RxPrep Diabetes Part 4 (Insulin Administration/BG Monitoring/Hypoglycemia/Hyperglycemia/Etc.)

100

Most insulin products contain ________ units/mL of insulin.

10

Insulin comes in vials, usually containing ________ mL.

3; 1.5

All insulin pens contain ________ mL of insulin, except for Toujeo which is also available in a(n) ________ mL size.

reduces injection volume

Why is concentrated insulin useful?

regular insulin U-500

The concentrated insulin that comes in both a pen and a vial is ________, which has higher risk.

Humalog KwikPen, Lyumjev KwikPen

What are 2 rapid-acting concentrated insulins?

200

Rapid-acting concentrated insulin is available as ________ units/mL.

Humulin R U-500

What is a brand name for short-acting concentrated insulin?

500

Short-acting concentrated insulin is available as ________ units/mL.

Toujeo SoloStar, Tresiba FlexTouch

What are 2 brand names for long-acting concentrated insulin?

200

Tresiba FlexTouch is a long-acting concentrated insulin available as ________ units/mL.

300

Toujeo SoloStar is a long-acting concentrated insulin available as ________ units/mL.

true

True or False: Tresiba FlexTouch U-100 and U-200 pens would both be dialed to 80 units to deliver an 80 unit dose.

>200

Humulin R U-500 insulin is useful for patients taking ________ units/day.

4 pens

35 x 30 = 1050

1050 / 300 = 3.5

If a patient is taking 35 units of Lantus daily, how many Lantus SoloStar pens would be dispensed to provide a 30-day supply?

refrigerator

How are unused insulin vials, pens, and cartridges stored?

manufacturer's expiration date

What is the expiration date of insulin that's been stored in the refrigerator?

room temperature

How are opened/used insulin vials, pens, and cartridges stored?

28 days

Most insulin is stable at room temperature for ________.

10 days

What is the room temperature stability of Humalog Mix 50/50 and 75/25 pens?

10 days

What is the room temperature stability of Humulin 70/30 pens?

14 days

What is the room temperature stability of Humulin N pens?

14 days

What is the room temperature stability of Novolog Mix 70/30 pens?

28 days

What is the room temperature stability of Apidra, Humalog, Novolog, Admelog, Lyumjev, and Fiasp vials?

28 days

What is the room temperature stability of Apidra, Humalog, Novolog, Admelog, Lyumjev, and Fiasp pens?

28 days

What is the room temperature stability of Humalog Mix 75/25 vials?

28 days

What is the room temperature stability of Novolog Mix 70/30 vials?

28 days

What is the room temperature stability of Novolin R U-100, N, and 70/30 pens?

28 days

What is the room temperature stability of Humulin R U-500 pens?

28 days

What is the room temperature stability of Lantus, Basaglar, and Semglee vials?

28 days

What is the room temperature stability of Lantus, Basaglar, and Semglee pens?

31 days

What is the room temperature stability of Humulin R U-100, N, and 70/30 vials?

40 days

What is the room temperature stability of Humulin R U-500 vials?

42 days

What is the room temperature stability of Novolin R U-100, N, and 70/30 vials?

42 days

What is the room temperature stability of Levemir vials?

42 days

What is the room temperature stability of Levemir pens?

56 days

What is the room temperature stability of Tresiba pens?

56 days

What is the room temperature stability of Toujeo pens?

<30

0.3 mL insulin syringes are for volumes that are ________ units.

30-50

0.5 mL insulin syringes are for volumes that are ________ units.

51-100

1 mL insulin syringes are for volumes that are ________.

green

What color are U-500 insulin vial caps and syringe needle covers?

orange

What color are U-100 insulin syringe needle covers?

thinner

The higher the pen needle gauge, the (thicker/thinner) the needle.

shorter; higher

(Longer/Shorter) and (higher/lower)-gauge pen needles cause less pain.

4; 5

The shortest pen needles are ________ mm and ________ mm in length and are preferred for most insulin pens.

false

True or False: 4 mm and 5 mm pen needles require the skin to be pinched during administration.

true

True or False: 8 mm pen needles are long enough for most patients and require the skin to be pinched up before injecting.

false

True or False: 12.7 mm (1/2) inch pen needles do not require the skin to be pinched up before injecting.

BD

What is a common brand for insulin pen needles and syringes?

true

True or False: Insulin pens containing NPH or protamine should be inverted to resuspend the suspension.

2

Prior to each insulin pen needle injection, prime the needle by turning the knob to ________ unit(s), face the needle away from you, and press the injection button.

clear; cloudy

If mixing NPH and regular or rapid-acting insulin in the same syringe, the (clear/cloudy) insulin should be drawn into the syringe before the (clear/cloudy) insulin.

abdomen

At what injection site is insulin best absorbed?

2-inch

With insulin needles >5 mm, gently pinch a(n) ________ portion of skin between your thumb and first finger.

90

Insulin pens are injected into the skin at a(n) ________º angle.

90; 45

Insulin syringes are injected at a(n) ________º angle for most or ________º angle if the patient is thin.

5-10 seconds

When injecting insulin, count ________ before removing the needle.

false (should do this to prevent skin damage)

True or False: Insulin injection sites do not have to be rotated.

sharps disposal container

Where should used insulin needles, syringes, single-dose pens, and lancets be disposed of?

blood glucose monitoring

refers to patients tracking their blood glucose using a glucose meter or a continuous glucose monitor

interstitial fluid

Continuous glucose monitor probes provide measurements of the glucose level in the ________.

true

True or False: Glucose meter test strips should be kept in the original container with the cap closed.

side of fingertip (less painful)

Where should you prick the finger with a lancet when checking your blood glucose?

forearm, palm, thigh

What are 3 alternative glucose testing sites approved by some glucose meters?

steady

Alternative testing sites are only useful when the blood glucose is (fluctuating/steady).

after eating, after exercise, suspected hypoglycemia

What are 3 times when alternative blood glucose testing sites should not be used?

<70

Hypoglycemia is defined as a blood glucose of ________ mg/dL.

fall

What is a severe consequence of low blood glucose?

cognitive impairment

Each hypoglycemia episode contributes to irreversible ________.

anxiety, confusion, hunger, irritability, palpitations, shakiness, sweating, tremors

What are 8 symptoms of hypoglycemia?

coma, death, seizures

What are 3 things severe hypoglycemia can cause?

glucose

What is preferred to treat hypoglycemia?

take 15 g glucose; recheck BG after 15 minutes; if hypoglycemia continues take 15 more g glucose and recheck after 15 minutes; once BG is normal eat a small meal or snack

What is the "rule of 15"?

rule of 15

What method is used to treat hypoglycemia?

dextrose; glucagon

When oral treatment is not possible for hypoglycemia, treat with ________ if IV access is available or with ________ if IV access isn't available.

1 mg SC injection, nasal spray

Caregivers of someone at high risk for hypoglycemia should know how to use what 2 glucagon preparations?

lateral recumbent

If using glucagon to treat hypoglycemia in an unconscious patient, place the patient in a(n) ________ position to protect the airway and prevent choking when consciousness returns.

insulin

What is the primary cause of drug-induced hypoglycemia?

meglitinides, sulfonylureas

What 2 drug classes are high-risk for causing hypoglycemia?

glimepiride, glyburide

What 2 sulfonylureas are not recommended in the elderly due to hypoglycemia risk?

DPP-4 inhibitors, GLP-1 agonists, SGLT2 inhibitors, thiazolidinediones

What 4 diabetes drug classes have a low risk for hypoglycemia when used alone?

1 serving glucose gel, 1 tbsp sugar/honey/corn syrup, 3-4 glucose tablets, 4 oz juice, 4 oz regular soda, 8 oz milk

What are 6 examples of 15 g of simple carbs that can be used to raise blood sugar when treating hypoglycemia?

alcohol

________, especially if taken on an empty stomach, can cause hypoglycemia when used with insulin or sulfonylureas.

beta-blockers; non-selective

________, especially if (non-selective/selective), can cause hypoglycemia and mask adrenergic symptoms of hypoglycemia.

hunger, sweating

What 2 hypoglycemia symptoms are not masked by beta-blockers?

beta-blockers, quinolones

What 2 drug classes can cause either hypoglycemia or hyperglycemia?

tramadol

What non-diabetes drug can cause hypoglycemia?

antipsychotics, cough syrup, cyclosporine, loop diuretics, niacin, protease inhibitors, statins, steroids, tacrolimus, thiazide diuretics

What are 10 drugs/classes that can cause hyperglycemia?

olanzapine, quetiapine

What are 2 examples of antipsychotics that can cause hyperglycemia?

140-180

The target blood glucose range for most non-critical and critical care patients in the hospital is between ________ mg/dL.

false (this is discouraged)

True or False: The use of sliding scale insulin alone to control blood glucose in the hospital setting is encouraged.

insulin

What is used to treat most hospitalized patients with diabetes?

basal/bolus/correction dose regimen

What regimen is preferred to treat patients with diabetes in the hospital when oral intake is adequate?

insulin sensitivity factor; correction factor

A hospitalized patient's correction dose scale is designed based on the patient's ________, which is the same as the ________.

rapid-acting, regular

Inpatient insulin sliding scales and correction doses use what 2 types of insulin?

rapid-acting

What type of insulin is preferred for inpatient insulin sliding scales and correction doses, rapid-acting or regular?

diabetic ketoacidosis

life-threatening crisis with high blood glucose, ketoacidosis, and ketonuria

1

Diabetic ketoacidosis is most common in type (1/2) diabetes.

diabetic ketoacidosis

________ is commonly the initial presentation in type 1 diabetes or caused by insulin non-adherence or subtherapeutic insulin dosing.