Met 1: Insulin Therapy Flashcards
(25 cards)
How many units of insulin are secreted by a normal pancreas each day?
About 30
Is insulin only secreted in response to food?
No. There is a surge in response to food, but there is a base-line level of insulin released.
*This is why we give basal and bolus insulin
__ T1D and __ T2D patients need insulin
All T1D and some T2D need insulin
How can you determine if the insulin is exogenous or endogenous?
C-peptide!
C-peptide will be elevated only if it’s endogenous.
What are the three rapid acting insulins?
no LAG
- Lispro
- Aspart
- Glulisine
When are the rapid acting (no LAG) insulins given?
Just prior to a meal
What is the name of the inhaled insulin?
Name 1 pro and 1 con
Afrezza
Pro: Very rapid acting (given just before a meal)
Con: Only available in pre-set doses (4, 8, 12, etc)
Name the 2 “regular” insulins.
When are they given?
Humulin-R and Novolin-R
Given 30 minutes before meal
What are the intermediate insulins?
When are they given?
NPH insulin (Humulin-N, Novolin-N)
Given twice daily for basal coverage
Which insulin is CLOUDY?
NPH insulin
Name the 3 long-acting insulins.
When are they given?
Glargine (1x/day), Degludec (1x/day), Detemir (2x/day)
*all for basal coverage
Which insulins cannot be mixed in the same syringe with other insulins?
Long acting (glargine, degludec, detemir)
What is pre-mixed insulin?
What is one pro and one con?
Combines intermediate and short-acting insulin
Pro: Inject only twice per day to cover both basal and bolus needs
Con: can’t adjust doses
What is the purpose of basal insulin?
Suppress hepatic glucose production to maintain a normal fasting glucose
Why does the extra-concentrated version of insulin exist?
- Insulin absorption decreases as the volume of injection increases.
- So, if you have to inject a large volume b/c you take 100 units of insulin, it won’t get absorbed well
- A more concentrated solution will allow you to inject same # units in less volume, improving absorption
How much of total daily insulin should by basal?
50% basal
50% bolus
What is correction insulin?
What is the danger of correction insulin?
Insulin added to a meal dose to correct for any pre-meal HYPERglycermia.
Pts should be careful not to give more insulin before their current insulin has had time to work (ie stacking). If they do, they’ll become hypoglycemic
What is an appropriate insulin bolus?
All three meals should get bolus of
1/6*Total daily insulin dose + CF
What is the correction factor in insulin dosing?
Interpret CF of 30
CF (added to meal boluses) is the number of points you expect someone’s sugar to fall per unit of insulin administered. Based on insulin sensitivity
ie. With a CF of 30, BG should decrease by 30 points for every 1 unit insulin given
What is administered through an insulin pump?
Insulin pumps ONLY contain RAPID acting insulin
- Continuous infusion of rapid insulin given to create basal coverage
- You program how much to give before each meal
What is the idea of an artificial pancreas?
A continuous glucose sensor detects your blood sugar and then the pump adjusts your insulin accordingly.
Currently, we only have versions that CANNOT account for meals
Name 4 conditions for T2D that would require insulin therapy
- Lifestyle changes and other meds don’t achieve target A1c
- Contraindications to other medications (renal, liver dysf, CHF)
- Signs of insulin deficiency (weight loss, really bad blood sugars)
- Hospital admission for diabetes
What is the target for:
fasting BG
2 hr post meal BG
A1c
- Fasting BG: 80-130
- 2 hr post meal BG: under 180
- HbA1C: less than 7
Should you eliminate hypoglycemia or hyperglycemia first?
eliminate HYPOglycemia
b/c hypoglycemia causes rebound high BG
