INSULINS

Question 1

RAPID acting insulin types (3)

Answer 1

1. insulin aspart/NovoLOG
2. insulin glulisine/Apidra/inhaled Afrezza
3. insulin lispro/HumaLOG/Lyumjev

Question 2

SHORT acting insulin types (2)

Answer 2

1. regular insulin OTC/HumuLIN R, NovoLIN R, ReliOn R
2. regular concentrated insulin Rx/Humulin R, Novolin R, HumuLIN R U-500.

Question 3

INTERMEDIATE acting insulin names

Answer 3

isophane suspension insulin/ HumuLIN N, NovoLIN N, Novolin N Prefilled, ReliOn N.

Question 4

LONG acting insulin types (3)

Answer 4

1. insulin detemir/Levemir
2. insulin degludec/Tresiba
3. insulin glargine/Basaglar, Lantus, Semglee, Toujeo SoloStar

Question 5

insulin MIXTURE types ((5)

Answer 5

1. insulin degludec-insulin aspart / Ryzodeg 70/50
2. insulin isophane suspension-regular insulin/ HumuLIN70/30, NovoLIN70/30
3. NPH regular insulin mixture/ Humalin 7/30, Novolin7/30
4. insulin lispro mixture/ HumaLOG Mix75/25, HumLOG mix 50/50
5. insulin aspart mixture/ NovoLOG70/30, NovoLOG Mix Flexpen Prefilled 70/30.

Question 6

insulin HOW IT WORKS

Answer 6

decreases blood glucose and allows cells to use glucose for energy

Question 7

insulin MECHANISMS OF ACTION

Answer 7

• activates transport of glucose into cells
• facilitates conversion of glucose to glycogen
• indirectly increases blood pyruvate and lactate
• decreases phosphate and potassium

Question 8

insulin INDICATIONS (3)

Answer 8

Type I DM (chronic/ pancreas produces no insulin)

Type 2 DM

Gestational diabetes

Question 9

how to STORE insulins

Answer 9

• Keep away from heat/sunlight.
• Some can be stored at room temp for less than one month
• Regrigerate
• NPH and Premixed insulins should appear CLOUDY
• Regular, Rapid, and Long acting insulins should appear CLEAR
• do not freeze

Question 10

For administration of insulins, which type of syringes should be used?

Answer 10

ONLY insulin syringes with markings matching units/mL.

Question 11

Which types of insulins should appear as CLOUDY suspensions?

Answer 11

1. Premixed and 2. NPH (neutral protamine Hagedorn) insulins

(trout semen)

Question 12

which types of insulins should appear as CLEAR, colorless liquids? (3)

Answer 12

1. regular human insulin
2. rapid acting
3. long acting

Question 13

Is it OK to mix insulins when using a CSII pump?

Answer 13

NO

Question 14

To prevent FATAL hypoglycemia & hypokalemia, which labs should be monitored often when regular insulin is being given IV?

Answer 14

BLOOD GLUCOSE

SERUM POTASSIUM

Question 15

Common side effect of insulin use

Answer 15

hypoglycemia

Question 16

What are the SOMOGYI and DAWN EFFECTS

Answer 16

post hypoglycemic HYPERglycemia or hyperglycemia upon waking… clinical research is mixed

Question 17

insulin glulisine/Apidra/Afrezza ONSET, PEAK, DURATION

Answer 17

15-30 min onset

30min-90min peak

3-4hr duration

RAPID ACTING

Question 18

insulin aspart/Novolog ONSET, PEAK, DURATION

Answer 18

onset 10-20min

peak 1-3hr

duration 3-5hr

RAPID ACTING

Question 19

insulin lispro/Humalog ONSET, PEAK, DURATION

Answer 19

onset 15-20 min

peak 30 min- 90 min

duration 3-5hr

RAPID ACTING

Question 20

insulin regular ONSET, PEAK, DURATION

Answer 20

onset 30 min

peak 2.5-5hr

duration up to 7hr

SHORT ACTING

Question 21

insulin isophanse suspension NPH

ONSET, PEAK, DURATION

Answer 21

onset 1.5-4hr

peak 4-12hr

duration < 24hr

INTERMEDIATE acting

Question 22

insulin degludec/Tresiba

ONSET, PEAK, DURATION

Answer 22

peak 9-12 h

duration 24hr after 8 doses?

this is a ONCE-DAILY insulin - but is considered INTERMEDIATE acting???

takes 3-4 days to achieve steady state

Question 23

insulin detemir/ Levemir ONSET, PEAK, DURATION

Answer 23

onset 0.8-2hr

peak UNKNOWN??

duration _<_24h dependent upon concentration

LONG ACTING

Question 24

insulin glargine/Basaglar, Lantus, SemGlee, Toujeo Solostar PEAK, ONSET, DURATION

Answer 24

onset 90 min

peak not identified

duration greater than >24h

LONG ACTING

Question 25

which blood tests will be used to identify effectiveness of insulin therapy?

Answer 25

Fasting Blood Glucose HbA1c q3m

Question 26

Signs of HYPOglycemic reaction

Answer 26

* sweating * weakness, dizziness * chills * confusion * headache * rapid pulse * anxiety, tremors, slurred speech, hunger "Cold and clammy, need some candy"

Question 27

How are insulin requirements affected by STRESS, including illness or surgery?

Answer 27

Insulin requirements may INCREASE during times of stress

Question 28

Signs of HYPERglycemia

Answer 28

* acetone breath * polyuria * flushing * dry skin * lethargy "Hot and dry, sugar high."

Question 29

What should the nurse assess in patients receiving insulin therapy?

Answer 29

FBG/CBG HbA1c urine ketones during illness look for decrease in polyuria, polydipsia, & polyphagia to indicate therapeutic response

Question 30

What are three important points of patient teaching about insulin?

Answer 30

1. **Keep insulin equipment available at all times**, with candy or oral glucose and glucagon kit 2. **Recognize HYPOglycemic reaction**: headache, tremors, fatigue, tachycardia; **and HYPERglycemic reaction:** polyuria, thirst, flushing, dry skin, lethargy. (Cold and clammy, need some candy; hot and dry, sugar high) 3. How to use **blood glucose testing** equipment

Question 31

Insulin times of onset from fastest to slowest

Answer 31

TIMES OF ONSET 1. insulin ASPART **15**min 2. insulin GLULISINE **15**min 3. insulin LISPRO **15**min 4. regular insulin 30-60 min 5. insulin DEGLUDEC 1h (ultra long acting) 6. insulin DETEMIR 1-2hr (long acting) 7. insulin GLARGINE 1-2h (long acting) 8. insulin ISOPHANE suspension/NPH onset 2-4h (intermediate acting)

Question 32

Who are the three fast gals?

Answer 32

glulisine aspart lispro

Question 33

which insulin is ULTRA LONG ACTING (up to 42 hours)?

Answer 33

insulin degludec

Question 34

which long acting insulin has a typical duration of 24 hours

Answer 34

insulin glargine/Lantus

Question 35

which long acting insulin has a duration ranging from 6-24h?

Answer 35

insulin detemir/Levemir