Insulin Management

Question 1

pro and con of syringe route of administration

Answer 1

• can combine some insulins into one injection
• problem of maual dexterity

Question 2

pro and con of insulin pen ROA

Answer 2

pro: easier to use that syringes

con; patient cannot combine insulins

Question 3

CSII

Answer 3

continuous subcutaneous insulin infusion

Question 4

outline general insulin formulations

Answer 4

you can have short acting and longer acting insulins

Question 5

factors that affect insulin absorption

Answer 5

• skin temperature
• anatomic injection site
• insulin dose
• injection technique
• exercise of underlying muslce
• smoking
• lipoatrophy/lipohypertrophy
• needle length

Question 6

There are only three significant adverse effects of
insulin therapy (both common)

Answer 6

1. hypoglycemia
2. weight gain
3. injection site issues

Question 7

first factor to consider when deriving an insulin regimen

Answer 7

start with meal planning

• ask what does the child normally eat– when, how much, day to day variation etc.

create a meal plan accordingly– variety is fine but aim for consistent CHO

Question 9

flexibility can be instillied in an inuslin routine:

Question 10

Insulin Sensitivity factor

Answer 10

ISF = 100/total daily dose of insulin

Question 11

Question 12

Advanced topic 2
• What if you want flexibility

• E.g. Eat 30 grams of CHO for breakfast and take 3
units of rapid insulin to put it away? but now you want waffles?

Answer 12

you can just give more insulin. if 3 units = 30 grams of carbs in this person, just add up the carbs you wanna eat and add the insulin necessary to fulfill the normal insulin/carb ratio.

Question 13

classic triad of hypglycemia

Answer 13

1. autonomic or neuroglycopenic symptoms
2. low plasma glucose level
3. relief of symptoms with administration of carbohydrates

Question 14

outline symptoms of mild to severe hypoglycemia

Answer 14

Question 15

hypoglycemia symptoms

Answer 15

Question 16

physiologic response to hypoglycemia (normally, not with diabetes)

1. decrase in ___ secretion
2. the decrease in insulin secretion causes the secretion release of ___. this promotes an increase in __ and __ in the liver
3. as glucose levels lower, there is a section of __, which promotes an increase in __ and __ in the liver, and a decrease in glucose uptake.
4. at lowerlower levels, __ hormone and __ is seen due to prolonged fast or prolonged hypoglycemia

Answer 16

1. decrase in insulin secretion
2. the decrease in insulin secretion causes the secretion release of glucagon. this promotes an increase in glycogenlysis and gluconeogenesis in the liver
3. as glucose levels lower, there is a section of epinephrine, which promotes an increase in glycogenlysis and gluconeogenesis in the liver, and a decrease in glucose uptake.
4. at lowerlower levels, growth hormone and cortisol is seen due to prolonged fast or prolonged hypoglycemia

Question 17

outline the physiological response to hypoglycemia in normally healthy individuals vs people with diabetes

Answer 17

NORMALLY:

1. decrase in insulin secretion
2. the decrease in insulin secretion causes the secretion release of glucagon. this promotes an increase in glycogenlysis and gluconeogenesis in the liver
3. as glucose levels lower, there is a section of epinephrine, which promotes an increase in glycogenlysis and gluconeogenesis in the liver, and a decrease in glucose uptake.
4. at lowerlower levels, growth hormone and cortisol is seen due to prolonged fast or prolonged hypoglycemia

IN DIABETES,

there is no decrease in insulin secretion, which results in NO secretion of glucagon. there is NO secretion of epinephrine, and growth hormone and cortisol are too late to help

Question 18

which glucose transporter is prevalent in the brain to provide it with sufficien glucose use

Answer 18

they have GLUT1 receptors

Question 19

Relation between HbA1c and rates of hypoglycemia

Answer 19

if you have good control, you have a higher chance of getting hypoglycemia because you are more likely to be using your insulin.

if you have uncontrolled A1c /high levels, you won’t be dipping down as low, since its higher to begin with

Question 20

Insulin secretagogues (sulfonylureas and
meglitinides) = \_\_ risk of hypoglycemia

Answer 20

Insulin secretagogues (sulfonylureas and
meglitinides) = **higher** risk of hypoglycemia

Question 21

T/F:Monotherapy with metformin, thiazolidinediones
and alpha-glucosidase inhibitors not associated
with hypoglycemia

Answer 21

true. less vulnerable to hypoglycemia.

Question 22

T/F combintaion therapy increases the risk of hypoglycemia

Answer 22

true. there may be times of day where there are multiple insulin agents at once.

Question 24

outline risk factors for severe hypoglycemia in type I Bm and type 2 DM

Answer 24

Question 25

Prevention of Hypoglycemia with Insulin Therapy

Answer 25

Question 26

treatment of hypoglycemia during mild to moderate episodes

Answer 26

Question 27

treatment for severe episode of hypoglycemia

Answer 27

Next meal or snack more than 1 hour away: add an extra snack.

Question 28

Exclusion criteria for commerical driving

Answer 28

• Any severe hypo in last 2 years
  – Hypoglycemia unawareness
  – Uncontrolled diabetes: HbA1c > 2 times normal
  – More than 10% of blood glucose values less than 4
  mmol/l

– Inadequate self-monitoring

Question 29

safe blood glucose for driving:

Answer 29

BG>5mmol/L

• if BG is under, take 15g carbs, re-check in 15 minutes. when BG>5mmol/L for at least 45 minutes –> safe to drive.
• need to re-check BG every 4 hours of continuous driving and carry simple carbohydrate snacks.