Diabetes Treatment Flashcards
Ultra short-acting insulin
Aspart (Novolog), Lispro (Humalog), Glulisine (Apidra)
Short acting insulin
Regular insulin (Humilin)
Intermediate insulin
NPH (Humulin N)
Long acting insulin
Glargine (Lantus), Detemir (Levemir)
Ultra long acting insulin
Degludec (Tresiba)
C- peptide
Endogenously produced insulin is cleaved from proinsulin to active form plus C-peptide
IV insulin
Regular insulin is used as the IV formulation. aspart, glulisine, and lispro are all approved for intravenous use
Temperature effect on absorption
Increase
Exercise/massage effect on absorption
increase
Advantages of short acting insulin
Decreases post prandial hypoglycemia and superior post prandial lowering of BS, fewer occurrences of hypoglycemia, flexability
Disadvantages of short acting insulin
risk of hypoglycemia if no meal within 15 minutes, will need to combine with longer acting, if mixed with another give immediately after mixing, hyperglycemia/ ketosis may occur more rapidly
Advantages of long acting insulin
24 hr coverage with constant absorption pattern and no pronounced peak
Disadvantages of long acting
+ cancer risk (breast possible colon and pancreatic) for glargine use. cant be mixed with other insulin
Insulin dosing for T1
0.5-0.6U/kg/day
Basal insulin
1-2 doses of long-acting or NPH
Bolus insulin
meal time short-acting or ultra short-acting insulin
Ratio of basal-bolus insulin
50-70% basal 30-50% bolus
Insulin dosing for T2
long acting or intermediate is started in combination with non-insulin. 0.1-0.2U/kg/day. +2 unites every 3 days to reach FBS goal
when to add bolus insulin
if patient is on >0.5U/kg/day. start with 10% basal dose with largest meal adjust by 10-15% every 3-4 days.
Carb ratio 3 day strategy
assess average number of CHO per meal over a 3 day period.divide the number of grams of CHO for a meal by amount of bolus insulin given
Rule of 500
takke 500/ total daily insulin dose and this = # of CHO for one unit of insulin
Correction Factor (Rule of 1800)
1800/ total daily dose = # of mg/dL blood glucose will drop for every 1 unit of insulin
Empiric starting point for T1 adjustments
Increase insulin dose by 2 units to decrease blood sugar by 50mg/dL
Empiric starting point for T2 adjustment
Increase insulin by 4 units to decrease the blood sugar by 50mg/dL
Somogyi Effect
nocturnal hypoglycemia with rebound hyperglycemia. check BS at 3AM. add a bedtime snack.
