Extra DM podcast

Question 1

A1C 6.5-7.5

7.6-9

> 9

Glycemic goals in adults
in newly dx pt w short dz duration

Pt w severe hypogly, limited LE, advanced CV dz

Pt w long LE, no sig CVD

Answer 1

monotherapy

dual therapy

insulin + others

<7

<8

<6.5

Question 2

Insulin is a

cant be taken

insulin preps are

Goal of insulin sec

sec 2 ways

Blous w

Answer 2

peptide

orally (only subQ)

chemically modified

normalize

basal/tonic

food intake

Question 3

Basal insulin blunts

Glcagon stimulates

Mods to insulin structure affect

Rate limiting factor determining insulin activity

Only insulin that can be admin parenteral

Directly absorbed into

large portion of injected insulin cleared from

Answer 3

HGP by glucagon

glycogen breakdown, gluconeogenesis

absorption from SQ injection site

Regular

bloodstream

circ by kidneys (think renal dysfxn)

Question 4

Rapid acting insulin products mimic
limit

Intermediate/long acting insulin products mimic
reduce
limit

Short acting insulin product

commercial preps of insulin alter _____ to affect rate of onset/duration

Answer 4

bolus insulin release
PPH

Basal insulin
glucagon
fasting hyperGly

regular

size/chem structure

Question 5

Rapid acting onset/duration

long acting onset/duration

Appearance of NPH, others

Answer 5

fast, short

delayed, long

cloudy, clear

Question 6

Rapid acting insulin mimic bodys

ADV to regular insulin
Dose
Less

Pt most likely to benefit

Answer 6

normal mealtime insulin

immediately prior to eating
hypoGly, nocturnal

T1 at high risk for hypoGly (low HbA1c)
Flexible
Recent onset Type 1

Question 7

Long actin insulin has ___ profile

Dose glargine ___ and detemir

Adv to NPH

Do not mix w
Glargine is pH
Precipitates at

Answer 7

peakless- more consistent

once daily subQ, 2x daily

less nocturnal hypoGly

other insulin
4
7 (inj site)

Question 8

Insulin regimen to recreate normal sec

intensive tx of T1DM can dec

AE of intensive therapy

avoid in kids <
bc ___ development ongoing

inc in

Answer 8

basal-bolus

microvasc comps

3x more hypogly

7

brain

wg

Question 9

Intensive insulin therapy characterized by

HypoGly sx

adrenergic sx at BG

Neuro sx (BG <60)

Answer 9

3+ insulin inject/day
A1c <7.5
BG 150

60-80

dizzy, confusion, drowsi, blurry vision, coma

Question 10

Pt w PN has defective ____ when hypogly present

Insulin allergies (regular/NPH)

NPH

dont give NPH to pt w

sx

allergies dec w

Answer 10

counter-reg

Zn2+

protamine

Fish, proc/surg w protamine

cutaneous rxn

human insulin

Question 11

Lipohypertrophy

enlarged ____ depots at injection site

occurs when

calulating insulin requirement
w
kg

1 u= ___ ug

1/2 total requir for

other half for

Answer 11

subq fat depots

inject at same site

w/4
.55 u/kg

45

basal

bolus w food

Question 12

Rapid acting + NPH

mix
use within

long acting insulins should not be

Answer 12

immediately prior to use
15 min

mixed w others

Question 13

Premixed insulins
25-30%
70-75%
MC example

Adminster _x day

ADv

Disadv

Answer 13

short/rapid
intermediate
NPH/regular

2

no mixing, few inject

few inject

Question 14

Insulin induced hypoGly
frequent in pt achieving
in concious pt treat w
in unconc, treat w

Alcohol intox
EtOH inhibits
can be problem w

Answer 14

tight control
oral carbs
glucagon

HG
low glycogen

Question 15

Postprandial hypoGly
Exaggerated ___ w meal
Recommend meals be
less freq w

Fasting hypoGly
assc w
untx results in
occurs in fasting pt w lots of

Answer 15

insulin sec
smaller, more freq
rapid acting insulin

neuro sx (lost cons, seizure, coma), liver dz
alcohol

Question 16

FPG reflects

A1C

Glycemic goal for adults w DM

Preprandial

Postprandial (2hr post meal)

Answer 16

GLU overprod by liver

that + dec GLU taken into tissues (LT)

80-130

<180