Insulin

Question 1

Other than being a treatment for T1D/T2D, what else can insulin be used to treat?

Answer 1

Acute hyperkalemia (drip should not only contain insulin but should contain glucose as well)

Question 2

What are general adverse effects of insulin?

Answer 2

1. Hypoglycemia (dose depends on level of physical activity, alcohol consumption, and stress)
2. Lipodystrophy at injection site (change injection sites)
3. Weight gain
4. Hypokalemia (activates Na/K-ATPase pump)

Question 3

What are examples of rapid acting insulin?

Answer 3

Lispro, aspart, and glulisine

Question 4

What are examples of long acting insulin?

Answer 4

Glargine, detemir, degludec (ultra long acting)

Question 5

What is the duration for rapid acting insulin?

Answer 5

Onset of action- 15 min
Peak effect- 1 hr
Duration of action- 2-4 hrs

Question 6

What is the duration for short acting insulin?

Answer 6

Onset of action- 30 min
Peak effect- 2-4 hours
Duration of action- 5-8 hours

Question 7

What is the duration for intermediate insulin?

Answer 7

Onset of action- 2 hours
Peak effect- 6 hours
Duration of action- 12-16 hours

Question 8

What is the duration for long acting insulin?

Answer 8

Onset of action- 2 hours
Peak effect- no peak
Duration of action- 20-26 hours

Question 9

T/F: rapid acting insulin is basal insulin

Answer 9

False; rapid acting represents bolus insulin since it mimics insulin after meals while NPH,detemir, and glargine represent basal insulin since they tend to last long

Question 10

T/F: Most insulins are a concentration of 100units/mL

Answer 10

True, this can be termed as U100

Question 11

What are characteristics of basal insulin?

Answer 11

1. Given once a day usually
2. Covers the body’s 24 hour insulin needs in the fasting state or between meals (decreases hepatic glucose production and ketogenesis)
3. Low risk of hypoglycemia

Question 12

What are characteristics of bolus insulin?

Answer 12

1. Usually given with a meal
2. Two functions
   - nutritional= reduce blood glucose rise with meals
   - correctional= rapidly correct hyperglycemia
3. Higher risk of hypoglycemia

Question 13

What is pre-mixed insulin?

Answer 13

• Basal and rapid acting insulin combined= typically 70/30 where 70 is basal and 30 is bolus (regular or rapid)
• Given 2x a day before meals

Question 14

T/F: T1Ds need basal and bolus insulin

Answer 14

True

Question 15

When would a patient with T2D need insulin?

Answer 15

1. In cases of severe hyperglycemia where A1C> 9-10% despite trying oral meds
2. Hyperglycemia where oral meds are CI like if pt has CKD
   Note: typically start with basal first then see if they need bolus

Question 16

What is insulin dosing for T1D?

Answer 16

0.4-0.7 units/kg/day of basal and bolus

Question 17

What is insulin dosing for T2D?

Answer 17

1. If on basal and bolus give 0.5-2 units/kg/day
2. If basal only give 10 units daily or 0.2 units/kg/day

Question 18

How to adjust dose for basal and bolus insulin?

Answer 18

Basal- adjust based off fasting glucose levels (goal of 80-130 mg/dL)
Bolus- adjust based on glucose levels 2 hours after meals or glucose before next meal (goal of <180 mg/dL)

Question 19

How to adjust dose for premixed insulin?

Answer 19

Adjust morning (breakfast) dose based on pre-lunch and pre-dinner glucose. Adjust evening (dinner) dose based on post dinner, bedtime, and/or morning fasting glucose