Diabetes Management and Treatment

Question 1

For T1DM, what is the weight-based dosing for insulin?

Answer 1

0.4-1 U/kg

Question 2

which insulin therapies are preferred in pregnancy?

Answer 2

regular (R) insulin, insulin aspart (novolog), insulin lispro (humalog), NPH, and insulin detemir (levemir)

Question 3

for women with GDM who cannot use insulin, what is first-line?

Answer 3

metformin

Question 4

what is initiation dose of basal analog/NPH insulin? what is titration dose and what is fasting blood sugar goal? **titrate until goal reached)

Answer 4

10 units per day
2 units every 3 days until fasting blood sugars 80-130

Question 5

T/F oral agents should often be continued with the addition of basal insulin

Answer 5

true

Question 6

if pts BG is <56 during the week, what do we do to basal dose?
adding this amount of basal insulin correlates to what mean fasting BG?
2 units
4 units
6 units
8 units
if hypoglycemia occurs with no clear reason, what should we do?

Answer 6

decrease basal dose 2-4 units
100-120
120-140
140-180
over 180
decrease dose by 10-20%

Question 7

list the basal insulin drugs

Answer 7

NPH
glargine (lantus)
detemir (levemir)
degludec (tresiba)

Question 8

what is considered overbasalization?

Answer 8

basal dose greater than 0.5-0.7 units/kg

Question 9

what dosing of detemir (levemir) is required for a duration of action around 23 hours?

Answer 9

0.8 units/kg

Question 10

A patient is put onto NPH 30 units at bedtime, their fasting blood glucose is within normal range, but their bedtime blood glucose is not. what is a reasonable next option?

Answer 10

splitting the dose to 15 NPH fasting in the morning and 15 at bedtime

Question 11

for adding meal-time insulin:
if highest before lunch:
if highest before dinner:
if highest at bedtime:

Answer 11

add insulin at breakfast
add at lunch
add at dinner

Question 12

what is starting dosing/titration for prandial insulin?

Answer 12

4 units and then 1-2 units every 3-4 days until within range

Question 13

how to calculate insulin sensitivity factor (ISF) for regular insulin and rapid-acting insulin?
how do we use the ISF to calculate the correction dose?

Answer 13

regular: 1500/TDD = ISF
rapid: 1800/TDD = ISF
actual blood glucose - target blood glucose / ISF

Question 14

how to calculate the insulin to carb ratio (ICR)?

Answer 14

ICR= 500/TDD

Question 15

what is the dawn phenomenon and somogyi effect?

Answer 15

severe drops in blood sugar overnight which causes rebound fasting hyperglycemia in the morning

Question 16

how do you convert lantus, levemir, tresiba, or basaglar to NPH?

Answer 16

it’s a 1:1 conversion