Diabetes Monitoring & Management

Question 1

Describe Insulin Pens
preferred use
max dose
key pearls

Answer 1

Insulin pens: preferred over the syringe/vial as it smuch easier to turn dial to dose & administer

Doses
- most pens contain a maximum of 300 units/3mL per pen: varies depending on the pen and formation
- (1mL of insulin = U100!!)
- 60 unit max dose mark per injection

Positives
- good for visually impaired: just point and shoot the pen
- location is importnat, given subQ, inner thigh or belly

insulin tips should also be perscribed per how many a day they need (never resue the needle!!)

Question 2

Described Insulin Vials + Syringes
- amount
- technique

Answer 2

Amount
- vial comes with 1000 units/10mL but variable with formulation

Technique
- need to draw up proper amount within the syriange: can be tricky to do
- syringes come in different gagues/sizes and mL amounts
- technique is important!!! 45 degree angle for subQ injections

Question 3

Insulin Pumps
who can use
how do they work
blood sugar checks
types of pumps

Answer 3

Pumps: can be used by type 1 and type 2

how they work
- insulin pumps are a continuous subQ infusion of rapid acting or bolus insulin

Sugars
- must still be checked at min 4x daily v a CGM
- must still carb count to ensure not over giving insulin
- must meet with dietary or pump trainer to ensure proper use

Types
- medtronic: a pump integrated with CGM or without
- T slim: can be integrated with dexcom CGM
- omnipod: insulin pump with pod wihtout CGM buit in

on all pumps: allows the ability to edit and adjust basal and bolus insulin amounts given

Question 4

who can use an insulin pump
indications
benefits

Answer 4

• those with T1DM who cannot achieve A1c goal
• those T2DM who cannot achieve A1c goal and have/need high insulin doses
• diability, recurring hypoglycemicevents
• ight shift workers with variable patterns of eating/sleeping
• athletes! thsoe who are active

Benefits
- tigher glycemic control
- control over basal rates
- alter carb ratio per meal
- prevent hypoglycemia

must be motivated pt. who can still accuratel check blood sugar 4x daily!!! an carb count

if the pump is not a closed loop system where they can change and adjust the basal dose –> the basal rates are set by pump trainer and hten later they are adjusted

if closed loop: basal rates will cahnge depending on the CGM glucose reading (self-adjusts)

all pt. need to carb count via the I:C ratio (insulin:carb ratio)

Question 5

how is the pump managed in terms of basal rates and adjustments

Answer 5

if closed loop system: the CGM will “sample” the glucose level and then adjust the insulin levels accordingly

if not a closed loop system: the basal rates are set by the pump provider and they are adjusted as needed
- severely high glucose, rising or hypoglycemi events will trigger the need to cahnge the basal rates
- changes are usually made in 0.05-0.1incremits

adjusting the I:C ratio if a rapid rise in blood glucose after eating occurs

Question 6

what is a CGM
how do they work

Answer 6

CGM: continuous glucose monitor: can be used with a pump, an MDI or those on new oral medications

• minimized (but does NOT elimitate) the number of finger sticks required
• provides “flash” intermittenet numbers or real time monitoring
• measures interstitial glucose NOT serum!!!: so there is variation
• can give weekly/graphs/charts or sensor readings every 15 mins.

abnormal results should always be followed with a FS glucose check

helps with trends of sugar: usually a 10-15 min lag from teh serum to the intersitital reading

Question 7

Management of the CGM

Answer 7

• need to check if pt ate, exercised
• following bolus recommendations?
• correcting hypoglycemia?

Limitations
- expensive!!
- data overload
- irritation from sensor
- can require additional FS if labile BS
- can be inaccrate readings due to lag

Question 8

manage DM with
- visual impariment
- cognitive impairment
- Tremors/OA

Answer 8

Visual
- pens if needing insulin
- CGM > basic glucomete
- help from caregiver

Cognitive
- smartphone reminder to inject and check
- written remineder s
- pill box for oral
- assistance from caretaker

Tremor/OA
- pens for insulin
- CGM to decrease FS need
- assistance from caregiver

Question 9

lab studies needed for DM

Answer 9

• H A1C : 3 month average
• glucose, blood
• glucose, fasting and post-prandial
• OGTT
• Glucose, urine
• urine micorlabumin
• C-peptide
• insulin assay: only if needed to see if they’re taking their insulin
• glucagon