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Therapeutics II > Insulin Dosing > Flashcards

Insulin Dosing Flashcards

1
Q

Average TDD insulin type 1

A

-0.4-1 unit/kg/day
-higher amts during puberty, menses, medical illness

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2
Q

Insulin dosing in newly diagnosed type 1

A

-lower dose
-0.2-0.6 units/kg/day

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3
Q

BG testing type 1

A

-QID
-before meals and hs
-sometimes at 3 am

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4
Q

Basal-Bolus Dosing

A

-50-70% basal
-30-50% bolus divided among meals

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5
Q

Basal doses

A

-1-2 doses glargine or degludec
-1-2+ doses NPH

-important
-will keep ketoacidosis in checj

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6
Q

Bolus insulin doses

A

-Ultra or short acting before meals
-TID
-nothing at bedtime unless late night eaters

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7
Q

Carb counting

A

-1 unit insulin for 15g

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8
Q

intermediate + short acting dosing

A

-less common
-2 injections qd of mix
-split daily dosing:
am: 40%NPH + 15% shortacting
pm: 30%NPH + 15% short acting
-move NPH dose to bedtime if hyperglycemia occurs at night

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9
Q

Moving intermediate to HS

A

-Breakfast: L/A/G/N/R
-lunch: o
-dinner: L/A/G/R
-bedtime: N

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10
Q

Other insulin regimens

A

-pre-mix
-pump

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11
Q

pre-mix injections

A

-70/30 - 0 - 70/30 - 0
-75/25 - 0 - 75/25 - 0

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12
Q

Insulin pump

A

-rapid acting insulin
-basal rate constant
-bolus calculated baseed on glucose levels, carbs, insulin

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13
Q

Medtronic Mini-Med 770G

A

-pump
-close to artificial pancreas
-correct bolus or reduce insulin
-adjustable target
-fewer alarms
-not 100% automatic
-pt 2yo<

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14
Q

Insulin dosing type 2

A

-long or intermediate acting + oral agents
-bedtime dose
-suppress hepatic glucose production at night
-eventually can discontinue sulfonylurea once pt is on basal bolus regimen

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15
Q

Starting basal dose type 2

A

-0.1-0.2 units/kg/day
0.2-0.3 if A1c over 8%

-10-15 units

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16
Q

Adjusting dose type 2

A

-inc by 2 units every 3 days to reach FBS goal
-140-180+: add 10-20% TDD
-110-139 add unit
-less than 40-70: dec 10-20% - 20-40%

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17
Q

Eventual basal-bolus dosing type 2

A

-add bolus esp pt on more than 0.5 units/kg/day
-start w 10% basal dose or 4 units ultra/short acting w largest meal
-start one meal at a time or all 3 based on severity of readings
-adjust dose by 10-15% every 3-4 days
-can pull some from basal dose if needed to prevent hypoglycemia

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18
Q

more insulin dosing type 2

A

-1-2 units insulin every 15g carb/meal
-mixes can be used
-average dose often >1unit/kg/day

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19
Q

Mixes in type2

A

-N/R - 0 - N/R - 0
-N/R - 0 - R - N
-L/A/G instead regular too

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20
Q

General insulin dosing principles

A

-inc/dec dose q2-4 days
-target FBS (A1c >10)first then PPG (A1c<10)
-pt can be taught how to adjust their own dose for exercise/meals

21
Q

Adjusting / Indivdualizing insulin doses

A

-carbohydrate ratio
-sensitivity factor
-overall principles

22
Q

Insulin to carb ratio

A

-guide for how much insulin one needs to cover an amount of carb in a meal or snack

23
Q

Average insulin to carb ratio

A

-1unit: 10-15g carbs adults
-1unit: 20-30g carbs children

24
Q

calculating insulin:carb ratio

A

-total carbs/day for 3-day
-establish avg carb intake amount per meal
-g of carbs/amt of bolus given
-60g/6unit= 1:10 ratio
-check blood sugar pre/post meal to determine effectiveness
-rule of 500

25
Q

rule of 500 to calc insulin:carb

A

-500/TDD = g/1unit
-500/40 units = 1:12.5g
-for 60g = 5 units insulin to cover meal

26
Q

more than one insulin:carb ration might be needed

A

-physical activity
-body weight
-insulin needs
-type of meal

27
Q

Insulin sensitivity factor (correction factor) CF or ISF

A

-rule of 1800 (1500 in case they on regular insulin)
-1800/TDD
-estimates how much 1 unit will lower blood glucose
-1800/90units = 20mg/dL lowered by 1 unit
-used most to add to a dose of prandial insulin when BG elevated
-caution just using to correct hyperglycemia often

28
Q

CF/ISF

A

=x:50>150

-add x units for every 50 over 150 (BG)
-x from rule of 1800
-50/20 = 2 units
-2 units for every 50mg/dL above 150

-if u give an hs dose, maybe half it

29
Q

Fasting hyperglycemia causes

A

-bedtime eating
-not enough insulin
-Somogyl effect

30
Q

Fasting hyperglycemia tx

A

-if once daily basal, inc dose or change to BID
-if BID, inc supper/bedtime dose
-if basal-bolus, inc basal or PM bolus depending on hs readings

31
Q

Prelunch hyper glycemia tx

A

-add/inc shortacting to am dose

32
Q

predinner hyperglycemia tx

A

-inc am basal or add short acting at lunch
-inc short-acting dose if applicable

33
Q

bedtime hyperglycemia tx

A

-add/inc dose short acting at dinner

34
Q

Fasting hypoglycemia tx

A

-dec evening insulin dose
-check timing of AM test and dose

35
Q

Pre lunch hypoglycemia tx

A

-dec/omit shortacting dose in AM

36
Q

Pre-dinner

A

-dec lunch bolus
-dec AM basal

37
Q

Bedtime hypoglycemia

A

-add bedtime snack
-dec predinner shortacting
-dec predinner intermediate if give in the early afternoon

38
Q

How to adjust insulin type 1

A

-2 units dec BG 50mg/dL

39
Q

how to adjust insulin type 2

A

-4 unit dec BG 50mg/dL

40
Q

how to adjust insulin

A

-dec dose for low readings (2 or 4 units)
-can calc their correction factor to adjust dosage

41
Q

Somogyi effect

A

-nocturnal HYPO w rebound HYPER
-check BG at 3 am
-move NPH from dinner to bedtime or add bedtime snack

42
Q

Sick days not eating

A

-continue insulin
-let doc know they are sick
-stress will inc insulin need
-maintain fluid intake
-test BG q4h
-test for ketones
-can admin more insulin

43
Q

seek med attention if

A

-ketones present
-BG>250
-SOB
-fruity breath
-thirst/urination
-mental changes
-vomiting

44
Q

other patient information

A

-double check insulin label before purchasing insulin
-never freeze or leave in sunlight
-purchase correct syringes

45
Q

when to change to a concentrated form

A

-problems w large doses
-advantages of concentrated forms
-consider w TDD 200-300

46
Q

Other insulin dosage forms

A

-Afrezza (nasal)
-oral tablets
-sprays
-patches
-once weekly

47
Q

Insulin Icodec

A

-insulin w fatty acid chain to last long
-approved in EU
-t1+2dm: daily dose *7 round to nearest 10, titrate by 20
-t2dm (naive): 70qweek titrate by 20

48
Q

Teplizumab

A

-mAb
-delays progression of type 1 diabetes

Therapeutics II (20 decks)

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