DM part 5 Insulin

Question 1

The diagnosis of DM is made using 1 of what 4 methods?

Answer 1

1. Glycated/Glycosylated Hemoglobin A1C level: 6.5% or higher
2. Fasting plasma glucose level: higher than 126 mg/dL
3. Two hour plasma glucose level during OGTT (oral glucose tolerance test): (with glucose load of 75 g) the normal value should be less than 140 mg/dL
4. Classic symptoms of hyperglycemia (polyuria, polydipsia, polyphagia) crisis or a random plasma glucose level of 200 mg/dL or higher
   - these need to be confirmed with repeat testing

Question 2

What does glycated/glycosylated hemoglobin diagnostic study reflect?

Answer 2

the glucose levels over the past 2 to 3 months (glucose remains attached to the RBC for its life 120 days)
-glucose attaches to hemoglobin molecule; higher the glucose levels = higher the A1C

Question 3

What is A1C used for?

Answer 3

diagnose
monitor therapy
screen patients with prediabetes
-goal: <6.5% to 7%

Question 4

What can influence the A1c level?

Answer 4

diseased affecting the RBC like iron deficiency anemia or sickle cell anemia

Question 5

What are ketones and what do they signal?

Answer 5

• by products of fat breakdown
• they signal there is a deficiency of insulin and control in T1DM
• When there is no efficient insulin available the body starts to break down stored fat for energy.

Question 6

When should urine ketone testing be done?

Answer 6

-when patient with T1DM has glycosuria
for 2 testing periods in a row. 
-during illness
-pregnancy with preexisting diabetes
-in gestational diabetes

Question 7

What are the goals of diabetes management?

Answer 7

• decrease symptoms
• promote well-being
• prevent acute complications
• delay onset and progression of long-term complications
• maintain blood glucose levels as near to normal as possible

Question 8

What are the patient teaching topics for DM?

Answer 8

• nutritional therapy

- drug therapy (insulin, oral therapy, noninsulin injectable agents)

Question 9

What might be sufficient enough for someone with T2DM?

Answer 9

diet
exercise
weight loss

Question 10

If someone with T2DM is maintaining glucose with diet when might they need insulin?

Answer 10

during times of stress like surgeries or illness

Question 11

What is the agent, onset, peak, duration and indication for rapid acting insulin?

Answer 11

-Agent: lispro (Humalog), aspart (Novolog), glulisine (Apidra)
-Onset: 5-15 minutes
-Peak: 30 min to 1 hour
-Duration: 2-4 hours
Indication: used for rapid reduction of glucose level, to treat postprandial hyperglycemia, and/or to prevent nocturnal hypoglycemia

Question 12

What is the agent, onset, peak, duration and indication for short acting insulin?

Answer 12

• Agent: regular (Humulin R, Novolin R, Iletin II regular)
• Onset: 30 -60 minutes
• Peak: 2 to 3 hours
• Duration: 4-6 hours
• Indication: usually given 20 to 30 minutes before a meal; may be taken alone or in combination with longer acting insulin

Question 13

What is the agent, onset, peak, duration and indication for Intermediate acting insulin?

Answer 13

Agent: NPH (Humulin N, Iletin II Lente, Iletin II NPH, Novolin N NPH)

• Onset: 2 to 4 hours
• Peak: 4 to 12 hours
• Duration: 16 to 20 hours
• Indications: Usually taken with food

Question 14

What is the agent, onset, peak, duration and indication for Very long acting insulin?

Answer 14

• Agent: glargine (Lantus), detemir (Levemir), glargine (Toujeo)
• Onset: 1 hour or 6 hours
• Peak: no peak, continuous
• Duration: 24 to 36 hours
• Indications: used for basal dose

Question 15

What is the agent, onset, peak, duration and indication for rapid acting inhaled insulin?

Answer 15

• Agent: Afrezza
• Onset: less than 15 minutes
• Peak: 50 minutes
• Duration: 2-3 hours
• Indications: used as rapid acting insulin