Classifications
When should insulin therapy be started in patients with type 1? 2?
Type 1: started at time of diagnosis, need both basal and bolus
Type 2: can be at time of diagnosis if S/Sx are severe or A1C > or = 10% or BG > or =300, can add if non-insulin therapies fail, usually starts with basal
How fast is onset of rapid acting insulin? When should it be given and how long does it last?
give just before or after eating, lasts a few hours
What is the dose for initiating insulin in type 2 diabetes?
10 units daily or 0.1-0.2 units/kg/day
When do insulin dosages need to be increased for type 1? When should they check their sugar?
May need to increase during puberty, pregnancy, and illness
Should check BG at least fasting and pre prandial
What is the carbohydrate factor?
number of grams of carbohydrates that one unit of insulin will "cover"
500/TDD
For non-diabetics, what is a normal basal amount and what glucose level is maintained?
0.5-0.7 units/kg/day through a continuous release
40-160 mg/dL
How fast is onset of short/fast acting insulin? When should it be given and how long does it last?
within 30-60 minutes
give 30-45 minutes before eating, lasts a few hours
How should basal insulin be titrated?
Increase pts dose by 2 units every 3 days until target fasting glucose is reached
If patient experiences hypoglycemia, determine the cause. May need to decrease the dose 10-20%
What is the initiation dose for type 1?
0.5 units/kg/day
50% given as prandial/mealtime insulin and 50% given as basal
When is the carbohydrate factor used?
Used when the patient is carb counting
Best estimate for type 1 patients
What type of insulin is put into an insulin pump?
rapid acting
How fast is onset of intermediate acting insulin? When should it be given and how long does it last?
within 2-4 hours
Helps with control between meals, can be morning, bedtime or both, duration can depend
When and how do we initiate bolus insulin in type 2?
Can initiate in patients who remain above the A1C target despite titrating basal insulin and/or adding GLP-1
add prandial insulin starting at the largest meal of the day, start with 4 units per day or 10% of the basal dose
How often can insulin be adjusted? What are the 2 carbohydrate factors rules? What are the 2 correction factor rules?
no more than every 3-7 days
rule of 450 or 500
Rule of 1800 for rapid acting and 1500 for regular
What is the correction factor?
number of points of BG that drops for each unit of insulin
intended for type 1
Which insulins are considered bolus vs basal?
Bolus: rapid acting, short/fast acting
Basal: intermediate, long, ultra long, pre-mixed
How fast is onset of long acting insulin? When should it be given and how long does it last?
within 2-4 hours
Give usually in the morning or at night for a basal response, lasts up to 24 hours
How do we titrate bolus insulin in type 2 pts?
Increase dose by 1-2 units or 10-15% twice weekly
If patient experiences hypoglycemia, determine the cause. May need to decrease dose 10-20%
If NPH was selected as basal dose, may consider twice daily NPH
titrate as needed to maintain a post prandial BG <180
Who is inhaled insulin used for? When is it contraindicated?
Can be for type 1 or 2, considered mealtime/prandial
CI: any sort of chronic lung condition such as asthma, COPD and not recommended in smokers
When do we use the 1800 correction factor vs the 1500?
1800: rapid acting insulin
1500: regular insulin
When is pre-mixed insulin good to use? How do we initiate if pt is insulin naive?
Alternative to basal+bolus
Begin with 10-12 units or 0.3 units/kg/day divided into 2 doses
give 2/3 dose in AM and 1/3 dose in PM
How fast is onset of ultra long acting insulin? When should it be given and how long does it last?
within 6 hrs
administration depends and can last longer than 24 hours
What is a sliding scale? When is this used?
Insulin dosing based on the patient's current blood sugar
typically inpatient to help determine a patient's daily insulin requirement especially if they are a new diabetic or not compliant
What is concentrated insulin? How are their DOAs different? When is this considered?
Typically 2-5 more concentrated than U-100
U-500 has an onset like R but duration like N
Allows for higher doses per volume, typically not considered until the pt is using over 200 units/day due to high insulin resistance
How do we need to store insulin pens or vials?
Vials or pens should be stored in fridge
Once they are in use they can be stored at room temp for generally 28-30 days