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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
Q

What A1C indicates a problem with fasting blood sugar?

A

A1C > 10% indicates that 70% of the problem involves FBS

26
Q

What A1C indicates a problem with PPG?

A

An A1C <7.5% indicates that 70% of the problem involves PPG

27
Q

What is the Insulin to Carbohydrate ratio?

A

A guide for how much insulin a person would need to cover the amount of carbohydrate in a meal or snack

28
Q

What is the average carbohydrate ratio for an adult?

A

1 unit: 10-15 g carbs

29
Q

What is the average carbohydrate ratio for a child?

A

1 unit: 20-30 g carbs

30
Q

When would you use 1500 instead of 1800 for the “Rule of 1800”?

A

If the patient is on regular insulin

31
Q

If a patient is on once daily long-acting or intermediate insulin but still experiencing fasting hyperglycemia, what should be done?

A

Increase the dose or consider dividing into BID dosing

32
Q

If a patient is on split dose BID but still experiencing fasting hyperglycemia, what should be done?

A

Increase pre-supper or bedtime dose of insulin

33
Q

If a patient is on basal-bolus insulin but still experiencing fasting hyperglycemia, what should be done?

A

Increase the basal or PM bolus
*depending on nighttime blood sugar readings

34
Q

If a patient is experiencing hyperglycemia pre-lunch what should be done?

A

Add/increase short-acting to morning dose/breakfast

35
Q

If a patient is experiencing hyperglycemia pre-dinner what should be done?

A

Increase morning intermediate/long acting insulin OR add/increase short-acting at pre-lunch

36
Q

If a patient is experiencing bedtime hyperglycemia what should be done?

A

Add/increase short-acting to pre-dinner dose

37
Q

If a patient is experiencing hypoglycemia during fasting what should be done?

A

Decrease evening insulin dose

-Check timing of morning test and dose

*If on basal-bolus regimen, DECREASE BASAL

38
Q

If a patient is experiencing pre-lunch hypoglycemia, what should be done?

A

Decrease/omit short-acting dose in the morning

39
Q

If a patient is experiencing pre-dinner hypoglycemia, what should be done?

A

Decrease lunch bolus dose OR morning intermediate/long-acting dose

40
Q

If a patient is experiencing hypoglycemia at bedtime, what should be done?

A
  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
Q

What is the Somogyi effect?

A

Nocturnal hypoglycemia with rebound hyperglycemia

42
Q

What should be done if a patient is thought to be experiencing the Somogyi effect?

A

-Check BS at 3am
-Add a bedtime snack

-Possibly: move NPH from dinner to bedtime or decrease long-acting dose at bedtime

43
Q

How does sickness affect insulin requirements?

A

Stress of illness increases insulin requirements even when food intake is decreased

44
Q

If a patient is sick, how should their insulin be managed?

A

-Continue insulin even if food intake is decreased

45
Q

How often should sick patients be checking their blood glucose levels?

A

Every 4 hours minimum

46
Q

What additional test should be conducted in Type 1 patients who are sick to make sure they do not develop ketoacidosis?

A

Test urine for ketones with every urination

47
Q

When should you consider switching to concentrated insulin?

A

When Total Daily Dose is 200-300 units/day

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

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