NAPLEX: Ch 44 Diabetes
What is the onset of afrezza?
15 min
What is the onset of insulin lispro?
15 min
When should rapid acting insulin be administered?
15 minutes before or at time of meal
What is the onset of concentrated insulin?
15-30 min
What is the onset of regular insulin?
15-30 min
What is the correction dose calculation for regular insulin?
1500 rule 1500/ TDD = correction factor for 1 u of insulin
What is the duration of NPH/Regular?
18-24 h
What is the correction dose calculation for rapid insulin?
1800 Rule 1800/ TDD = correction factor for 1 unit of insulin
What is the onset of degludec?
1h
What is the peak of lispro?
1h
What is the peak of NPH/Regular?
2-12 hours
What is the duration of lispro?
2-3 hours
What is the peak of regular insulin?
2.5-5 hours
What is the room temperature stability of Xultopathy 100/3.6?
21 days
What is the room temperature stability of Admelog vial and pen?
28 days
What is the room temperature stability of Apridra vial and pen?
28 days
What is the room temperature stability of Bydureon vial and pen?
28 days
What is the room temperature stability of Byetta pen?
28 days
What is the room temperature stability of Fiasp vial and pen?
28 days
What is the room temperature stability of Humalog 50/50 and 75/25 vials?
28 days
What is the room temperature stability of Humulin 70/30 vial?
28 days
What is the room temperature stability of Humulin N vial?
28 days
What is the room temperature stability of Humulin R U-500 pen?
28 days
What is the room temperature stability of Humulin R vials?
28 days
What is the room temperature stability of Lantus vial and pen?
28 days
What is the room temperature stability of Novolog 70/30 vial?
28 days
What is the room temperature stability of Novolog vial and pen?
28 days
What is the room temperature stability of Soliqua 100/33 pen?
28 days
What is the room temperature stability of Symlin pen?
28 days
What is the room temperature stability of Victoza pen?
28 days
What is the room temperature stability of basaglar pen?
28 days
What is the typical gauge size for insulin needles?
28-32 G
What is the room temperature stability of afrezza if opened?
3 days
What is the onset of detemir?
3-4 hours
What is the onset of glargine?
3-4 hours Lantus 6h Toujeo
What is the duration of aspart?
3-5 hours
What is the onset of NPH/Regular?
30 min
What is the duration of regular insulin?
4-12 hours
What is the peak of NPH?
4-12 hours
What is the peak of concentrated insulin?
4-8 hours
What is the room temperature stability of Humulin R U-500 vial?
40 days
What is the room temperature stability of Novolin 70/30 vial?
42 days
What is the room temperature stability of Novolin N vial?
42 days
What is the room temperature stability of Novolin R vial?
42 days
What is the room temperature stability of levemir vial and pen?
42 days
What is the room temperature stability of toujeo pen?
42 days
What is the room temperature stability of ozempic pen?
56 days
What is the room temperature stability of tresiba pen?
56 days
What is concentrated regular insulin? Brand name?
5x as concentrated as regular insulin, recommended when patients require >200 units/day Humulin R U-500
What is the duration of detemir?
6-23 hours
What is the duration of degludec?
> 24h
What is the duration of glargine?
>= 24 h
What is the best absorption site for insulin to be injected to?
Abdomen
What is a BBW for afrezza?
Acute bronchospasm in pts with asthma or COPD
What is a CI to insulin?
Acute hypoglycemia
What is a CI for afrezza?
Asthma, COPD
What non-DM medications can cause hypoglycemia?
BB Linezolid Lorcaserin (Belviq) Pentamidine FQs
Define hypoglycemia
BG <70
What are factors used to recognize DKA?
BG >250 Ketones Anion Gap >12 pH <7.35
What are factors to recognize HHS? Hyperosmolar Hyperglycaemic State
BG >600 High serum Osm >320 Extreme dehydration pH >7.3
How is basal insulin titrated once initiated in T2DM?
By 10-15% or 2-4 units once or twice weekly
What medications should be avoided in peripheral neuropathy?
Canagliflozin
What medications have cardiac benefits?
Empagliflozin Canagliflozin Liraglutide Semaglutide Exenatide
What is a monitoring parameter for afrezza?
FEV1- requires lung monitoring with pulmonary function test.
What medications should be avoided in gastroparesis or other GI disorders?
GLP-1 RA, pramlintide
in which treatment should insulin dose be decrease?
Hepatitis C treatment (direct active antivirals-DAAs) -the risk of hypoglycemia
What is the brand name of 70% NPH/30% Regular insulin?
Humulin 70/30 or Novolin 70/30
What are warnings associated with insulin?
Hypoglycemia Hypokalemia
What are considerations for afrezza?
Not recommended in patients that smoke Replace inhaler every 15 days
What is the insulin to carb ratio?
Patient specific and helps determine the units of insulin required to cover grams of carbs
What are ADRs for insulin?
Weight gain and lipodystrophy
lipodystrophy
a medical condition characterized by abnormal or degenerative conditions of the body's adipose tissue
Which medication increase risk of hear failure when given with insulin?
rosiglitazone (do not use together with insulin)
When to start insulin in type 2
when A1C>10% or BG >300 or if symptoms of catabolism are present (DKA)
which combination should be avoided insulin?
with sulfonylureas or meglitinides because of risk of hypoglycemia
What is the duration of NPH?
14-24 hours
What is the calculation for the correction dose?
(BG now) - (target BG) / Correction Factor
How much percentage of Pramlintide should be reduce for mealtime insulin when staring on pramlintide?
-50% to reduce hypoglycemia
which are preferred injectable in T2D?
-GLP-1 receptor agonist if not appropriate insulin can be started
Which combination can be given with insulin?
-SGLT2 inhibitors, GLP-1 agonists, TZD and DPP-4 inhibitors
If a patient injects <30 units of insulin what size syringe do they need?
0.3 mL
If a patient injects 30-50 units of insulin what size syringe do they need?
0.5 mL
How should insulin be initiated when using NPH and regular?
0.5 units/kg/day TBW 2/3 NPH and 1/3 Regular
How should insulin be initiated in T1DM?
0.5 units/kg/day TBW divided 50% basal, 50% bolus then bolus divided by 3 for mealtime
What is the peak of insulin aspart?
0.5-3h
If a patient injects >= 50 units of insulin what size syringe do they need?
1 mL
What is the onset of NPH?
1-2 hours
What are the treatment steps for hyperglycemia crisis?
1. Fluids - Start NS until BG <=200 then switch to D5W1/2NS 2. IV Insulin (regular) - 0.1 u/kg bolus, then 0.1 u/kg/hr 3. Potassium 4. Bicarb is pH <6.9
What size pen needle should be used in obese patients?
1/2 inch
What is the room temperature stability of Humalog 50/50 and 75/25 pens?
10 days
What is the room temperature stability of Humulin 70/30 pen?
10 days
What is the room temperature stability of afrezza if unopened?
10 days
What is the onset of insulin aspart?
10-30 min
What is the duration of concentrated insulin?
13-24 hours
What is the room temperature stability of Adlyxin?
14 days
What is the room temperature stability of Humulin N pen?
14 days
What is the room temperature stability of Novolog 70/30 pen?
14 days
What is the room temperature stability of Trulicity?
14 days
What medications have the biggest decrease in A1c? (>1%)
Insulin Metformin SUs TZDs GLP-1RA
What is the Rule of 500?
Insulin to carb ratio for RAPID insulin 500/ TDD = g carbs covered by 1 unit insulin
What DM medications are high risk for hypoglycemia?
Insulin, SU, meglitinide
What medications are associated with weight gain?
Insulin, SUs, TZDs, meglitinides
What multidose pens do NOT include needles?
Insulin: - Flexpens - Kwikpens - Flextouch - Solostar GLP-1RA - Byetta - Victoza - Adlyxin Pramlinitide
What type of insulin is NPH? Brand names?
Intermediate insulin Humulin N, Novolin N
What type of insulin is glargine? brand name?
Long acting Lantus, Toujeo
What type of insulin is degludec? brand name?
Long acting Tresiba
What type of insulin is detemir? brand name?
Long-acting Levemir
What medications should be avoided in CrCl <30?
Metformin, SGLT2, exenatide, glyburide
What medications are the cheapest?
Metformin, SU, TZDs
What are warnings associated with concentrated regular insulin?
Must be prescribed with U-500 syringe to avoid dosing errors Represents 5u and no dose conversion needed
What insulin regimens are not preferred in T1D?
NPH and regular insulin
What are the exceptions to the 1:1 insulin conversions?
NPH dose BID to Lantus or Basaglar - Use 80% of TDD NPH Toujeo to Lantus or Basaglar - Use 80% toujeo dose
How should new pens be primed?
Prime needle by turning knob 2u and pressing the injection button away from you
What type of insulin is glulosine? brand name?
Rapid acting Apidra
What type of insulin is lispro? brand name?
Rapid acting Humalog
What type of insulin is afrezza?
Rapid acting, oral inhalation powder
What is the mixing order for NPH with rapid or short insulin?
Rapid or Short acting first! Clear before cloudy
What type of insulin is aspart? brand name?
Rapid-acting Novolog, Fiasp
What insulin products are concentrated?
Rapid-acting: Humulog Kwikpen 200u/mL Regular: Humulin R U-500 Long: Tresiba 200 u/mL Toujeo 300 u/mL
What is the insulin of choice for IVs? TPNs?
Regular insulin
How is hypoglycemia treated?
Rule of 15 1. Take 15-20g glucose or simple carb 2. Recheck BG after 15 3. If hypo continues repeat steps 1-2 4. Once resolved, eat small meal or snack
What rule do you use for insulin to carb ratio for regular insulin?
Rule of 450 =450/(total daily dose of insulin)
What medications are associated with weight loss?
SGLT2, GLP-1 RA, pramlinitide
What medications should be avoided in sulfa allergies?
SUs
What type of insulin is regular insulin? brand names?
Short acting Humulin R, Novolin R
What medications should be avoided in HF?
TZDs alogliptin saxagliptin
What is the correction dose calculation?
The amount of insulin needed to return BG to normal range Added to the dose pt normally gets at meals
What are the symptoms of hypoglycemia?
dizziness, shakiness, sweating, slurred speech, heart palpitations, and or unconsciousness.
