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cdm 1 exam 2 > Diabetes: Lecture 4 > Flashcards

Diabetes: Lecture 4 Flashcards

1
Q

Does insulin technically have max dose?

A

No

but high risk of hypoglycemia

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2
Q

Has any cardiovascular benefit been shown with insulin?

A

nah

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3
Q

Spikes of glucose will…. with spikes of insulin

A

match

One keeps the other lower and in control in normal people

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4
Q

Basal insulin

A

used to maintain level, cover the glucose that’s been produced over night by the liver

usually constant, about ~50% of basal needs

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5
Q

bolus/Prandial insulin

A

given at mealtime to prevent the post meal rise in BG

usually about ~50%

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6
Q

Physiological regimen

A

mimic what we should see in the body but isn’t happening

usually giving a basal insulin dose and then bolus at meal time

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7
Q

Nonphysiological regimen

A

adding insulin to someone taking orals or GLP1 injectables

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8
Q

When is insulin indicated?

A

Type 1 = always
Type 2 = monotherapy or in combo with oral/injectable
Gestational diabetes = preferred

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9
Q

In those with decreased eGFR, which should be done with the insulin dose?

A

Decreased

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10
Q

Short insulin info

A

Onset: 30-60min
Peak: 2-3hr
Duration: 4-6hr

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11
Q

Intermediate insulin info

A

Onset: 2-4hr
Peak: 4-8hr
Duration: 10-16hr

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12
Q

Rapid Acting Analog insulin info

A

Onset: 5-15min
Peak: 30-90min
Duration: 3-5hr

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13
Q

Long Acting Analog insulin info

A

Onset: 2-5hr
Peak: Flat
Duration: Up to 24hrs

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14
Q

Ultra Long Acting Analog insulin info

A

Onset: 1hr
Peak: Flat
Duration: > 25hr

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15
Q

Human Regular

A

given 30 min before meal

Prandial insulin

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16
Q

Analog (Rapid)

A

Give ~15min before or at 1st bite

Glulisine can be 20min after start of meal

Prandial insulin

17
Q

Human (intermediate)

A

NPH

Lasts about ~12hr, twice a day and a basal insulin

18
Q

Analog (Long) acting names

A

Glargine
Detemir
Degludec

19
Q

Which insulin lowers fasting glucose?

A

Basal insulin

titrated to fasting dose

20
Q

Human Premixed Insulin

A

~30min before meal, usually poor lunch coverage

Doses twice a day

21
Q

Analog Pre-mixed insulin

A

Can take it right before meal
~Dosed twice a day
usually poor lunch coverage

22
Q

Insulin concentrations?

A

U-100
U-200
U-300

Lower volume = more consistent absorption for those with high insulin dose

23
Q

Pre-mixed insulin advantages

A

No mixing
convenient and easy to use
usually only 2 injection per day

24
Q

Pre-mixed insulin disadvantages

A

no allow for meal flexibility
risk of hypoglycemia if patient skips a meal

cloudy, have to roll cloudy ones. Don’t shake

25
Q

Most common side effects of insulin?

A

Weight gain
Hypoglycemia
injection site reactions

26
Q

Patient barriers to insulin

A

fear of needles/injections

fear of hypoglycemia or weight gain

Inconvenience

Sense of personal failure and guilt*** #1

Fear can cause complications

Cost

27
Q

Provider barriers to insulin

A

Lack of time and resources to supervise treatment

Weight gain

Hypoglycemia

Perception that patients resist

clinical inertia = things go on too long, stay same and don’t improve

28
Q

Basal-bolus regimen

A

4 daily injections

1 long acting basal
3 rapid acting, 1 for each meal

preferred for Type 1 w/ carb counting

29
Q

Starting dose for Type 1?

A

0.5 unit/kg/day typical daily dose

50% basal
50% rapid acting divided into 3 doses

30
Q

When to add insulin to Type 2 Diabetes?

A 
A1c >10%
Glucose >300
Symptoms of Hyperglycemia
Evidence of ongoing catabolism
Contraindication to GLP1-RA, unacceptable side effects
31
Q

Starting Basal Insulin Type 2

A

10 units once daily or 0.1-0.2 unit/kg/day

continue orals/injectables on same dose

titrate using fasting BG, 2-4 units once or twice weekly until target met

32
Q

When have we “Over-Basalized”

A

Fasting Glucose in range but A1c target not met

Hypoglycemia

High Glycemic variability

Elevated bedtime-morning or post-to preprandial glucose differential (>50mg/dL)

33
Q

When does prandial insulin become more likely?

“Over Basalized”

A

as daily basal insulin dose exceeds 0.5 units/kg/day

34
Q

How to proceed if “Over Basalized”

A

Add Prandial Insulin

4 units or 0.1 unit/kg/day or 10% basal dose w/ biggest meal

35
Q

which drugs discontinued if adding Prandial Insulin?

A

DPP4 inhib or Sulfonylurea, continue others

consider decreasing basal dose if A1c getting close to goal or <8%

36
Q

What to monitor when adding Prandial insulin?

A

Post prandial BG

37
Q

Prandial insulin titration

A

1-2 units or 10-15% once or twice weekly until target is met

If still not at goal, work towards basal/bolus therapy and injection with each meal

38
Q

What medications to discontinue if on Pre-mixed insulin?

A

DPP4 inhib and Sulfonylurea

39
Q

Titration dose of pre-mixed insulin?

A

adjust dose by 1-2 units or 10-15% once or twice weekly until targets are met

if A1c uncontrolled, consider changing to something else or basal bolus regimen

cdm 1 exam 2 (16 decks)

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