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E2 - L8 - Fast Acting Insulins

Terms in this set (21)

When is fast acting insulin needed in type 1 diabetes?
-mealtime coverage
-could be a schedules set dose or variable dose
When is fast acting insulin needed in type 2 diabetes?
-add on therapy when prandial coverage is needed
-pt likely already on basal insulin
What is the onset, peak, duration, and administration of insulin lispro u100 and u200 (Humalog pen/vial)- Admelog is a biosimilar
onset: <15 minutes
peak: 0.5-1.5 hours
duration: 3-4 hours
administration: within 15 minutes of a meal (before or after)
What is the onset, peak, duration, and administration of insulin aspart (Novolog pen)
onset: <15 minutes
peak: 0.5-1.5 hours
duration: 3-5 hours
administration: IV or SQ, within 15 minutes of a meal
What is the onset, peak, duration, and administration of insulin glusine (Apidra)
onset: <15 minutes
peak: 0.5-1.5 hours
duration: 3-4 hours
administration: within 15 minutes of a meal
What is the onset, peak, duration, and administration of insulin regular u100
onset: 30-60 minutes
peak: 2-3 hours
duration: 4-6 hours
administration: 30-45 min prior to meal (IV,IM, or SQ)
What is the average total daily insulin requirement for type 1 diabetes?
0.6-0.7units/kg (50/50 basal and bolus)
Explain set dosing for fast acting insulins
-consistent CHO content at meals
-dose is set before the meal and titrated
Explain variable dosing for fast acting insulins
-vary dose based on preprandial BG, anticipated CHO, and anticipated activity
-allows for more flexibility
How much does 1 unit of insulin usually reduce blood sugar by?
30mg/dL
What is the rule of 1800
-insulin sensitivity factor, tells how much insulin dose will decrease BG
1800/total daily dose= change in BG
What is the starting fast acting insulin therapy for type 2 diabetics?
4 units, or 0.1u/kg, or 10% of total insulin dose before the largest meal
How should fast acting insulin dosing be titrated in type 2 diabetics
-titrate based on 2 hour post-meal BG or next pre-meal value
-may add to additional meal times if A1C is still elevated
-titrate every 5-7 days
What is the disease oriented goal of fast acting insulins?
handle meal time glucose excursions
How should effectiveness be monitored for fast acting insulins?
-check 2 hour post meal BG or next pre-meal value
-check A1C in 3 months
What is the patient oriented goal of fast acting insulin?
reduce microvascular complications (no effect on CV complications)
What monitoring parameters are there for the safety of fast acting insulin
-fasting BG, pre-meal BG, 2 hour post-meal BG
-check BG if symptoms of hypoglycemia
-report if <90mg/dL with symptoms or <70mg/dL
What should you counsel a patient on for short acting insulin?
- setting the dose
-administration
-disposal of needles
-storage
-hypoglycemia and symptoms
-possibility of weight gain and need for healthy diet
What are the pros of fast acting insulin?
no ceiling dose and its effective
What are the cons of fast acting insulin?
hypoglycemia, weight gain, injection, and cost
When should you follow up if changing insulin therapy or dose?
5-7 days
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