Class 11 Deck 1

Question 1

What are the rapid acting insulins?

Answer 1

• Lispro (humalog)
• Aspart (Novolog)
• Glulisine (apidra)

Question 2

What are the Short acting insulins?

Answer 2

-Regular (Humulin R / Novolin R)

Question 3

What are the Intermediate acting insulins?

Answer 3

-NPH (Humulin N / Novolin N)

Question 4

What are the long acting insulins?

Answer 4

-Glargine (Lantus)

Detemer (Levimir)

Question 5

Alpha stimulation does what to insulin secretion?

Answer 5

-Decrease secretion

Question 6

Beta / Parasympathetic stimulation does what to insulin secretion?

Answer 6

-Increase secretion

Question 7

Insulin response to glucose is_______ for oral ingestion than for I.V. infusion.

Answer 7

Greater

Question 8

What is the onset, peak, DOA, and critical hypoglycemia time for Lispro (humalog)

Answer 8

• 15 minutes
• 30-90 minutes
• 3-5 hours
• 1/2 to 1 & 1/2 hours

Question 9

How does Lispro compare to regular insulin in pump administration?

Answer 9

• Better glyccemic control

- Less hypoglycemia

Question 10

Which insulin is clear, has a neutral PH and contains a small amount of zinc?

Answer 10

-Regular (Humulin R, Novolin R)

Question 11

Regular insulin does what when SQ injected?

Answer 11

-It forms hexamers, that must dissociate into monomers before it can be absorbed

Question 12

What is the onset, peak and DOA of regular insulin?

Answer 12

• Onset = 30-60 min
• Peak = 2-4 hours
• Duration 5-8 hours

Question 13

How is regular insulin dosed perioperatively?

Answer 13

• 1-5 units IV

- 0.5-2 units /hr infusion (50 in 50)

Question 14

Describe intermediate insulin.

Answer 14

• Humulin N and Novolin N
• Turbid solution w/ neutral PH
• Contain protamine which delays absorption

Question 15

Can Humulin N or Novolin N be given IV?

Answer 15

No, SQ only

Question 16

What is the onset, peak and duration of intermediate insulins?

Answer 16

• Onset = 1-3 hrs
• Peak = 8 hours
• Duration = 12-16 hours

Question 17

What insulin is used as a basal insulin replacement?

Answer 17

-Long acting (Lantus, levemir)

Question 18

Can long acting insulins be given IV, mixed with other insulins?

Answer 18

No and No

Question 19

What is the PH of Long acting?

Answer 19

Acidic

Question 20

What is the onset, peak and duration of long acting?

Answer 20

• Onset = 1hr
• no peak
• 20-26 hours

Question 21

When is long acting administered and what might is cause?

Answer 21

• H.S

- nocturnal hypoglycemia

Question 22

What drug is a useful baseline for diabetics, and what drugs are they usually used with?

Answer 22

• Long acting

- Short acting or orals

Question 23

How are the all the insulins types dosed?

Answer 23

• Rapid/short = AC and HS
• Intermediate = BID
• Long = Daily

Question 24

What is the most serious side effect of insulin? and what is it related to?

Answer 24

• Hypoglycemia

- Compensatory effects of increased epinepherine

Question 25

What are the symptoms of hypoglycemia?

Answer 25

- Diaphoresis - Tachy - HTN - Mental confusion → Seizures → Coma

Question 26

What may mask the the correct diagnosis of hypoglycemia?

Answer 26

-Rebound hyperglycemia from SNS activity in response to hypoglycemia

Question 27

What are the allergic reactions associated with insulin?

Answer 27

-Redness at site if injection

Question 28

Chronic ______ administration may lead to the development of antibodies to protamine

Answer 28

NPH

Question 29

What is lipodystrophy? and how do you avoid it?

Answer 29

- Atrophy of fat at injection site | - rotating injection sites

Question 30

Define insulin resistance.

Answer 30

-Patients requiring more than 100 units per day | acute can be caused by trauma, surgery, infection

Question 31

How are hypoglycemic effects of insulin countered?

Answer 31

- ACTH or Glucocorticoids - Estrogen - Glucagon

Question 32

How does epinepherine effect insulin?

Answer 32

- Inhibits insulin secretion | - Stimulates glyconeogensis

Question 33

What is the normal Hgb A1c? What is the ADA reccomendation?

Answer 33

- 4-6% | - 7-8.5%

Question 34

What insulins can be given IV?

Answer 34

-Regular or Short acting

Question 35

How should multiple SQ insulin be given?

Answer 35

- 70% of total dose as intermediate or long acting at bedtime - Additional doses of rapid before meals/snacks

Question 36

What are the goals of insulin therapy?

Answer 36

- Maintain BG levels as close to normal as possibe | - Delay long term complications of DM

Question 37

What are the risks of periop hyperglycemia?

Answer 37

- Microangiopathy - Impaired leukocyte - Cerebral edema - Impaired wound healing - Post op sepsis

Question 38

What is desired more periop, High or low BG? and whay?

Answer 38

-High, because GA can mask hypoglycemia signs

Question 39

What is the optimal BG levels intraop?

Answer 39

- 80-180 | - <80

Question 40

How to dose patients preop with SQ insulin ( needing non-tight control)

Answer 40

-1/4 to 1/2 the AM dose of intermediate or long the morning of surgery (or decrease long acting PM)

Question 41

What is Dr. Shulkosky's insulin control dose?

Answer 41

- 1 unit regular for every 50-60 mg/dl of glucose

Question 42

What is the goal for larger/longer procedures? and why?

Answer 42

- BG 80-120 | - Improve healing, prevents infection, improves outcomes after CNS ischemia

Question 43

how to treat hypoglycemia?

Answer 43

-15-25ml of D50 and stop infusion

Question 44

Larger/longer procedures may require insulin drip, how much and when do you start?

Answer 44

- 0.05units/kg/hr (0.5-1unit/hr) | - Start at BG of 150

Question 45

How to treat patients w/ insulin pumps?

Answer 45

- Maintain basal rate - Turn off preprandial boluses - Measure q1 hour - Know typical bolus to decrease 50mg/dl