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Therapeutics 2 Exam 3 -Diabetes pt 2 > Insulin Dosing > Flashcards

Insulin Dosing Flashcards

1
Q

What is the average daily insulin dose for Type 1 patients?

A

0.5-0.6 U/kg/day

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2
Q

What dose is used for newly diagnosed Type 1 patients in the honeymoon phase?

A

0.1-0.4 units/kg/day

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3
Q

How often should patients test their blood glucose?

A

4 times daily before meals and at bedtime

-occasionally at 3 am to assess insulin dosages

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4
Q

What insulin provides basal dosing?

A

1-2 doses of Glargine, Detemir, or Degludec

OR

1-2+ doses of NPH

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5
Q

What insulin provides Bolus/Prandial dosing?

A

Meal-time short-acting or ultra-short acting insulins
(Regular, Lispro, Glulisine, or Aspart)

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6
Q

What percent of insulin requirements are given as basal?

A

50-70%

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7
Q

What percent of insulin requirements are given as bolus?

A

30-50%

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8
Q

Example of how to dose

A

60kg patient
Total insulin requirement: 0.5 units/kg/day

60 x 0.5 = 30 units

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9
Q

How is prandial (bolus) dosing adjusted based on carbohydrate content of meals?

A

1 unit for every 15 gm of carbohydrates
(1:15 Insulin:Carb)

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10
Q

When is split daily dosing used?

A

Two daily injections of a mixture of intermediate insulin (NPH) and short-acting insulin

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11
Q

When is split daily dosing given?

A

Breakfast and Dinner

Regular(R)/N(NPH)–0–R/N– 0

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12
Q

When patients are experiencing lows at night, what is one way we can adjust their insulin?

A

Move intermediate (NPH) to bedtime

R/N–0–R–N

(R=regular)
(N=NPH)

*not the best because the patient must receive 3 shots

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13
Q

What do insulin pumps take into consideration when determining the bolus dose to give a patient?

A

-Glucose levels
-Carbohydrate intake
-Insulin on board

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14
Q

What insulin is typically started in Type 2 patients?

A

Long-acting
(glargine, detemir, or degludec)
OR
Intermediate Insulin (NPH)

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15
Q

How is insulin normally first dosed in Type 2 patients?

A

Bedtime insulin is added to previous non-insulin therapies

*helps suppress hepatic glucose production at night

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16
Q

What is the starting insulin dose for Type 2 patients?

A

0.1-0.2 units/kg/day
OR
10-15 units/day

**10 units may be too small if patient weight is very high

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17
Q

How should basal insulin dosing be adjusted in Type 2 patients?

A

Increase dose by 2 units every 3 days to reach fasting blood sugar goal

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18
Q

When should bolus insulin doses be considered in Type 2 patients?

A

When patient is on > or = 0.5 units/kg/day

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19
Q

How should bolus insulin be dosed in Type 2 patients?

A

Start with 10% of BASAL dose
OR
4-5 units of ultra-short or short-acting insulin with largest meal

*Can start with one meal at a time or all three based on severity of readings

20
Q

How should the bolus dose be adjusted in Type 2 patients?

A

Adjust by 10-15% every 3-4 days

21
Q

What carb ratio of Insulin:Carbs should be used in Type 2 patients?

A

1-2 units of insulin for every 15 gm carbs

22
Q

What is the average insulin dose for patients with Type 2 diabetes?

A

> 1 unit/kg

23
Q

What is the general guideline for adjusting insulin for all patients with diabetes?

A

Increase/Decrease dose every 2-4 days until goals are met

24
Q

Should we target fasting blood sugar OR post-prandial glucose first?

A

Fasting Blood Sugar

25
What A1C indicates a problem with fasting blood sugar?
A1C > 10% indicates that 70% of the problem involves FBS
26
What A1C indicates a problem with PPG?
An A1C <7.5% indicates that 70% of the problem involves PPG
27
What is the Insulin to Carbohydrate ratio?
A guide for how much insulin a person would need to cover the amount of carbohydrate in a meal or snack
28
What is the average carbohydrate ratio for an adult?
1 unit: 10-15 g carbs
29
What is the average carbohydrate ratio for a child?
1 unit: 20-30 g carbs
30
When would you use 1500 instead of 1800 for the "Rule of 1800"?
If the patient is on regular insulin
31
If a patient is on once daily long-acting or intermediate insulin but still experiencing fasting hyperglycemia, what should be done?
Increase the dose or consider dividing into BID dosing
32
If a patient is on split dose BID but still experiencing fasting hyperglycemia, what should be done?
Increase pre-supper or bedtime dose of insulin
33
If a patient is on basal-bolus insulin but still experiencing fasting hyperglycemia, what should be done?
Increase the basal or PM bolus *depending on nighttime blood sugar readings
34
If a patient is experiencing hyperglycemia pre-lunch what should be done?
Add/increase short-acting to morning dose/breakfast
35
If a patient is experiencing hyperglycemia pre-dinner what should be done?
Increase morning intermediate/long acting insulin OR add/increase short-acting at pre-lunch
36
If a patient is experiencing bedtime hyperglycemia what should be done?
Add/increase short-acting to pre-dinner dose
37
If a patient is experiencing hypoglycemia during fasting what should be done?
Decrease evening insulin dose -Check timing of morning test and dose *If on basal-bolus regimen, DECREASE BASAL
38
If a patient is experiencing pre-lunch hypoglycemia, what should be done?
Decrease/omit short-acting dose in the morning
39
If a patient is experiencing pre-dinner hypoglycemia, what should be done?
Decrease lunch bolus dose OR morning intermediate/long-acting dose
40
If a patient is experiencing hypoglycemia at bedtime, what should be done?
1. Add bedtime snack 2. Decrease pre-dinner dose of short-acting insulin 3. Decrease pre-dinner dose of intermediate insulin if given earlier in the afternoon
41
What is the Somogyi effect?
Nocturnal hypoglycemia with rebound hyperglycemia
42
What should be done if a patient is thought to be experiencing the Somogyi effect?
-Check BS at 3am -Add a bedtime snack -Possibly: move NPH from dinner to bedtime or decrease long-acting dose at bedtime
43
How does sickness affect insulin requirements?
Stress of illness increases insulin requirements even when food intake is decreased
44
If a patient is sick, how should their insulin be managed?
-Continue insulin even if food intake is decreased
45
How often should sick patients be checking their blood glucose levels?
Every 4 hours minimum
46
What additional test should be conducted in Type 1 patients who are sick to make sure they do not develop ketoacidosis?
Test urine for ketones with every urination
47
When should you consider switching to concentrated insulin?
When Total Daily Dose is 200-300 units/day

Therapeutics 2 Exam 3 -Diabetes pt 2 (8 decks)

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