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Clinical 2.0 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

typical split for long acting and rapid acting insulin

A

50:50

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2
Q

what are the number of units of insulin adjusted based on

A

BG readings and amount of carbs consumed each meal

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3
Q

do we adjust for single elevated BG

A

not unless it severe

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4
Q

how should insulin be adjusted in hyperglycemia

A

only one insulin at a time

10% change to insulin causing the effect

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5
Q

how should insulin be adjusted in hypoglycemia

A

insulin causing low level decreased 10%

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6
Q

how much of a decrease in BG from one unit of rapid acting insulin

A

take 100 divided by the total daily dose

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7
Q

decrease in BG for 1 unit of short acting insulin

A

divide 85 by the persons total daily dose

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8
Q

what is and how do you calculate insulin to carb ratio

A

divide 100 by total daily dose

gives the number of carbs that will require 1unit more of insulin

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9
Q

exercise effect on insulin

A

enhance the effect of exogenous insulin by increasing glucose uptake by muscle cells and intracellular glucose metabolism
depletion of glycogen stores may occur with mod to intense or prolonged exercise

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10
Q

when should exercise be avoided

A

BG >14 and ketones present

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11
Q

what happens if excessive hyperglycemia is present

A

insulin levels too low and glucose cant be used by muscles
glucose and free fatty acid metabolism continue to increase plasma glucose and ketone levels
can lead to progressive hyperglycemia and ketosis

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12
Q

is it better to adjust insulin or add food

A

adjust insulin when possible

young children wil likely need extra food bc often unplanned

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13
Q

hypoglycemia can occur ____ hours post exercise

A

36

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14
Q

disconnecting an insulin pump in exercise

A

may be disconnected during exercise for 1-2 hours

check BG before and after reconnecting

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15
Q

alwyas have ___ when exercising

A

quick carb source

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16
Q

which insulin should be adjusted during the activity

A

the insulin thats peaki at the time of the activity

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17
Q

why do you have to adjust on sick days

A

illness allows body to release hormones to counteract insulin
circulating BG rises and circulating fat cells
more acidic and ketone bodies increase

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18
Q

when should you do ketone testing

A

preprandial >14 or symptoms of DKA such as NV or ab pain

type 1 and 2

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19
Q

should you omit insulin on sick days

A

no

20
Q

what cna be given safely on sick days

A

rapid or short acting every 3-4 hours

21
Q

monitoring on sick days

A

BG and ketones every 2-4 hours arond the clock and usual times as long as significant hyperglycemia and ketonuria present

22
Q

BG goals in sicknes

A

4-13 and ketones negative

23
Q

what to do if patient has difficulty eating solids in illness

A

10-15 g carbs liquid or soft every 1-2 hours

24
Q

fluid consumption in illness

A

water broth or sugar free drinks to prevent dehydration and facilitate excretion of ketones in the urine
1 cup an hour while awake

25
Q

call physician when

A 
unable to tolerate fluid 
vomit more than once in 4 hours 
diarrhea more than 5 times a day 
two additional insulin and no improvement 
illness very sever >24hrs
unable to keep BG above 6
signs of DKA< dehydration
26
Q

how much usually should insulin be increased or decreased in sickness

A

10-15% of TDD increased

10-30% of TDD decreased

27
Q

problem with urine ketone testing

A

false positve and negatives
less accurate
urine has whats left in the bladder from the last void so ketones are detected later

28
Q

blood 3HB ketone measuring

A

3HB represents largest portion of ketone production but not measured in the urine
reflects current ketonuria, detects earlier

29
Q

type 2 starting insulin dose

A

10mg HS the increasee 1 unit at a time until target reached

30
Q

causes of low BG

A

weight loss
alchohol
exercise
diet change

31
Q

type 2 monitorin

A

initiating monitor twice a day
once a day when on 2 meds
on metformin a couple times a week

32
Q

major drug that causes increase in BG and management

A

prednisone

treat the high BG dont take off prednisone

33
Q

advantages of metformin

A

weight neutral
less hypoglycemia risk
proven to decrease complications

34
Q

disadvantage of metformin

A

need good renal function
GI upset
metallic taste

35
Q

disadvantages of sulfonylureas

A 
more hypo (gliclazide less than glyburide)
not shown to decrease stroke and heart attack
36
Q

which drugs do you discontinue when sick

A 
sulfonylurea
acei
diuretics, direct renin inhibitors
metformin 
arb
nsaids
37
Q

what is the sick acronym stand for

A

blood sugar testin every 2-4 hr
continue insulin
eat/drink carbs and a cup of fluid an hour (sugar free)
ketone testing

38
Q

why limit coffee, tea and pop on sick days

A

caffiene can cause dehydration

39
Q

ways to give extra insulin on sick days

A

extra with normal dose or

rapid can be given extra injection every 3-4 hours

40
Q

who with diabetes should receive low dose aspirin

A

over 50 with sig risk factor (family history, hypertension, smoking, dyslipidemia)
not at increased risk of bleeding
<50 with multiple CVD risk factors

41
Q

complications of hihg blood sugars in pregnancy

A 
macrosonia 
shoulder dislocation and nerve damage
neonatal hypoglycemia 
preterm delivery 
hyperbilirubinemia 
c section
42
Q

pregnancy targets

A

fasting <5.3
1hr post prandial <7.8
2hr post prandial <6.7

43
Q

diets for diabetes in pregnancy

A

avoid hypocaloric diet

3 meals with 3 snacks, moderate carb restriction

44
Q

control of diabetes in pregnancy

A

if targets not met with 2 weeks on diet start on rapid acting multiple injections insulin regimen

45
Q

what to do if someone refuses injections in pregnancy

A

off label use of metformin and glyburide
warn them there is no long term data and insulin is preferred
glyburide may be better

Clinical 2.0 (24 decks)

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