Injectable Agents in Type 2 Diabetes Mellitus
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Questions and Answers

What is the recommended treatment regimen for patients with established or high risk of ASCVD, heart failure, and/or CKD?

  • GLP-1 receptor agonists + metformin (correct)
  • Insulin only
  • SGLT-2 inhibitors only
  • Combination oral therapy

    • When should early introduction of insulin be considered in diabetes management?

  • When A1c is above 10% (correct)
  • When A1c is below 7%
  • When blood glucose is less than 200 mg/dL
  • When blood glucose is under 150 mg/dL

    • What type of insulin is typically initiated first in patients with severe hyperglycemia?

  • Basal insulin (correct)
  • Intermediate-acting insulin
  • Premixed insulin
  • Rapid-acting insulin

    • What is preferred before transitioning to insulin in the treatment of Type 2 diabetes mellitus?

    <p>GLP-1 receptor agonist</p> Signup and view all the answers

    Which type of injectable agent should be included in the regimen to achieve and maintain treatment goals in Type 2 diabetes mellitus?

    <p>GLP-1 receptor agonists + metformin</p> Signup and view all the answers

    What adjustment would you recommend to the insulin regimen of a patient continuing with Lantus 75 units nightly at bedtime and Metformin 1000 mg BID, based on the provided blood glucose log?

    <p>Add insulin lispro 7 units before lunchtime</p> Signup and view all the answers

    Which type of insulin is Lantus typically switched to at a 1:1 ratio?

    <p>Levemir</p> Signup and view all the answers

    What is the recommended adjustment when switching from Degludec to Lantus or Levemir?

    <p>Reduce dose by 20%</p> Signup and view all the answers

    In what circumstances might a patient need to split their NPH dose to achieve comparable 24-hour coverage?

    <p>When switching from Lantus or Levemir to NPH</p> Signup and view all the answers

    Which insulin product is known for providing better post-prandial coverage but is also more expensive?

    <p>Biphasic analogs (Novolog and Humalog mix)</p> Signup and view all the answers

    What is the recommended step if a patient experiences a higher burden of depression in managing their diabetes?

    <p>Be mindful of sociobehavioral considerations in care</p> Signup and view all the answers

    What is the primary method of insulin replacement in Type 1 diabetes mellitus (T1DM)?

    <p>Basal insulin analogs combined with bolus insulin analogs</p> Signup and view all the answers

    What is a characteristic of Type 1 diabetes mellitus (T1DM) that necessitates lifelong insulin use?

    <p>Absolute insulin deficiency</p> Signup and view all the answers

    Which of the following is NOT part of the general principles of injectable agents for diabetes management?

    <p>Continuous glucose monitors (CGMs)</p> Signup and view all the answers

    In Type 1 diabetes mellitus (T1DM), what combination is used for insulin replacement therapy?

    <p>Basal and bolus insulin analogs</p> Signup and view all the answers

    What technology can lead to better blood glucose control compared to traditional methods in diabetes management?

    <p>Insulin pump therapy</p> Signup and view all the answers

    What is the primary method of achieving better control in diabetes management using technology?

    <p>Implementing insulin pump therapy</p> Signup and view all the answers

    What is the typical initial dosing schedule for NPH insulin?

    <p>Once daily at bedtime</p> Signup and view all the answers

    Which of the following is a common combination for NPH-like insulin with rapid-acting analogs?

    <p>NPH with Lispro</p> Signup and view all the answers

    When converting NPH insulin to twice daily dosing, what is the recommended proportion for the two doses?

    <p>60/40 split</p> Signup and view all the answers

    Which type of insulin provides better post-prandial coverage but is also more expensive?

    <p>Lispro</p> Signup and view all the answers

    In Type 2 diabetes, which of the following agents is commonly included in regimens to achieve treatment goals?

    <p>DPP-4 inhibitors</p> Signup and view all the answers

    When titrating NPH insulin based on fasting blood sugars, by how much should the dose be adjusted every 2 to 3 days?

    <p>$2$ units</p> Signup and view all the answers

    What is the dosing regimen for Novolog Mix 70/30?

    <p>10 minutes before breakfast and dinner</p> Signup and view all the answers

    If switching from Levemir to Lantus, what is the recommended conversion ratio?

    <p>1:1</p> Signup and view all the answers

    What is the dosing regimen for Humulin/Novolin 70/30?

    <p>Before breakfast and dinner</p> Signup and view all the answers

    If a patient is on NPH (dosed BID) and needs to switch to Lantus or Levemir, what is the recommended action?

    <p>Reduce the dose by 20% and give Lantus/Levemir once a day</p> Signup and view all the answers

    How should doses be adjusted when using NPH and Regular combinations like Humulin/Novolin 70/30?

    <p>Based on pre-breakfast and pre-lunch/dinner values</p> Signup and view all the answers

    What medication is recommended to reduce by 20% when switching to Glargine (U-100) or Basaglar from Toujeo (glargine U-300)?

    <p>Lantus</p> Signup and view all the answers

    Which combination of insulin is most appropriate for Ned, a 56-year-old male with T2DM, to achieve better glycemic control?

    <p>NPH (basal) + Rapid-acting Insulin Analog (bolus)</p> Signup and view all the answers

    When should Ned adjust his pre-lunch prandial insulin based on his pre-dinner blood glucose values?

    <p>When pre-dinner BG is elevated, adjust pre-lunch insulin</p> Signup and view all the answers

    Which insulin combination should be initiated for Ned if he experiences severe hyperglycemia?

    <p>NPH (basal) + Rapid-acting Insulin Analog (bolus)</p> Signup and view all the answers

    Ned has been prescribed a consistent daily schedule of injections with NPH + Regular Insulin. At which time should he take his Regular Insulin injection?

    <p>30 minutes before each meal</p> Signup and view all the answers

    Ned is considering switching from Lantus to another basal insulin. Which insulin product should he consider using at a 1:1 ratio?

    <p>Levemir</p> Signup and view all the answers

    Ned is struggling to maintain consistent meal times due to work commitments. Which insulin option is most suitable for him to maintain better glycemic control?

    <p>Lantus (basal) + Fiasp (bolus)</p> Signup and view all the answers

    What is an essential consideration when using combination insulins like Novolog Mix 70/30 or Humalog Mix 75/25?

    <p>The suspension must be mixed before use by rolling in hands</p> Signup and view all the answers

    When using NPH and Regular combinations like Humulin/Novolin 70/30, what should the dosing schedule be based around?

    <p>Evening mealtime</p> Signup and view all the answers

    What is a distinguishing feature between Humulin/Novolin and Humalog/Novolog insulins?

    <p>Humulin and Humalog are produced by different companies</p> Signup and view all the answers

    What is a common characteristic of U-500 insulin that makes it suitable for certain patients?

    <p>It is dosed in very small amounts, making it easy to adjust</p> Signup and view all the answers

    When considering combination therapy with GLP-1 RA and long-acting insulin, what benefit does the combination offer in terms of A1c reduction compared to monotherapy?

    <p>~0.5 to 1% reduction in A1c levels</p> Signup and view all the answers

    What is a key characteristic of long-acting analog insulins compared to NPH insulin?

    <p>Long-acting analogs offer less hypoglycemia, especially nocturnal hypoglycemia</p> Signup and view all the answers

    What is a key consideration when prescribing Afrezza for patients with diabetes?

    <p>It should not be used in smokers</p> Signup and view all the answers

    Which insulin delivery device should be avoided for patients with vision or dexterity issues?

    <p>Insulin Vial and Syringe</p> Signup and view all the answers

    When using NPH and Regular combinations like Humulin/Novolin 70/30, how should doses be typically adjusted?

    <p>Decrease the dose</p> Signup and view all the answers

    What is the recommended action if a patient on NPH insulin (dosed BID) needs to switch to Lantus or Levemir?

    <p>Increase the dose</p> Signup and view all the answers

    In which circumstances might a patient need to split their NPH dose to achieve comparable 24-hour coverage?

    <p>To manage morning hyperglycemia</p> Signup and view all the answers

    Which insulin product should Ned consider using at a 1:1 ratio if he is considering switching from Lantus to another basal insulin?

    <p>Basaglar</p> Signup and view all the answers

    What is a key requirement for success in a regimen using combination insulin products?

    <p>Consistent schedules and meals</p> Signup and view all the answers

    Which insulin combination includes a higher percentage of NPH insulin?

    <p>Humalog Mix 75/25</p> Signup and view all the answers

    Which insulin combination includes 50% lispro protamine and 50% lispro insulin?

    <p>Humalog Mix 50/50</p> Signup and view all the answers

    What is the recommended conversion ratio when switching from Levemir to Lantus?

    <p>1:1</p> Signup and view all the answers

    What adjustment might be necessary when switching from Lantus or Levemir to NPH insulin?

    <p>Decrease the dose by 20%</p> Signup and view all the answers

    Which insulin product is typically switched to at a 1:1 ratio when switching from Toujeo (glargine U-300)?

    <p>Lantus</p> Signup and view all the answers

    Which insulin product combination includes 70% NPH and 30% Regular insulin?

    <p>Novolog Mix 70/30</p> Signup and view all the answers

    What is a distinguishing feature between Humulin Mix 70/30 and Humalog Mix 75/25 insulins?

    <p>Regular insulin percentage</p> Signup and view all the answers

    When using NPH and Regular combinations, how should doses typically be adjusted?

    <p>Adjust both components</p> Signup and view all the answers

    Which insulin product should be considered when switching from Lantus at a 1:1 ratio for basal coverage?

    <p>Insulin detemir (Levemir)</p> Signup and view all the answers

    What benefit does combining GLP-1 RA with long-acting insulins offer compared to monotherapy?

    <p>+0.5% A1c reduction</p> Signup and view all the answers

    Which insulin product provides better post-prandial coverage but is also more expensive?

    <p>Insulin degludec (Tresiba)</p> Signup and view all the answers

    Which insulin combination requires a consistent schedule and meals for success?

    <p>NPH and Regular combinations</p> Signup and view all the answers

    Which insulin combination is an NPH-like + rapid-acting analog?

    <p>Humalog Mix 75/25</p> Signup and view all the answers

    When switching from NPH (dosed BID) to Lantus or Levemir, what action is recommended?

    <p>Reduce the dose by 20%</p> Signup and view all the answers

    Which insulin product is typically switched to at a 1:1 ratio when switching from Toujeo (glargine U-300)?

    <p>Glargine (U-100)</p> Signup and view all the answers

    Which insulin combination includes 50% lispro protamine and 50% lispro insulin?

    <p>Humalog Mix 50/50</p> Signup and view all the answers

    Which insulin combination includes a higher percentage of NPH insulin?

    <p>Humulin/Novolin 70/30</p> Signup and view all the answers

    What is the typical initial dosing schedule for NPH insulin?

    <p>Twice daily with morning and evening meals</p> Signup and view all the answers

    What is a key requirement for success in a regimen using combination insulin products?

    <p>Consistent daily injection schedule</p> Signup and view all the answers

    Which combination of insulin is most appropriate for a patient with T2DM to achieve better glycemic control?

    <p>Novolog Mix 70/30</p> Signup and view all the answers

    When converting NPH insulin to twice daily dosing, what is the recommended proportion for the two doses?

    <p>50% in the morning and 50% at bedtime</p> Signup and view all the answers

    If a patient is on NPH (dosed BID) and needs to switch to Lantus or Levemir, what is the recommended action?

    <p>Switch to Lantus or Levemir and keep the same dose, but adjust based on blood glucose levels</p> Signup and view all the answers

    Which insulin combination includes a higher percentage of NPH insulin?

    <p>Novolog Mix 70/30</p> Signup and view all the answers

    What adjustment would you recommend to the insulin regimen of a patient continuing with Lantus 75 units nightly at bedtime and Metformin 1000 mg BID, based on the provided blood glucose log?

    <p>Increase pre-breakfast insulin lispro dose to 9 units</p> Signup and view all the answers

    If a patient is currently on Lantus and needs to switch due to insurance formulary changes, which insulin product might be considered?

    <p>Toujeo (glargine U-300)</p> Signup and view all the answers

    When switching from Lantus or Levemir to NPH insulin, what is a potential consideration in dosing?

    <p>Split NPH dose for BID dosing</p> Signup and view all the answers

    Which insulin product is a combination of 70% NPH and 30% Regular insulin?

    <p>Humulin/Novolin 70/30</p> Signup and view all the answers

    In a switch from Lantus or Levemir to Degludec, what is the recommended action for adjusting the dose?

    <p>Reduce dose by 20%</p> Signup and view all the answers

    Which type of insulin combination provides better post-prandial coverage but is also more expensive?

    <p>Novolog Mix 70/30</p> Signup and view all the answers

    Which rapid-acting analog insulin has an ultra-rapid onset and can be dosed within 20 minutes of starting a meal per labeling?

    <p>Insulin aspart (Fiasp)</p> Signup and view all the answers

    What is the recommended proportion for the two doses when converting NPH insulin to twice daily dosing?

    <p>50% for breakfast dose and 50% for bedtime dose</p> Signup and view all the answers

    Which insulin combination includes a higher percentage of NPH insulin?

    <p>Humulin 70/30</p> Signup and view all the answers

    Which type of insulin provides better post-prandial coverage but is also more expensive?

    <p>Rapid-acting analog insulin</p> Signup and view all the answers

    Which insulin combination requires a consistent schedule and meals for success?

    <p>NPH + Regular insulin</p> Signup and view all the answers

    What is the typical initial dosing schedule for NPH insulin?

    <p>Twice daily</p> Signup and view all the answers

    When converting from Lantus to an NPH-like + rapid-acting analog combination, what is the recommended initial dosing schedule?

    <p>10 units of NPH-like insulin + 5 units of rapid-acting analog twice a day before breakfast and dinner</p> Signup and view all the answers

    For a patient experiencing severe hyperglycemia, which insulin combination should be initiated first?

    <p>NPH and Regular insulin</p> Signup and view all the answers

    When using NPH and Regular combinations like Humulin/Novolin 70/30, how should doses typically be adjusted?

    <p>Adjust the dose based on pre-meal and bedtime blood sugars</p> Signup and view all the answers

    When considering combination therapy with GLP-1 RA and long-acting insulin, what benefit does the combination offer in terms of A1c reduction compared to monotherapy?

    <p>Lower A1c by 1.5 to 2.0% compared to both GLP-1 RA and long-acting insulin monotherapy</p> Signup and view all the answers

    If a patient is on NPH (dosed BID) and needs to switch to Lantus or Levemir, what is the recommended action?

    <p>Convert NPH to once daily dosing before switching to Lantus or Levemir</p> Signup and view all the answers

    When using NPH and Regular combinations like Humulin/Novolin 70/30, what should the dosing schedule be based around?

    <p>Based around pre-meal blood sugars and bedtime blood sugars</p> Signup and view all the answers

    Combination insulin products are more flexible compared to individual intermediate/long-acting and rapid-acting components.

    <p>False</p> Signup and view all the answers

    Novolog Mix 70/30 contains 70% aspart protamine and 30% aspart insulin.

    <p>False</p> Signup and view all the answers

    Splitting a NPH dose to bid dosing may be necessary when switching from Lantus or Levemir.

    <p>True</p> Signup and view all the answers

    When switching from Toujeo (glargine U-300) to Glargine (U-100), the dose should be increased by 20%.

    <p>False</p> Signup and view all the answers

    Adding insulin lispro 7 units before lunch and dinner is recommended for this patient's regimen adjustment.

    <p>False</p> Signup and view all the answers

    For patients on NPH (dosed BID) switching to Lantus or Levemir, doses should be reduced by 10%.

    <p>False</p> Signup and view all the answers

    The patient's blood sugar levels have consistently decreased over the 7 days.

    <p>False</p> Signup and view all the answers

    Metformin should be discontinued when initiating insulin therapy.

    <p>False</p> Signup and view all the answers

    NPH insulin can initially be dosed twice a day at breakfast and dinner.

    <p>False</p> Signup and view all the answers

    Combining SGLT-2 inhibitors with insulin therapy typically increases the amount of insulin needed.

    <p>False</p> Signup and view all the answers

    Thiazolidinediones (TZDs) are commonly associated with weight loss.

    <p>False</p> Signup and view all the answers

    Glinides are recommended for use, especially as insulin therapy progresses to prandial/bolus insulin.

    <p>False</p> Signup and view all the answers

    Adjusting NPH insulin breakfast dose usually peaks at dinnertime.

    <p>False</p> Signup and view all the answers

    When initiating prandial insulin, it is recommended to start with 4 units before the smallest meal of the day.

    <p>False</p> Signup and view all the answers

    Ultra-rapid acting insulin analogs such as Insulin aspart (Fiasp) have an onset time of 10 minutes.

    <p>False</p> Signup and view all the answers

    Skipping a meal means skipping the dose of prandial insulin to maintain consistency.

    <p>True</p> Signup and view all the answers

    Patients using multiple daily injections (MDI) of basal plus prandial insulin should ideally monitor blood glucose 1 to 2 times per day.

    <p>False</p> Signup and view all the answers

    Post-prandial blood glucose values are historically recommended to be measured 1 hour after meals.

    <p>False</p> Signup and view all the answers

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