Insulins

Question 1

Name the types of insulin and label them by generic name.

Answer 1

1. Rapid-acting (Lispro, glulisine, aspart)
2. Regular
3. NPH
4. Long-acting (Detemir, Glargine)

Question 2

When do you administer a bolus dose of regular insulin?

Answer 2

30 min before meals

Question 3

When do you administer Lispro?

Answer 3

15 min before a meal

Question 4

When do you administer aspart and glulisine?

Answer 4

10 min before a meal

Question 5

Which type of insulin is considered a basal insulin but has a moderate duration of action and variable peaks?

Answer 5

NPH

Question 6

Which basal insulin has a long duration because it forms a precipitate inside the body.

Answer 6

glargine

Question 7

Which basal insulin has a long duration because it binds to albumin.

Answer 7

detemir

Question 8

Converting _____ to detemir is a 1:1 conversion.

Answer 8

NPH

Question 9

Converting _____ to detemir requires a 20% reduction to achieve an equivalent dose.

Answer 9

glargine

Question 10

What type of insulin is AFrezza? How does it act?

Answer 10

1. It is regular human insulin

2. It acts like a rapid-acting insulin

Question 11

How is Afrezza supplied/dosed?

Answer 11

4 and 8 unit cartridges, allowing them to be dosed in intervals of 4.

Question 12

When converting to Afrezza from a injectable bolus insulin, how do you determine the correct dose?

Answer 12

1:1 conversion…Always round up to the next factor of 4 (if the dose is 5 round to 8, if it is 15 round to 16)

Question 13

What is the one contraindication of AFrezza?

Answer 13

chronic lung disease

Question 14

When mixing insulins, which do you draw first?

Answer 14

rapid or regular (clear)

Question 15

Mixed insulin should be stored where?

Answer 15

Refrigerator

Question 16

Which 2 insulins should never be mixed?

Answer 16

glargine and detemir

Question 17

What are the available sites for insulin injection from most rapid to least rapid absorption?

Answer 17

1. Abdomen
2. Arm
3. Hip
4. Thigh
5. Buttocks

Question 18

How do you prevent lipodystrophy?

Answer 18

rotate injection sites

Question 19

What are some ADR of insulin Tx?

Answer 19

1. hypoglycemia
2. weight gain
3. injection site reactions
4. lipodystrophy

Question 20

Hypoglycemia is considered and BG less than _____?

Answer 20

70mg/dL

Question 21

What are the symptoms of hypoglycemia?

Answer 21

1. Autonomic (sweating, intense hunger, palpitations, tremor, tingling, anxiety)
2. Neuroglycopenic (lethargy, confusion, agitation, weakness, dizziness, fainting)

Question 22

What are some risk factors for hypoglycemia?

Answer 22

1. Reduced food intake
2. Renal/Hepatic dysfunction
3. alchohol
4. hypoglycemic unawareness
5. reduced food intake

Question 23

What are some treatment options for hypoglycemia?

Answer 23

1. glucose tablets (preferred)
2. OJ, hard candy, regular soda
3. Glucagon if patient is semi-conscious (train family/caregivers)

Question 24

How much weight does a typical patient gain when initiating insulin?

Answer 24

6.5-9kg (14-20lbs)

Question 25

_______ can cause adipose tissue degeneration and accumulation.

Answer 25

Lipodystrophy

Question 26

Injection site reactions can include...

Answer 26

bruising, allergic rxns, cutaneous eruptions