Exam 3 - diabetes management

Question 1

What type of management options are available for diabetes?

Answer 1

• medications: GLP-1 receptor agonists, insulin, oral agents
• self-management education
• monitoring (SMBG)
• physical activity
• medical nutrition therapy

Question 2

how is insulin categorized?

Answer 2

Onset, peak, duration

Question 3

What are the types of insulins available?

Answer 3

• bolus - before meals (rapid acting and regular)
• intermediate-acticing
• long acting: basal

Question 4

What are the types of insulin regimens?

Answer 4

• fixed: constant basal done, short bolus
• flexible: multiple daily of basal and bolus
• continuous subcutaneous insuling infusion (CSII - insulin pump)

Question 5

what is the typical insulin dosage?

Answer 5

• Type I: 0.5-1.0 unit/kg bw/day (1-1.5 unites/10-15g CHO)
• 0.5-1.2 units/kg bw per day (> 1.5 unit initially to overcome insulin resistance)
• insulin pupm - continuous injection of lispro or aspart

Question 6

Whats a barrier to using an insulin pump?

Answer 6

• can take 6+ months to calibrate with detailed record keeping
• cost

Question 7

How is blood glucose monitored?

Answer 7

• CGM - measures interstitial glucose and A1C
• SMBG - Persons on MDI (multiple dose insulin) or insulin pump should do SMBG before meals and snacks, occasionally postprandially, at bedtime, before exercise, before critical tasks such as driving and when they suspect low blood glucose (and upon correction)
• A1c - at least twice a year
• ketones - check when ill, may require insulin adjustment

Question 8

What are diabetes treatment goals and glycemic control for adults?

Answer 8

• a1c - < 7.0%
• preprandial plasma glucose: 70-130 mg/dl
• peak postprandial plasma glucose: < 190 mg/dl

Question 9

Other diabetes treatment options?

Answer 9

• islet cell transplants
• teplizumab - type I prevention
• bariatric surgey - 80% reduction in type II patients

Question 10

What are the typical medications for type 2 diabetes?

Answer 10

• At diagnosis – Metformin for 3 months; then add others as needed
• New guidelines – try GLP-1 Receptor Agonists
• Insulin if goals can’t be met with medications/GLP-1 Receptor Agonists and if acute injury, infection, surgery, pregnancy