hypo
  • Local reaction and fat hypertrophy at injection site can occur
22
Q

Rapid-acting insulin

A

Inject: immediately before meal
Onset: < 15 mins
Duration: 2-5 hours

Lower risk of hypo than soluble (short acting)
Alternative to soluble in emergency

23
Q

Examples of rapid-acting insulin

A

Lispro (Humalog)
Aspart (NovoRapid)
Glulisine (Apidra)
LAG - doesn’t lag

24
Q

Examples of Intermediate-acting insulin

A

Biphasic isophane, biphasic aspart / lispro (isophane insulin mixed with SA insulin)
Animal: Porcine isophane
Human: Insulatard, Humulin I, Insuman Basal

25
Intermediate-acting insulin
Onset: 1-2 hours Peak affect of 3-12 hours Duration: 11-24 hours Given in conjunction with short acting
26
intermediate-acting insulin counselling points
Roll in hands before administration to resuspend zinc-insulin particulate Never use IV (may block capillary; thrombosis)
27
intermediate-acting insulin side effects
- Never use IV (may block capillary; thrombosis) - Protamine may cause allergic reactions - Local reaction and fat hypertrophy at injection site can occur
28
Why should some insulins never be given IV
Particulate matter in suspension may lodge in the capillary beds of the lungs and the brain, leading to thrombus development
29
Examples of Long-acting insulin
Detemir (Levemir) Degludec (Tresiba) Glargine (Lantus, Abasaglar)
30
Long-acting insulin
Inject: OD (Detemir = BD) Onset: 2-4 days to reach steady state Duration: 36 hours
31
What patients are long-acting insulins better for
Insulin determir or insuline glargine is recommended for those: - require assitance injecting insulin - lifestyle if significantly restricted by recurrent symptomatic hypoglycaemia - would otherwise need BD basal insulin injection in combo with oral anti diabetic drugs - who cannot use device needed to inject isoprene insulin
32
Long-acting insulin counselling points
- Roll in hands before administration to resuspend zinc-insulin particulate - Never use IV (may block capillary; thrombosis) - Dont mix with soluble insulin - Use same time each day - to provide cover for 24H period - Clear liquids - potential for confusion with quick acting insulins
33
Long-acting insulin: side effects
- Local reaction and fat hypertrophy at injection site can occur
34
Biphasic insulin
- 1, 2 or 3 insulin injections per day of short acting MIXED with intermediate acting insulin - Preps may be mixed by pt or pre-mixed - More convenient - Less control as proportions are fixed
35
Examples of Biphasic insulin
NovoMix 30 30% insulin aspart, 70% insulin aspart protamine Humalog Mix 25 25% insulin lispro, 75% insulin lispro protamine Humulin M3 30% soluble human, 70% isophane human Insuman Comb 50 50% soluble human, 50% isophane
36
Benefits of biphasic insulins
Pt don't have to inject short- and long-acting insulins separately, good for poor dexterity and/or difficulty in measuring the insulins
37
Bisphasic insulin: side effects
- Protamine may cause allergic reactions. - Local reactions and fat hypertrophy at injection site can occur.
38
Acutely ill patients on biphasic insulins
- Can't use these biphasic mixtures to boost their insulin levels - Should ideally have short or rapid-acting insulins to use to manage their insulin requirement whilst being ill.
39
When do insulin requirements increase?
* Infections or intercurrent illness * Stress * accidental surgical trauma * Puberty * Pregnancy - 2nd/3rd trimester
40
When do insulin requirements decrease?
* Endocrine disorders e.g. Addisons disease, hypopituitarism * Coeliac disease (gluten intolerance) * Exercise * Reduced food intake * Impaired RF * Immediately after birth
41
Counselling - food
MIR - Adjust dose according to carbohydrate intake Biphasic - Regulate and distribute carbohydrate intake throughout day to match regimen
42
Interactions -HYPOglycaemia
Oral antidiabetics ACEi MAOIs Salicylates Beta blockers (masks symptoms) Alcohol
43
Interactions - HYPERglycaemia
Corticosteroids Diuretics Sympathomimetics (epinephrine, salbutamol, terbutaline) Thyroid hormones Oral contraceptives (oestrogen, progesterone)
44
Warning
Recurrent hypoglycaemic episodes - Sweating - Palpitations - Confusion - Drowsiness DKA - N + v - Drowsiness - Hepatotoxicity - Ulceration of foot tissue

PR - ENDOCRINE (25 decks)

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