Diabetes Treatment

Question 1

Ultra short-acting insulin

Answer 1

Aspart (Novolog), Lispro (Humalog), Glulisine (Apidra)

Question 2

Short acting insulin

Answer 2

Regular insulin (Humilin)

Question 3

Intermediate insulin

Answer 3

NPH (Humulin N)

Question 4

Long acting insulin

Answer 4

Glargine (Lantus), Detemir (Levemir)

Question 5

Ultra long acting insulin

Answer 5

Degludec (Tresiba)

Question 6

C- peptide

Answer 6

Endogenously produced insulin is cleaved from proinsulin to active form plus C-peptide

Question 7

IV insulin

Answer 7

Regular insulin is used as the IV formulation. aspart, glulisine, and lispro are all approved for intravenous use

Question 8

Temperature effect on absorption

Answer 8

Increase

Question 9

Exercise/massage effect on absorption

Answer 9

increase

Question 10

Advantages of short acting insulin

Answer 10

Decreases post prandial hypoglycemia and superior post prandial lowering of BS, fewer occurrences of hypoglycemia, flexability

Question 11

Disadvantages of short acting insulin

Answer 11

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

Question 12

Advantages of long acting insulin

Answer 12

24 hr coverage with constant absorption pattern and no pronounced peak

Question 13

Disadvantages of long acting

Answer 13

+ cancer risk (breast possible colon and pancreatic) for glargine use. cant be mixed with other insulin

Question 14

Insulin dosing for T1

Answer 14

0.5-0.6U/kg/day

Question 15

Basal insulin

Answer 15

1-2 doses of long-acting or NPH

Question 16

Bolus insulin

Answer 16

meal time short-acting or ultra short-acting insulin

Question 17

Ratio of basal-bolus insulin

Answer 17

50-70% basal 30-50% bolus

Question 18

Insulin dosing for T2

Answer 18

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

Question 19

when to add bolus insulin

Answer 19

if patient is on >0.5U/kg/day. start with 10% basal dose with largest meal adjust by 10-15% every 3-4 days.

Question 20

Carb ratio 3 day strategy

Answer 20

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

Question 21

Rule of 500

Answer 21

takke 500/ total daily insulin dose and this = # of CHO for one unit of insulin

Question 22

Correction Factor (Rule of 1800)

Answer 22

1800/ total daily dose = # of mg/dL blood glucose will drop for every 1 unit of insulin

Question 23

Empiric starting point for T1 adjustments

Answer 23

Increase insulin dose by 2 units to decrease blood sugar by 50mg/dL

Question 24

Empiric starting point for T2 adjustment

Answer 24

Increase insulin by 4 units to decrease the blood sugar by 50mg/dL

Question 25

Somogyi Effect

Answer 25

nocturnal hypoglycemia with rebound hyperglycemia. check BS at 3AM. add a bedtime snack.