RxPrep Diabetes Part 3 (Insulin Background/Dosing/Calculations)

SC

What is the most common route of administration for insulin?

IV

What route of administration is less commonly used for insulin but used for acutely high blood glucose?

high-alert

A(n) ________ medication has a high risk of causing patient harm and requires extra care during handling and administration.

human errors

Insulin is a high-alert medication primarily due to ________.

misreading measurements,

skipping meals,

wrong dose,

wrong frequency,

wrong insulin type,

wrong strength

What are 6 human errors that often occur with insulin that makes it a high-alert medication?

basal, rapid-acting

What 2 types of insulin are called insulin analogs?

a

What type of insulin is glargine?

a) basal

b) intermediate-acting

c) rapid-acting

d) short-acting

a

What type of insulin is detemir?

a) basal

b) intermediate-acting

c) rapid-acting

d) short-acting

a

What type of insulin is degludec?

a) basal

b) intermediate-acting

c) rapid-acting

d) short-acting

a

Which basal insulin is ultra-long acting?

a) degludec

b) detemir

c) glargine

a

What type of insulin is "peakless"?

a) basal

b) intermediate-acting

c) rapid-acting

d) short-acting

3-4 hours; ≥24 hours

Basal insulin has an onset of ________ and duration of ________.

fasting glucose

Basal insulin mainly impacts ________.

b

What type of insulin is NPH?

a) basal

b) intermediate-acting

c) rapid-acting

d) short-acting

1-2 hours; 4-12 hours; 14-24 hours

Insulin NPH has an onset of ________, peak at ________, and duration of ________.

b

What type of insulin has a variable, unpredictable duration of action?

a) basal

b) intermediate-acting

c) rapid-acting

d) short-acting

b

What type of insulin has a peak that can cause hypoglycemia?

a) basal

b) intermediate-acting

c) rapid-acting

d) short-acting

protamine

The "P" in insulin NPH is for ________, which helps to delay absorption/extend the duration of effect.

c

What type of insulin is aspart?

a) basal

b) intermediate-acting

c) rapid-acting

d) short-acting

c

What type of insulin is lispro?

a) basal

b) intermediate-acting

c) rapid-acting

d) short-acting

c

What type of insulin is glulisine?

a) basal

b) intermediate-acting

c) rapid-acting

d) short-acting

c

What type of insulin provides a bolus dose, similar to the pancreas releasing a burst of insulin in response to food?

a) basal

b) intermediate-acting

c) rapid-acting

d) short-acting

15 minutes; 1-2 hours; 3-5 hours

Rapid-acting insulin has an onset of ~________, peak at ________, and duration of ________.

d

What type of insulin is regular insulin?

a) basal

b) intermediate-acting

c) rapid-acting

d) short-acting

d

What type of insulin can be given as a bolus at mealtimes but has a slower onset and lasts longer than needed for a meal?

a) basal

b) intermediate-acting

c) rapid-acting

d) short-acting

30 minutes; 2 hours; 6-10 hours

Regular insulin has an onset of ________, peaks at ~________, and duration of ________.

regular insulin U-500

very concentrated insulin; has same onset as regular insulin U-100 but duration is closer to NPH

inhaled

________ insulin is not used commonly and is a mealtime insulin with fast absorption.

hypoglycemia, hypokalemia

What are 2 warnings associated with injectable insulin?

lipoatrophy, lipohypertrophy, weight gain

What are 3 side effects of injectable insulin?

lipoatrophy

loss of subcutaneous fat at the insulin injection site (which disfigures the skin)

lipohypertrophy

accumulation of fat lumps under insulin injection site

rotate injection site

What can be done to avoid lipoatrophy and lipohypertrophy due to insulin injections?

10; 3

Most insulin vials are ________ mL, and most insulin pens are ________ mL.

100

Insulin concentrations are ________ units/mL, unless otherwise noted.

true

True or False: Insulin vials/pens should not be shaken.

false

True or False: Insulin vials/pens can be frozen to extend their shelf life.

refrigerator

How are unopened insulin vials/pens stored?

room temperature

How are unopened insulin vials/pens stored?

true

True or False: Insulin pen devices should never be shred, even if the needle is changed, due to the risk for transmission of blood-borne pathogens.

rapid-acting, regular

What 2 types of insulin can be mixed with NPH in the same syringe?

clear

Regular insulin is (clear/cloudy).

clear

Rapid-acting insulin is (clear/cloudy).

cloudy

Insulin NPH is (clear/cloudy).

last

When mixing NPH with another insulin in the same syringe, is NPH drawn up first or last?

Novolog

What is the brand name for insulin aspart?

Humalog

What is the brand name for insulin lispro?

5-15 minutes; before

Rapid-acting insulin should be injected ________ (after/before) meals.

c, d

What type of insulin is used as prandial insulin to prevent high blood glucose from a meal and for correction doses when blood glucose is high? (select all that apply)

a) basal

b) intermediate-acting

c) rapid-acting

d) short-acting

sliding scale

Rapid-acting insulin correction doses are often dosed by a(n) ________.

lung disease

What is a contraindication for inhaled insulin?

FEV1

Inhaled insulin requires lung monitoring with what pulmonary function test?

Humulin R, Novolin R

What are 2 brand names for regular insulin?

false (Rx and OTC)

True or False: Regular insulin is available by prescription only.

30 minutes; before

Regular insulin should be injected ________ (after/before) meals.

regular

What type of insulin is preferred for IV infusions, including in parenteral nutrition?

non-PVC

IV regular insulin should be prepared in a(n) ________ container.

5

Concentrated regular U-500 insulin is ________ times as concentrated as regular insulin.

>200

Concentrated regular U-500 insulin is only recommended when patients require ________ units of insulin per day.

true

True or False: All patients using the U-500 insulin vial must be prescribed U-500 insulin syringes to avoid dosing errors.

false (should not be mixed w/ any other insulin)

True or False: Concentrated regular U-500 insulin can be mixed with insulin NPH.

Humulin N, Novolin N

What are 2 brand names for insulin NPH?

true

True or False: Insulin NPH is available by both prescription and OTC.

BID

How often is insulin NPH typically dosed?

Levemir

What is the brand name for insulin detemir?

Lantus, Toujeo

What are 2 brand names for insulin glargine?

QD

How often is basal insulin typically dosed?

100

Lantus is ________ units/mL.

300

Toujeo is ________ units/mL.

100 units/mL, 200 units/mL

What 2 concentrations is Tresiba FlexTouch available in?

Tresiba

What is the brand name for insulin degludec?

NPH; regular

Humulin 70/30 and Novolin 70/30 are 70% ________ and 30% ________ insulins.

15 minutes

If a 70/30 insulin mixture contains rapid-acting insulin, it should be injected ________ before a meal.

30 minutes

If a 70/30 insulin mixture contains regular insulin, it should be injected ________ before a meal.

first; second

In premixed insulins, the percentage of NPH insulin is listed (first/second) and the percentage of short- or rapid-acting insulin is listed (first/second).

24 units

60 x 0.3 = 18

20 x 0.3 = 6

18 + 6 = 24

A 35 YOF injects Humulin 70/30 60 units before breakfast and 20 units before dinner. What is her TDD of regular insulin?

meglitinides, sulfonylureas

Avoid the combination of insulin with ________ or ________ due to risk of hypoglycemia.

pramlintide

The mealtime insulin dose must be reduced by 50% when starting ________ to avoid severe hypoglycemia.

NPH, premixed 70/30, regular

What 3 types of insulin are available OTC?

GLP-1 agonist

If an injectable medication is needed to reduce the A1C in type 2 diabetes, a(n) ________ is preferred and should be considered first.

>10; ≥300

Insulin is considered to initially treat type 2 diabetes when A1C is ________% or blood glucose is ________ mg/dL.

basal

What type of insulin is added on first when initiating insulin for the treatment of type 2 diabetes?

10; 0.1-0.2

When initiating basal insulin for the treatment of type 2 diabetes, it should be dosed at ________ units daily or ________ units/kg/day.

fasting plasma glucose

What are basal insulin doses titrated based on when treating type 2 diabetes?

prandial

If fasting plasma glucose is not at goal after initiating basal insulin for the treatment of type 2 diabetes, ________ insulin should be added to the regimen.

4; 10

When adding a prandial insulin to basal insulin for the treatment of type 2 diabetes, dosing should be started at ________ units or ________% of the basal dose once daily prior to the largest meal.

prandial blood glucose

What are prandial insulin doses titrated based on when treating type 2 diabetes?

full basal/bolus regimen, mixed insulin regimen

What are 2 courses of action if A1C is still not at goal when treating type 2 diabetes with both basal and prandial insulin?

basal insulin QD + prandial insulin before each meal

What does a full basal/bolus insulin regimen consist of?

BID NPH + short/rapid self-mixed or premixed

What does a mixed insulin regimen consist of?

insulin

All people with type 1 diabetes require treatment with ________.

long-acting basal, rapid-acting

What 2 types of insulin are preferred when treating type 1 diabetes?

0.5

The typical starting dose for insulin for type 1 diabetes is ________ units/kg/day.

total body weight

What body weight is used to dose insulin in type 1 diabetes?

50; 50

Commonly, ________% of the total daily dose of insulin is administered as basal insulin and ________% as prandial insulin for type 1 diabetes.

21 units Lantus QD; 7 units Humalog TID before meals

84 x 0.5 = 42

42 / 2 = 21 units basal insulin

21 / 3 = 7 units bolus insulin

Start a basal-bolus regimen with Lantus and Humalog in a patient with type 1 diabetes that weighs 84 kg.

false (neither has a profile that can mimic the natural insulin release from the pancreas)

True or False: NPH and regular insulin regimens are preferred for treating type 1 diabetes.

2/3; 1/3

When using a mixed insulin regimen to treat type 1 diabetes, ________ of the total daily dose is given as NPH and ________ is given as regular insulin.

prior experience w/ multiple daily insulin injections

What is a requirement for switching to an insulin pump?

rapid-acting;

bolus, continuous

Insulin pumps deliver ________ insulin by two complementary methods, ________ and ________ dosing.