DM2 - Insulin Management Flashcards
What percentage of the Total Daily Dose (TDD) of insulin is apportioned to the Basal insulin?
50%
What is CSII?
Continuous
Subcutaneous
Insulin
Infusion
What type of insulin goes in a CSII?
Rapid-acting (one of the “logs”)
What is the average daily insulin requirement for a type 1 diabetic?
0.5units per kg
What percentage of the TDD is apportioned to each meal? (Appx)
10-20%
Describe traditional split-injections:
Breakfast - rapid AND NPH
Dinner - rapid AND NPH
A patient with T1DM who eats light lunched might be a candidate for which strategy of insulin therapy?
Traditional split-injections
Describe modified split injections:
Breakfast - rapid and intermediate
Dinner - rapid
Bedtime - intermediate
Describe Basal-Bolus insulin management:
Rapid at breakfast, lunch, and dinner
Intermediate at Bedtime
OR
Intermediate at breakfast and bedttime
What is the insulin to carbohydrate ratio for regular insulin?
450/TDD = CHO coverage dose
What is the insulin to carbohydrate ratio for rapid-acting insulin?
500/TDD = CHO coverage dose
Corrective or supplemental doses - what is the correction dose formula?
Correction dose = Current BG - Desired BG / Correction Factor
What is the correction factor for regular insulin?
1500/TDD
What is the correction factor for rapid-acting insulin?
1800/TDD
What does the carbohydrate coverage does tell you?
How many grams of carbohydrates 1 unit of insulin will cover
What is the Dawn Phenomenon?
Insufficient evening basal insulin leading to hyperglycemia in the morning
What is the Somogyi Effect?
Too much evening basal insulin leading to hypoglycemia at 0300 - in response, body produces glucose leading to hyperglycemia in the morning
What do the Dawn Phenomenon and Somogyi effect both have in common?
They both result in morning hyperglycemia, but via different mechanisms
What is the normal starting dose of insulin for a T2DM patient? (TDD)
0.1 - 0.25 units per kg
What is the big difference between insulin management for T1 and T2?
T2 does not get any BOLUS insulin - it’s 100% basal
If the T2DM pt is not achieving their target goals, at what rate may you increase their basal insulin dose?
By adding 1 unit per day, and maintaining vigilant monitoring of BG
