General
Which pen needs to be primed 3 times?
Toujeo Solostar Pen
How long to keep the needle under the skin for Flexpen?
6 seconds
Which insulin is cloudy?
Insulin NPH
State 3 important counselling points.
1. Use a proper insulin syringe.
2. Avoid rubs and massages after administering medication.
3. Avoid exercising immediately after administration.
What is the difference between storage of sealed and opened insulin?
Sealed: Refrigerate (2-8 ̊C). Do not freeze!
Opened: Store in a cool, dry place at room temperature
Where to inject to get the fastest absorption
Abdomen/ outer upper arms/ top upper thighs/ BUTTOCKS
What is the difference prandial and basal glucose?
Prandial is elevated between meals whereas basal is constantly elevated
What are the 3 steps to do before injecting insulin
1. Alcohol swab the area of injection
2. Pinch the area to be injected
3. Inject at 90 degrees
If a patient's basal glucose is high, which long-acting insulin should a patient use and how many times a day?
Insulatard, Insulin Glargine (Toujeo/Lantus), Levemir
State and explain a side effect.
Any 1 us fine
Hypoglycaemia (due to direct introduction of insulin without food)
Weight gain (4kg increment within 10 years)
Lipohypertrophy (bulging of adipose tissue due to inflammation from repeatedly using the same injection site)
Toujeo Solostar 24u BD X3/52 (1.5mL Pen). Calculate how many pens to dispense to the patient.
Calculation by dose:
Total dose = (24+3) x 2 x (3x7) = 1134u
Pen supply = 1134/450 = 2.52 (~3 pens)
Calculation by shelf-life:
Pen supply = (3x7) / (4x7) = 0.75 (~1 pen)
Hence, to dispense 3 pens to patient.
State all the steps for insulin mix
1. Draw in air equal to dose of cloudy insulin
2. Insert needle into vial of cloudy insulin and inject air into bottle. Ensure that the tip of the needle does not come into contact with the insulin
3. Take needle out and draw in air equal to dose of clear insulin
4. Put needle into clear insulin and inject air. Ensure that the tip of the needle does not come into contact with the insulin.
5. Invert bottle of clear insulin and draw out exact dose
6. Re-insert needle into cloudy insulin and draw out dose (amount of insulin in syringe = amount of clear insulin + cloudy insulin)
Patient’s glucose level spikes above baseline after eating a meal, suggest an appropriate insulin therapy to be given.
Rapid acting/ short acting
Demonstrate how to use Solostar insulin pen
Goodluck
Ms Angela, 28 y/o, no other medical conditions and not taking any other mediations. Has been urinating more frequently, feeling thirsty and hungry throughout the day even after eating a meal.
HbA1c = 11.8%
Fasting Blood Glucose = 9.6 mM
Postprandial Glucose = 8.6mM
Suggest a suitable insulin therapy to be given. (Brand name not required)
intermediate/ long acting