Insulin Management Flashcards
pro and con of syringe route of administration
- can combine some insulins into one injection
- problem of maual dexterity
pro and con of insulin pen ROA
pro: easier to use that syringes
con; patient cannot combine insulins
CSII
continuous subcutaneous insulin infusion

outline general insulin formulations
you can have short acting and longer acting insulins

factors that affect insulin absorption
- skin temperature
- anatomic injection site
- insulin dose
- injection technique
- exercise of underlying muslce
- smoking
- lipoatrophy/lipohypertrophy
- needle length
There are only three significant adverse effects of insulin therapy (both common)
- hypoglycemia
- weight gain
- injection site issues
first factor to consider when deriving an insulin regimen
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

flexibility can be instillied in an inuslin routine:

Insulin Sensitivity factor
ISF = 100/total daily dose of insulin


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?
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.

classic triad of hypglycemia
- autonomic or neuroglycopenic symptoms
- low plasma glucose level
- relief of symptoms with administration of carbohydrates
outline symptoms of mild to severe hypoglycemia

hypoglycemia symptoms

physiologic response to hypoglycemia (normally, not with diabetes)
- decrase in ___ secretion
- the decrease in insulin secretion causes the secretion release of ___. this promotes an increase in __ and __ in the liver
- as glucose levels lower, there is a section of __, which promotes an increase in __ and __ in the liver, and a decrease in glucose uptake.
- at lowerlower levels, __ hormone and __ is seen due to prolonged fast or prolonged hypoglycemia
- decrase in insulin secretion
- the decrease in insulin secretion causes the secretion release of glucagon. this promotes an increase in glycogenlysis and gluconeogenesis in the liver
- 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.
- at lowerlower levels, growth hormone and cortisol is seen due to prolonged fast or prolonged hypoglycemia
outline the physiological response to hypoglycemia in normally healthy individuals vs people with diabetes
NORMALLY:
- decrase in insulin secretion
- the decrease in insulin secretion causes the secretion release of glucagon. this promotes an increase in glycogenlysis and gluconeogenesis in the liver
- 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.
- 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
which glucose transporter is prevalent in the brain to provide it with sufficien glucose use
they have GLUT1 receptors

Relation between HbA1c and rates of hypoglycemia
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

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

T/F:Monotherapy with metformin, thiazolidinediones
and alpha-glucosidase inhibitors not associated
with hypoglycemia
true. less vulnerable to hypoglycemia.
T/F combintaion therapy increases the risk of hypoglycemia
true. there may be times of day where there are multiple insulin agents at once.
outline risk factors for severe hypoglycemia in type I Bm and type 2 DM

Prevention of Hypoglycemia with Insulin Therapy

treatment of hypoglycemia during mild to moderate episodes

treatment for severe episode of hypoglycemia
Next meal or snack more than 1 hour away: add an extra snack.

Exclusion criteria for commerical driving
- 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
safe blood glucose for driving:
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.