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Insulin
Injectable DM Drugs Insulin
| Term | Definition |
|---|---|
| What is the three main functions of insulin? | 1- converts glucose --> glycogen 2 - enhance the uptake of glucose by muscle cell 3- regulates converting glucose --> fat --> store it in the adipose tissue |
| Which insulin formulation is used to mimic the basal insulin/ mealtime insulin? | - basal insulin: long acting or intermediate acting insulin - mealtime: rapid or short acting |
| list the names of rapid acting insulin? | - aspart - novoLOG - lispro - humaLOG - glulisine - soloStar - afrezza inhaler |
| What is the recommended timing for dosing rapid acting insulin? | - given within 15 min prior to meal 2/2 rapid acting with short duration - given immediately after the meal |
| What are the common warning of using rapid acting insulin? | ** hypoglycemia ** HYPO KALEMIA ** renal/hepatic |
| What are the most common side effects of rapid acting insulin? | - Wt gain - LIPODYSTROPY - injection reaction - peripheral edema |
| What is the suffix for Rapid Acting insulin? | LOG |
| When is the use of rapid acting inhaler Afrezza C/I? | - Asthma - COPD - Chronic lung ds |
| Which Rapid acting insulin needs detailed medical history, physical examination, and spirometry FEV1 prior to initiation? | The rapid acting insulin inhaler -- Afrezza 2/2 - BBW of acute bronchospasm in pt with chronic lung ds - warning of reduction in pulmonary function FEV1 , lung cancer and DKA |
| What are some common side effect while using Afrezza? | - cough - throat pain |
| What is the main monitoring parameter for the use of Afrezza? | FEV1 - pulmonary function test |
| Which cases is the use of Afrezza NOT recommended? | - pt who smokes - pt who recently stops smoking |
| What are the available concentration of Lispro? | - HumaLOG kwikPen 100 units/ml - HumaLOG kwik Pen 200 units/ml |
| list the names of short acting regular insulin? | - Regular insulin: 1- aspart: novoLIN -R/ novoLin-R ReliOn 2- lispro: humaLIN -R - concentrated Regular insulin: 1- Lispro: HumaLIN-R U-500 |
| What is the recommended timing for dosing Short acting regular insulin? | - 30 min prior to meal |
| Which insulin formulation can be used in IV solutions? | SHORT acting REGULAR insulin |
| which insulin are available without Rx? | -short acting regular insulin: NOVOLIN-R, HUMULIN- R - itermediate acting insulin: NPH ( HUMULIN-N, NOVOLIN-N) - Pre mixed insulins: HUMULIN 70/30, HUMULIN70/30 pen, NOVOLIN70/30 |
| When is HumuLINR U500 is indicated? | - 5X more concentrated than Humulin-R - when pt needs > 200 units/day - should be dispensed with U-500 syringe |
| Which insulin products can NOT be mixed with other insulin? | - short acting regular insulin: HumuLIN-R U500 - long acting insulin : detemir, glargine, degludec |
| What are some recommendations to avoid Humulin-R U-500 dosing errors? | - avoid using other syringes - avoid transfer pen- syringe - don't GIVE IT OTHER THAN SC |
| List the names of intermediate acting insulin products? | - NPH insulin: 1- HUMULIN-N, HUMULIN-N pen 2- NOVOLIN-N, NOVOLIN-N ReliON |
| What is the suffix for short acting regular insulin? | LIN-R |
| what is the suffix for intermediate acting insulin? | LIN-N |
| when mixing short or rapid acting with intermediate acting, what should be considered? | - draw the clear solution first |
| Which long acting insulin has acidic pH? | Glargine ( lantus) |
| Which long acting insulin causes sting feeling upon injection? | Glargine ( Lantus) 2/2 to acidic pH |
| list the name of long acting insulin products? | - detemir ( levemir) - glargine ( lantus, toujeo, basagl) - Degludec( tresiba) - |
| What is the common insulin conc of long acting insulin products? | - U100units/ml EXCEPT: TRESIBA : insulin degludec 200 units/ml and Toujeo ( glargine) 300 units/ml |
| what is the recommended dosing for short acting insulin? | - meal time dosing |
| what is the recommended dosing for intermediate acting insulin? | - once or twice a day |
| what is the recommended dosing for long acting? | once at bedtime OR 2x/day |
| when should Afrezza oral inhalation powder be replaced? | every 15 days |
| What are the individual components of the following pre mixed rapid and intermediate acting products? Novolog and Humalog 70/30 premixed | - NovoLog mix 70/30: 70 aspart protamine suspension and 30 aspart - HumaLog mix 75/25 : 75 lispro protamine suspension and 25 lispro - Humalog mix 50/50: 50 lispro protamine and 50 lispro ******************* |
| What are the individual components of the following pre mixed short and intermediate acting products? HumuLin and NovoLin 70/30 | - HumuLin 70/30: 70 NPH + 30 short acting regular lispro - Novolin 70/30: 70 NPH + 30 short acting regular aspart |
| What combination of drugs should never be used? | - insulin + SU + Meglitinides 2/2 hypoglycemia risk |
| What is the common insulin conc? and what are the exceptions? | - the common conc is 100 units/ml - exception: 1- rapid acting Humolog kwikpen 200unit/ml 2- short acting regular insulin: HumLIN-R U 500 3- long acting insulin: tresiba flex touch U200 and Toujeo solostar U300 |
| what is the common size of insulin vial? and what are the exceptions? | - 10 ml - except Humulin-R U 500 20 ml |
| what is the common size of insulin pen? and what are the exceptions? | - 3ml - except toujeo 1.5 ml |
| What is the route of insulin administration using insulin pump? | - SC |
| What insulin is used in insulin pump? | - short acting regular insulin LIN-R - rapid acting insulin Log |
| which pt population are good candidate for the use of insulin pump? | - type -1 - NOT appropriate for newly diagnosed pt |
| What is the recommended initial insulin dose for type-1 vs. Type-2? | - type 1: 0.6 units/kg/day using actual body wt - type II: 0.1-0.2 units/kg/day using actual body wt ( OR 10 units/day ) |
| what are the two insulin dosing strategies ? | - basal/ bolus strategy: 50% TDD basal long acting ( once at bed time) and 50% TDD bolus rapid ( the bolus is further divided into 3 x/day) - NPH/ regular strategy:2/3 NPH intermediate and 1/3 NPH short regular ( 2x/day together prior to meal) |
| Which insulin dose is usually adjusted based on the patient sensitivity and needs? | - mealtime ( bolus) - ICR: insulin to carb ratio allows bolus adjustment - ICR: is used to determine the # grams of carbs covered by the patient bolus |
| what is the rule of 500 in ICR? | - rapid acting: 500/TDD= grams of carbs covered by 1 units |
| what is the rule of 450 in ICR" | - short regular acting 450/TDD = grams of carbs covered by 1 unit |
| example of 500-ICR and 450-ICR? | - e.g: TDD is 60 u, insulin used: Novolog ( rapid acting) , 500-ICR = 500/60 - 500-ICR: 500/60= 8 gr carbs IF NovoLIN-R ( regular short): 450-ICR = 450/60= 7.5 gram carbs |
| What is the correction factor and correction dose insulin? | - it's the additional units of insulin ( correction dose) needed to bring the pt blood glucose to normal level - add the correction dose to the normal meal dose - other words: correction dose + daily meal dose |
| what is the difference between ICR and correction dose? | - ICR: determine # gram of carbs pt can take based on his/her TDD of insulin - Correction dose: # of insulin units added to the normal units of insulin given prior to meal to bring blood sugar to normal level |
| what is the 1800 and 1500 correction factor rules ? | - 1800 for shot acting insulin; 1800/TDD= correction factor - 1500 for rapid acting insulin; 1500/TDD=correction factor |
| What is the correction dose? | - the correction dose= blood glucose now - target blood glucose / correction factor - the correction dose is then added to the normal daily dose |
| correction dose example: pt on Novolin-R 60 units. BG target 130 and current is 180; what is the correction dose? | - calculate correction factor for regular insulin= 1800/60= 30 - correction dose= 180-130/30= 2 units - the total dose admin = normal daily dose + correction dose = 60+2= 62 units |
| When is it recommended to start insulin in type II DM? | - A1c> 10% - TG> 300 - pt fails multiple regimens - start pt on 0.1-0.2 units/kg/day or 10 units/day - increase by 10-15% or 2-4 units once or twice/ week - basal-bolus still can be used if A1c is not controlled |
| What is the common conversion ratio for most insulin products? | - 1:1 except 1- NPH ( intermediate) BID --> long acting ONCE= use 80% of TDD 2- long acting Toujeo U300 ONCE --> long acting U100 ONCE = use 80% of TDD |
| what are some counseling point a pt should know while using insulin suspension and/or pen? | - for suspension: DO not shake - pen: invert 4-5X |
| What are some counseling point a pt should know while mixing insulin? | - draw the clear insulin first - recommends injecting air into the cloudy insulin , then inject air into the clear insulin before drawing |
| What is the best site for insulin SC injection/administration? | - The abdominal area: best absorption |
| what is the angle of insertion for insulin SC injection? | - 90 unless pt is thin 45 |
| what are some counseling point pt should know about insulin SC injection? | - rotate the site of injection - |
| why should the pt wash hand with warm water prior to testing and dry hand very well? | - warm water: increase the blood circulation - dry hand: as water can cause reading error |
| what are some tips pt can follow to minimize finger pain while testing? | - lance the finger on the side; fever nerves - keep hand below the heart level |
| what are some other alternative testing sites? | - forearm - thigh - palm |
| what is the stability of insulin injectable drugs? | - if unopened and refrigerated: stable until the expiration date - room temperature, different stability ; product specific |
| what is the stability of the following injectable insulin medications at room temperature? 1- Afreezza, humalog 50/50, humulin 70/30: 2- xultophy 100/3.6 3- symlin, victoza and byetta pen 4- novolin R U100, toujeo, levemir vial/pen | 1-10 days 2- 21 days 3- 30 days 4- 42 days ( 6 weeks) |
| Which injectable insulin medication has the least stability at room temp? and which medication has the longest duration of stability? | - shortest: Afrezza if opened ( 3 days) - longest: tresiba pen ( 56 days) |
| What is the recommended size/volume of syringe for insulin injections? | - use the smallest syringe that can hold the dose - the smaller the easier to read the scale - draw up the correct dose |
| What is the size of the syringe to inject the following # of insulin units? 1- less than 30 2- 30-49 3- > 50 | 1- <30 --> use 0.3 ml 2- 30-49 --> use 0.5 ml 3- > 50 --> use 1.0 ml *** if humuLin-R U 500: use the U500 syringe |
| When the 1/2" needles is recommended? what other sizes? | - obese pt - leakage of drug after removing the needle other sizes: 1/2", 5/16, 3/16, 5/32 |
| Which multi-dose pens do NOT include needles? | 1- FlexPEN: 2- KwikPEN: humalog, humulin basglar 3- FlexTouch: levemir/ tresiba 4- SoloStar : toujeo/ lantus 5- GLP-1 agonist: byetta/ victoza, Adlyxin 6- Pramlintide: symlinPEN |
Created by:
Smoham38
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