Diabetes Flashcards
typical split for long acting and rapid acting insulin
50:50
what are the number of units of insulin adjusted based on
BG readings and amount of carbs consumed each meal
do we adjust for single elevated BG
not unless it severe
how should insulin be adjusted in hyperglycemia
only one insulin at a time
10% change to insulin causing the effect
how should insulin be adjusted in hypoglycemia
insulin causing low level decreased 10%
how much of a decrease in BG from one unit of rapid acting insulin
take 100 divided by the total daily dose
decrease in BG for 1 unit of short acting insulin
divide 85 by the persons total daily dose
what is and how do you calculate insulin to carb ratio
divide 100 by total daily dose
gives the number of carbs that will require 1unit more of insulin
exercise effect on insulin
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
when should exercise be avoided
BG >14 and ketones present
what happens if excessive hyperglycemia is present
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
is it better to adjust insulin or add food
adjust insulin when possible
young children wil likely need extra food bc often unplanned
hypoglycemia can occur ____ hours post exercise
36
disconnecting an insulin pump in exercise
may be disconnected during exercise for 1-2 hours
check BG before and after reconnecting
alwyas have ___ when exercising
quick carb source
which insulin should be adjusted during the activity
the insulin thats peaki at the time of the activity
why do you have to adjust on sick days
illness allows body to release hormones to counteract insulin
circulating BG rises and circulating fat cells
more acidic and ketone bodies increase
when should you do ketone testing
preprandial >14 or symptoms of DKA such as NV or ab pain
type 1 and 2
should you omit insulin on sick days
no
what cna be given safely on sick days
rapid or short acting every 3-4 hours
monitoring on sick days
BG and ketones every 2-4 hours arond the clock and usual times as long as significant hyperglycemia and ketonuria present
BG goals in sicknes
4-13 and ketones negative
what to do if patient has difficulty eating solids in illness
10-15 g carbs liquid or soft every 1-2 hours
fluid consumption in illness
water broth or sugar free drinks to prevent dehydration and facilitate excretion of ketones in the urine
1 cup an hour while awake
call physician when
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
how much usually should insulin be increased or decreased in sickness
10-15% of TDD increased
10-30% of TDD decreased
problem with urine ketone testing
false positve and negatives
less accurate
urine has whats left in the bladder from the last void so ketones are detected later
blood 3HB ketone measuring
3HB represents largest portion of ketone production but not measured in the urine
reflects current ketonuria, detects earlier
type 2 starting insulin dose
10mg HS the increasee 1 unit at a time until target reached
causes of low BG
weight loss
alchohol
exercise
diet change
type 2 monitorin
initiating monitor twice a day
once a day when on 2 meds
on metformin a couple times a week
major drug that causes increase in BG and management
prednisone
treat the high BG dont take off prednisone
advantages of metformin
weight neutral
less hypoglycemia risk
proven to decrease complications
disadvantage of metformin
need good renal function
GI upset
metallic taste
disadvantages of sulfonylureas
more hypo (gliclazide less than glyburide) not shown to decrease stroke and heart attack
which drugs do you discontinue when sick
sulfonylurea acei diuretics, direct renin inhibitors metformin arb nsaids
what is the sick acronym stand for
blood sugar testin every 2-4 hr
continue insulin
eat/drink carbs and a cup of fluid an hour (sugar free)
ketone testing
why limit coffee, tea and pop on sick days
caffiene can cause dehydration
ways to give extra insulin on sick days
extra with normal dose or
rapid can be given extra injection every 3-4 hours
who with diabetes should receive low dose aspirin
over 50 with sig risk factor (family history, hypertension, smoking, dyslipidemia)
not at increased risk of bleeding
<50 with multiple CVD risk factors
complications of hihg blood sugars in pregnancy
macrosonia shoulder dislocation and nerve damage neonatal hypoglycemia preterm delivery hyperbilirubinemia c section
pregnancy targets
fasting <5.3
1hr post prandial <7.8
2hr post prandial <6.7
diets for diabetes in pregnancy
avoid hypocaloric diet
3 meals with 3 snacks, moderate carb restriction
control of diabetes in pregnancy
if targets not met with 2 weeks on diet start on rapid acting multiple injections insulin regimen
what to do if someone refuses injections in pregnancy
off label use of metformin and glyburide
warn them there is no long term data and insulin is preferred
glyburide may be better
