9 Intro and Types of Insulin

What are the 4 principles of Diabetes Mellitus Treatment?

1. Complications of diabetes are avoided by keeping glucose levels tightly controlled

2. Healthy diet, exercise, tight control of BP and lipids also important; Calories can be important but varies depending on the person.

3. Type 1 patients require insulin replacement

4. Type 2 patients likely start with oral meds and may eventually need insulin replacement

What are the 3 glucose monitoring options?

• Fasting blood glucose levels

• Glycosylated hemoglobin (HbA1C)

• Continuous Glucose Monitoring (CGM)

True or False: All types of insulin can be given parenterally (IV, IM, SQ, TD).

True

True or False: All types of insulin are usually given IV, but only one type can be given SQ.

False

What are the different types of insulin?

• Rapid-acting

• Short-acting

• Intermediate-duration (slow acting)

• Long-duration (slowest acting)

• Ultra-long duration (ultra slow acting)

All types of insulin carry some risk of what complication with it being a higher risk in the shorter-acting forms?

hypoglycemia

What measurement is used for insulin?

units

Insulin is considered a high-alert drug, meaning what?

requires 2 RN signatures before administration

What is a rapid duration insulin example?

lispro insulin (Humalog)

When should Insulin Lispro (Humalog) be used/given?

before meals

What are the effects of Insulin Lispro (Humalog)?

• begin in ~15 mins

• peaks in 30 mins – 2 hrs

• duration up to 5 hours

What type of suspension does Insulin Lispro (Humalog) have?

clear

True or False: Insulin Lispro (Humalog) is available in U-100 & U-200.

True

How can Insulin Lispro (Humalog) be given?

only subq, never IV

What is a short duration insulin example?

regular insulin (Humalin R)

When should Regular Insulin (Humalin R) be used/given?

before meals and basal control

What are the effects of Regular Insulin (Humalin R)?

• begin <60 mins

• peaks in 1 -5 hrs

• duration up to 10 hrs

What type of suspension does Regular Insulin (Humalin R) have?

clear

How can Regular Insulin (Humalin R) be given?

subq or IV

True or False: Regular Insulin (Humalin R) requires a prescription.

False

What is a intermediate duration insulin example?

NPH Insulin (Humalin N)

When should NPH Insulin (Humalin N) be used/given?

twice daily for continued glucose control

What are the effects of NPH Insulin (Humalin N)?

• Effects begin in 1-2 hrs

• peaks 6 – 8 hrs

• duration up to 24 hours

What type of suspension does NPH Insulin (Humalin N) have?

cloudy

True or False: You should gently mix NPH Insulin (Humalin N) before drawing it up in a syringe.

True

True or False: NPH Insulin (Humalin N) can be mixed with short-acting insulins.

True

True or False: It is ok to draw NPH Insulin (Humalin N) when it is cloudy

False

True or False: Short Duration Insulins (ex: Regular Insulin [Humalin R] and Intermediate Duration Insulin (ex: NPH Insulin [Humalin N]) are available without a prescription.

True

What is a long duration insulin example?

insulin glargine (Lantus)

When should Insulin Glargine (Lantus) be used/given?

Once daily (usually at hs/bedtime)

True or False: Insulin Glargine (Lantus) is the best insulin to mimic basal control and come in U-100 in pre-filled pens

True

What are the effects of Insulin Glargine (Lantus)?

• No significant peak, steady all day

• Effects begin within 1 hour

• Duration ~24 hours

How can Insulin Glargine (Lantus) be given?

only subq, never IV

What is a ultra long duration insulin example?

Insulin Glargine (Toujeo) and Insulin Degludec (Tresiba)

The following describes which Ultra Long Duration Insulin?

• Used once daily

• U-300 (3 x concentrated) in pre-filled pens

• Mimics basal control

• No significant peak, steady all day

• Effects begin within 6 hrs

• duration > 24 hrs

• Only given subq, never IV

Insulin Glargine (Toujeo)

The following describes which Ultra Long Duration Insulin?

• Used once daily

• U-100 or U-200 in pre-filled pens

• Mimics basal control

• No significant peak, steady all day

• Effects begin < 90 min

• duration > 24 hrs

• Only given subq, never IV

Insulin Degludec (Tresiba)

If you want to advocate for a pt with low insulin to receive insulin long term, working over 24 hours, but need it to work asap, which insulin would you contact the provider about?

Insulin Degludec (Tresiba)