Insulin Scenario #1
Strengthen your insulin skills with this insulin quiz. Scores don't count for anything besides trying to improve comfort and skills with insulin management.
- 1.
KK is a patient in your hospital. You receive an order for Lantus 39 units Q24h for him. What do you need to assess?
- A.
What is KK's renal function?
- B.
What is KK's HgbA1c?
- C.
What is KK's weight?
- D.
Was KK on hypoglycemics at home prior to admission?
- E.
Are there any medications that are causing KK's BG to be so high?
- F.
Is KK receiving nutrition?
- G.
What hyperglycemia treatment is KK currently receiving?
- H.
Does KK has a history of diabetes?
Correct Answer(s)
A. What is KK's renal function?
B. What is KK's HgbA1c?
C. What is KK's weight?
D. Was KK on hypoglycemics at home prior to admission?
E. Are there any medications that are causing KK's BG to be so high?
F. Is KK receiving nutrition?
G. What hyperglycemia treatment is KK currently receiving?
H. Does KK has a history of diabetes? -
- 2.
You find out that KK is a 64 yo male who has type 2 diabetes, and he is currently on an insulin infusion in the ICU. He was on glyburide-metformin and sitagliptin at home. His A1c is 7.9. He is 6'2" and weighs 155kg. His SCr is 1. His insulin infusion was just decreased to 6 units/hr, but had been @ 12 units/hr for the previous 6 hours. He is getting tube feeds, Glucerna 1.5 @ 60mL/hr. There are no medications that are likely to be contributing to KK's hyperglycemia. What should you do? (May be more than one answer.)
- A.
Add correctional insulin.
- B.
Lantus 39 units Q24h is not enough for a patient who is on an insulin infusion @ 6-12 units/hr, so you should page the MD and offer to have pharmacy dose this patient's insulin.
- C.
Verify the order.
- D.
Lantus 39 units Q24h is not enough for a patient who is on an insulin infusion @ 6-12 units/hr, so you should page the MD and recommend a higher dose.
Correct Answer(s)
B. Lantus 39 units Q24h is not enough for a patient who is on an insulin infusion @ 6-12 units/hr, so you should page the MD and offer to have pharmacy dose this patient's insulin.
D. Lantus 39 units Q24h is not enough for a patient who is on an insulin infusion @ 6-12 units/hr, so you should page the MD and recommend a higher dose. -
- 3.
The MD tells you to have pharmacy to dose this patient's insulin. Calculate KK's daily insulin requirement based on his insulin infusion rate. (May be more than one answer.)
- A.
144 units
- B.
252 units
- C.
264 units
Correct Answer(s)
B. 252 units
C. 264 units -
- 4.
You decide to use the average rate over the past 6 hours to calculate KK's daily insulin requirement, we get 264 units/day. What total daily dose of insulin is/are reasonable in order to transition KK to sub-Q insulin? (May be more than one answer.)
- A.
58 units
- B.
78 units
- C.
158 units
- D.
185 units
- E.
211 units
- F.
264 units
Correct Answer(s)
C. 158 units
D. 185 units
E. 211 units -
- 5.
You decide to be conservative, and calculate the total daily sub-Q insulin dose at 60% of the daily insulin infusion requirement, which is 158 units. What dose of Lantus do you want to start for basal coverage? (May be more than one answer.)
- A.
Lantus 10 units Q24h
- B.
Lantus 20 units Q24h
- C.
Lantus 40 units Q12h
- D.
Lantus 79 units Q24h
- E.
Lantus 158 units Q24h
Correct Answer(s)
C. Lantus 40 units Q12h
D. Lantus 79 units Q24h -
- 6.
When should the insulin infusion be discontinued? (May be more than one answer.)
- A.
1 hour before the first dose of Lantus is administered
- B.
As soon as the first dose of Lantus is administered
- C.
1 hour after the first dose of Lantus is administered
- D.
2 hours after the first dose of Lantus is administered
Correct Answer
D. 2 hours after the first dose of Lantus is administered -
- 7.
What dose of prandial lispro do you want to start? (May be more than one answer.)
- A.
Lispro 5 units TIDAC
- B.
Lispro 5 units Q6h
- C.
Lispro 12 units TIDAC
- D.
Lispro 13 units Q4h
- E.
Lispro 20 units Q6h
Correct Answer(s)
D. Lispro 13 units Q4h
E. Lispro 20 units Q6h -
- 8.
What other orders should you enter? (May be more than one answer.)
- A.
Correctional insulin
- B.
Fingersticks to correlate with prandial insulin
- C.
Time insulin infusion to end 2 hours after first dose of Lantus is scheduled
- D.
D/C Q1h fingersticks from insulin infusion
Correct Answer(s)
A. Correctional insulin
B. Fingersticks to correlate with prandial insulin
C. Time insulin infusion to end 2 hours after first dose of Lantus is scheduled
D. D/C Q1h fingersticks from insulin infusion -
- 9.
You decided to start KK on Lantus 40 units Q12h, lispro 13 units Q4h, and lispro 1-5 units prn BG >150mg/dL. The next day you assess the results. KK's BG range is 151-229mg/dL. What adjustments do you want to make?
- A.
Increase prandial lispro to 20 units Q4h
- B.
No adjustments since 1 day is not enough time to assess response to insulin regimen
- C.
Increase prandial lispro to 16 units Q4h
- D.
Increase correctional insulin to 2-8 units prn BG >150mg/dL
- E.
Increase Lantus to 50 units Q12h
- F.
Increase Lantus to 80 units Q12h
Correct Answer(s)
C. Increase prandial lispro to 16 units Q4h
D. Increase correctional insulin to 2-8 units prn BG >150mg/dL
E. Increase Lantus to 50 units Q12h -
- 10.
What is causing KK's hyperglycemia? (May be more than one answer.)
- A.
His uncontrolled diabetes
- B.
Stress from acute illness
- C.
Morbid obesity
- D.
His propofol infusion
- E.
Phos replacements on the critical care electrolyte replacement protocol
Correct Answer(s)
A. His uncontrolled diabetes
B. Stress from acute illness
C. Morbid obesity -
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Current Version
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Jan 28, 2013Quiz Edited by
ProProfs Editorial Team -
Jun 15, 2011Quiz Created by
Jbphdelaney
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