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Pharm T1DM
Endocrinology Type I DM
| Question | Answer |
|---|---|
| Name the rapid acting insulins | Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra) |
| What is the duration of rapid-acting insulin? | 3-5 hours; peak is under 1 hour |
| What type of insulin is REGULAR? | Short-acting; duration 3-6 wtih a peak of 2-3 hours |
| When should rapid acting insulin be dosed? | within 15 minutes of a meal. Glulisine can also be dosed wtihin 20 minutes after starting a meal. |
| Name the two Regular/short acting insulin options | Novolin and Humulin |
| When should short acting insulin be dosed? | It is for meal coverage, so dose within 30 minutes of a meal |
| What can be used as rescue insulin? | Short-acting or regular |
| What is the advantage of a pump | it mimics an actual pancreas's response to insulin |
| Why is regular insulin rarely given in outpatient situations? | higher risk for hypoglycemia b/c it stays in the body longer |
| NPH is what type of insulin? | Basal. High risk of hypoglycemia |
| Glargine and Determir are considered _______ insulins | long-acting peakless insulin |
| Which insulins are available OTC? | Regular and NPH |
| What type of insulin is used in insulin pumps? | Only rapid |
| IV insulin is always | regular |
| What type of insulin is NPH? | Basal, intermediate acting. Onset is 2-4 hours, so not good for acute Blood glucose lowering action |
| How is NPH dosed in T1DM? | Typically injected twice daily (breakfast and supper). Patients must eat lunch b/c that is when the peak it. |
| Which is the only insulin that is good past 30 days? | Levemir (detemir) - 42 days |
| How should Levemir (detemir) be dosed initally? | Once a day; most type I patients will need twice a day. For type II, just 1 dose. |
| Long acting insulin is often dosed when? | At night. Once a day. |
| NPH is dosed at breakfast is out of the body by ______. | Supper |
| Which insulin is the only true intermediate insulin? | NPH |
| Regular insulin is used as a _____ | bolus |
| What age group of T1DM pts requires the greates total daily dose/kg of insulin? | Pubertal. 1.5u/kg/day |
| What is the 50/50 rule? | Split total daily dose of insulin into 50% basal and 50% bolus. |
| If you are using NPH as basal, how do you adjust bolus? | Increase amount of bolus by 20% and titrate up as needed. |
| In a regular type I patient, how much does 1 unit of bolus change blood glucose? | 50mg/dL |
| In an insulin resistant patient, how much does 1 unit of bolu change blood glucose? | 25-30mg/dL |
| In an insulin sensitive patient, how much does 1 unit of bolus typically change blood glucose? | 70-100mg/dL |
| If a patient has a frequent low blood glucose, how do you adjust TDD? | decrease by .5 units |
| After insulin, diet and exercise, what can you give Type I patients? | Insulin sensitizers - Biguanide and glitazone |
| Type I patients can also take | Amyin agonist - pramlintide |
| What is the MOA of Amylin | Increases satiety |
| In a type I patient taking Pramlintide, how do they adjust their meal-time insulin? | Decrease by 50%. 15mcg of Pramlintide before every meal initially, and then increase dose every 3-7 days as tolerated to 60mcg |
| Black box warning of Pramlintide | TYPE 1: Insulin-induced severe hypoglycemia, typically occurs within 3 hours of dosing |
| AE's of Pramlintide | Nausea, Anorexia and hypoglycemia |
Created by:
ltm12