WorksheetsInsulin
Total questions: 61
Worksheet time: 2hrs 2mins
Typically, insulin dosing for a type 1 diabetic starts at ~__ units/kg/day.
0.1
0.5
1
0.2
Typically, maintenance insulin dosing for a type 1 diabetic ranges from ~_____ units/kg/day.
0.1-0.2
0.2-0.5
0.5-1
0.2-1
Type _ diabetics should always be started on a basal and bolus insulin.
1
2
Which of the following are true for the Rule of 500?
Only for use in type 1 DM
500/TDD
Calculates how many grams of total carbs 1 unit of insulin will cover
Can be used for patients to carb count for meals vs. a set insulin dose per meal
Only for use in type 2 DM
Basal insulin dosing for a type 2 diabetic starts at __ units or ____ units/kg.
0.1-0.2
0.5-1
10
5
20
Which are true for starting a bolus insulin in type 2 diabetics?
Consider starting when basal insulin is >0.5units/kg or based on BG readings
Starts at 4 units or 10% of bolus insulin with largest meal
Consider starting when basal insulin is >1 unit/kg or based on BG readings
Starts at 4 units or 10% of bolus insulin with first meal
Which are true for insulin titrations for wither T1 or T2 DM?
Titrate 10-20% for dose adjustments
Hypoglycemia: decreasy by 10-20%
Severe hypoglycemia (<54 mg/dL): decready by 20%
Titrate 5-15% for dose adjustments
Hypoglycemia: increase by 10%
Choose the correct pairs for insulin titrations in type 2 diabetics.
Basal: titrate q3d
Bolus: titrate 2 times per week
Basal: titrate 2 times per week
Bolus: titrate q3d
Which are true for NPH dosing once daily to BID?
80% of total once daily dose
2/3 of dose in AM and 1/3 dose in PM
1/3 of dose in AM and 2/3 dose in PM
75% of total once daily dose
Which are true for NPH dosing BID to long/ultra long acting?
80% of NPH dose = daily dose of long/ultra long acting
60% of NPH dose = daily dose of long/ultra long acting
75% of NPH dose = daily dose of long/ultra long acting
85% of NPH dose = daily dose of long/ultra long acting
90% of NPH dose = daily dose of long/ultra long acting
Which of the following are true for the Rule of 1800?
Used in T1 and T2 DM
1800/TDD (1500 for short acting insulin)
X mg/dL of glucose will decrease with 1 unit of insulin (rapid acting)
Used to create correction factor for patients; to correct the BG prior to a meal
+/- units of bolus insulin; can only be done if pt checks BG prior to meal; need to set goal BG prior to meal
Which of the following are true for sliding scale insulin?
Does not have a set bolus dose with a meal, based off pts pre-meal BG level
Often used in the inpatient in place of oral DM medications
Not a preferred regimen outpatient
Preferred outpatient regimen
Based of pt BG readings from the day before
What effects does insulin have on the body?
Decrease gluconeogenesis
Increase glycogen synthesis
Increase glucose uptake
Decrease lipolysis
Increase lipogenesis
Why must insulin be stored in the refrigerator before being opened?
Protein denaturation
Bacterial growth
Longer expiration date
Ease of administration
What are common side effects of using insulin?
Weight gain
Lipodystrophy
Hypoglycemia
Polydipsia
Weight loss
Unlike other antidiabetic medications, insulin does not have a limit on its HbA1c lowering potential.
True
False
Which are basal insulins?
Intermediate acting
Ultra long acting
Long acting
Short acting
Rapid acting
Which are bolus insulins?
Intermediate acting
Ultra rapid acting
Long acting
Short acting
Rapid acting
Which are mixed insulins?
Intermediate + short
Intermediate + rapid
Intermediate + long
Intermediate + intermediate
Which are true for basal insulins?
Mimics normal background pancreatic insulin secretions
Suppresses glucose production
Mimics pancreatic insulin spikes after meals
Which are true for bolus insulins?
Mimics normal background pancreatic insulin secretions
Suppresses glucose production
Mimics pancreatic insulin spikes after meals
Which are intermediate acting (NPH) insulins?
Humulin N
Novolin N
Insulin glargine
Humulin R
Novolin R
Which of the following are true for the pharmacokinetics of NPHs?
Peak: 6 hours
Duration: 14-24 hours
Dosing: 1-2 times daily
No peak
Peal 2-4 hours
Which are counseling points of intermediate acting insulins (NPHs)?
Increased risk of hypoglycemia compared to long-acting insulins
Should be cloudy
Decreased nocturnal, severe, and overall hypoglycemia compared to long-acting insulins
May be initiated with the largest meal of the day
Contraindicated in patients with chronic lung disease
Which are long-acting insulins?
Insulin glargine U-300
Insulin detemir
U-100
Insulin glargine U-100
Insulin degludec U-100 and U-200
Insulin lispro
Which are insulin glargine U-100?
Lantus
Basaglar
Semglee
Levemir
Tresiba
Which are insulin detemir?
Lantus
Basaglar
Semglee
Levemir
Tresiba
Which of the following are true for the pharmacokinetics of insulin glargine U-100?
Small peak
Duration: ~24 hours
Dosing: 1-2 times daily
No peak
Duration is dose-dependent, shorter at lower doses
Which of the following are true for the pharmacokinetics of insulin detemir?
Small peak
Duration: ~24 hours
Dosing: 1-2 times daily
No peak
Duration is dose-dependent, shorter at lower doses
Which are ultra long-acting insulins?
Insulin glargine U-300
Insulin detemir
U-100
Insulin glargine U-100
Insulin degludec U-100 and U-200
Insulin lispro
Which are insulin glargine U-300?
Toujeo
Toujeo Max
Semglee
Levemir
Tresiba
Which are insulin degludec?
Toujeo
Toujeo Max
Semglee
Levemir
Tresiba
Which of the following are true for the pharmacokinetics of insulin glargine U-300?
Small peak
Duration: ~24 hours
Dosing: once daily
No peak
Duration: ~36 hours
Which of the following are true for the pharmacokinetics of insulin degludec?
Small peak
Duration: ≥ 42 hours
Dosing: once daily
No peak
Duration: ~36 hours
Which are counseling points of ultra long acting insulins??
Increased risk of hypoglycemia compared to long-acting insulins
Should be cloudy
Decreased nocturnal, severe, and overall hypoglycemia compared to long-acting insulins
May be initiated with the largest meal of the day
Contraindicated in patients with chronic lung disease
Which are counseling points of Toujeo Max and Tresiba U-200?
The manufacturer recommends these insulins for patients on ≥ 20 units of basal insulins daily
Should be cloudy
Allow for injection of up to 160 units at once
May be initiated with the largest meal of the day
Each click on the pen's dial is 2 units instead of 1 unit
Which are short acting insulins?
Humulin N
Novolin N
Insulin glargine
Humulin R
Novolin R
Which of the following are true for the pharmacokinetics of short acting insulins?
Peak: 6 hours
Duration: 14-24 hours
Dosing: typically prior to breakfast
Duration 6-8 hours
Peak: 2-4 hours
Which are rapid acting insulins?
Insulin lispro U-100 and U-200
Insulin aspart U-100
Insulin glargine U-100
Insulin glulisine U-100
Insulin degludec U-100 and U-200
Which are insulin lispro?
Humolog
Novolog
Admelog
Apidra
Tresiba
Which are insulin aspart U-100 rapid acting?
Humolog
Novolog
Admelog
Apidra
Tresiba
Which are insulin glulisine U-100?
Humolog
Novolog
Admelog
Apidra
Tresiba
Which of the following are true for the pharmacokinetics of insulins lispro and aspart U-100?
Peak: 4 hours
Duration: 8 hours
Dosing: typically 15-30 minutes prior to eating
Duration 4 hours
Peak: 2 hours
Which of the following are true for the pharmacokinetics of insulin glulisine?
Peak: 4 hours
Dosing: May be given up to 20 minutes after the start of eating
Dosing: typically 15-30 minutes prior to eating
Duration 4 hours
Peak: 2 hours
Which are counseling points of rapid-acting insulins?
Increased risk of hypoglycemia compared to long-acting insulins
Should be cloudy
Decreased nocturnal, severe, and overall hypoglycemia compared to long-acting insulins
May be initiated with the largest meal of the day
Contraindicated in patients with chronic lung disease
Which are ultra rapid acting insulins?
Insulin lispro-aabc U-100 and U-200
Insulin aspart U-100
Insulin glargine U-100
Insulin glulisine U-100
Inhaled insulin
Which are inhaled insulin?
Humolog
Novolog
Admelog
Apidra
Afrezza
Which are insulin aspart U-100 ultra rapid acting?
Fiasp
Lyumjev
Admelog
Apidra
Afrezza
Which are insulin lispro-aabc?
Fiasp
Lyumjev
Admelog
Apidra
Afrezza
Which of the following are true for the pharmacokinetics of ultra rapid acting insulins?
Peak: 4 hours
Dosing: May be given at the start of a meal or within 20 minutes after the start of eating
Dosing: typically 15-30 minutes prior to eating
Duration 4 hours
Peak: 1-2 hours
Which are counseling points of inhaled insulins?
Does not hace as much HbA1c lowering potential as subQ insulin
Spirometry must be performed at baseline , 6 months, then annually
Decreased risk of hypoglycemia compared to subQ insulin
May be initiated with the largest meal of the day
Contraindicated in patients with chronic lung disease
Which are counseling points of insulin aspart (fiasp)?
Increased risk of hypoglycemia compared to long-acting insulins
Should be cloudy
Decreased nocturnal, severe, and overall hypoglycemia compared to long-acting insulins
May be initiated with the largest meal of the day
Has significant glycemic improvements in T1DM
Which are counseling points of insulin lispro-aabc?
Increased risk of hypoglycemia compared to long-acting insulins
There is no difference in safety or efficacy between Lyumjev and Humolog
Decreased nocturnal, severe, and overall hypoglycemia compared to long-acting insulins
May be initiated with the largest meal of the day
Has significant glycemic improvements in T1DM
Which of the following are true for combo insulin glargine + lixisenatide?
Initiation: insulin naive or <30 units/day- 15u/5mcg daily; ≥ 30u/day-30u/10mcg daily
Titrate 2-4u q7d until goal FBG is reached
Max dose 60u/20mcg daily
Must be given 1-60 minutes prior to first meal of the day
Titrate 2u q3-7d until FBG is reached
Which of the following are true for combo insulin degludec + luraglutide?
Initiation: insulin or GLP-1 RA naive- 10u/0.36mcg daily; on basal or GLP-1 RA- 16u/0.58mcd daily
Titrate 2-4u q7d until goal FBG is reached
Max dose 50u/1.8mcg daily
Must be given 1-60 minutes prior to first meal of the day
Titrate 2u q3-7d until FBG is reached
Which are insulin glargine + lizisenatide?
Xultophy
Lyumjev
Soliqua
Apidra
Afrezza
Which is insulin degludec + liraglutide?
Xultophy
Lyumjev
Soliqua
Apidra
Afrezza
Which of the folloing are insulin U500 (humulin R)
Concentrated regular insulin (mimics mixed insulin pharmacokinetics)
Only for use with significant insulin resistance (TDD >200u/day)
Peak: 4-8 hours
Duration: ~18-24 hours
Dosing: 2-3 times daily
Which of the following are true fro cats and dogs using insulin?
Cats and dogs are often diagnosed with diabetes and community pharmacists may dispense prescriptions for these patients
Insulins included in the American Animal Hospital Association (AAHA) for the treatment of feline and canine diabetes are insulin glargine, insulin detemir, insulin NPH, protamine zinc insulin, and insulin lente (an intermediate-acting insulin, "Vetsulin®")
Other antidiabetic medications such as sulfonylureas, GLP-1 RAs, acarbose, and the newly approved SGLT2i bexagliflozin for cats may play some role in treating this population.
