Insulin

Question 1

List some rapid acting insulins

Answer 1

These are given at the start of meals

E.g. Novorapid, Humalog

Question 2

List some short acting insulins

Answer 2

These are given 15-30 min before meals

E.g. ActRapid, Haumulin S

Question 3

List some intermediate acting insulins

Answer 3

Humulin I, Insulatard, Insuman basal

Question 4

List some long acting insulin

Answer 4

E.g. Lantus, Levemir

Given once daily

Question 5

What are the main insulin regimens?

Answer 5

Question 6

How would you adjust a basal bolus regimen?

Answer 6

• High/low before breakfast: -> increase/decrease the evening long-acting insulin
• High/low before lunch or dinner or bed: -> increase/decrease rapid-acting that is given with the meal before

Question 7

How would you adjust a twice daily regimen?

Answer 7

• High/low before bed and before breakfast: -> increase/decrease the evening insulin
• High/low before lunch and before evening meal: -> increase/decrease morning insulin

Basically adjust the insulin given before.

Question 8

What circumstances cause an increase in requirements?

Answer 8

Increased requirements:

• Sepsis
• If steroids are given
• Pancreatitis
• In states of dehydration

Question 9

What circumstances cause a decrease in requirements?

Answer 9

Decreased requirements:

• If reduced calorific intake
• Reduced renal function
• Alcohol

Question 10

What are the main insulin sick day rules?

Answer 10

• Increased frequency of blood glucose monitoring. Also should be able to check ketones.
• Increase fluid intake (>3 L/24 hours)
• If struggling to eat drink sugary drinks
• Continue to take normal insulin regimen
• Access to mobile phone has been shown to reduce risk of DKA