Insulin Therapy Flashcards
If a patient comes in presenting with Diabetic Ketoacidosis, what should you do.
Monitor them frequently!
A patient with diabetes needs what type of treatment in regards to fluid and insulin.
Aggressive treatment if fluid deficit
Non-aggressive treatment of insulin (hypoglycemic episodes can occur with too much insulin)
Factors to consider when putting a patient on Insulin Therapy:
- Cost
- Lifestyle
- Compliance
- Patient Education
- Social Support
What types of Insulin therapy are there?
- Syringe
- Pen
- Continuous Pump
- Inhaled (coming soon)
Where do you normally administer insulin (for optimal results)?
Shoulder
Outer Thigh
Abdomen
What are three “rapid-acting” insulins on the market?
- Humalog
- Novolog
- Apidra
What is the benefit of combining insulin drugs (synergy)?
Helps non-compliant patients with their hyperglycemia
What is the disadvantage of combining insulin drugs (synergy)?
Increased risk for hypoglycemia
Weight gain possible
When should we use a concentrated insulin? (U500)
Patients with very high insulin resistance
Rapid Acting Insulin: Onset, Peak, Duration
Onset: 15 minutes
Peak: 30-90 minutes
Duration: 3-5 hours
Regular Insulin: Onset, Peak, Duration
Onset: 30 min - 1 hour
Peak: 2 hours
Duration: 6 hours
NPH (Humilin): Onset, Peak, Duration
Onset: 1-2 hours
Peak: 6-8 hours
Duration: 10-16 hours
Lantus/Levemir Insulin: Onset, Peak, Duration
Onset: 1 hour
Peak: None
Duration: 24 hours
What could cause hyperglycemia when you wake up?
Silent Hypoglycemia in the evening that rebounds in the morning
What is the Somogyi Effect?
The Somogyi effect can occur when a person takes long-acting insulin for diabetes. If the blood sugar level drops too low in the early morning hours, hormones (such as growth hormone, cortisol, and catecholamines) are released. These help reverse the low blood sugar level but may lead to blood sugar levels that are higher than normal in the morning. An example of the Somogyi effect is:
- A person who takes insulin doesn’t eat a regular bedtime snack, and the person’s blood sugar level drops during the night.
- A person’s body responds to the low blood sugar in the same way as in the dawn phenomenon, by causing a high blood sugar level in the early morning.
What is the Dawn Phenomenon?
Hormones (growth hormone, cortisol, and catecholamines) produced by the body cause the liver to release large amounts of sugar (glucose) into the bloodstream. These hormones are released in the early morning hours. These hormones also may partially block the effect of insulin, whether it’s insulin your body produces or insulin from the last injection.
This can happen in anyone, but when there is insulin resistance, this will cause a bad effect.
How to tell the difference between Somogy and Dawn?
The Somogyi effect can occur any time you or your child has extra insulin in the body. To sort out whether an early morning high blood sugar level is caused by the dawn phenomenon or Somogyi effect, check blood sugar levels around 2 a.m. to 3 a.m. for several nights.
If the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect.
If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it’s likely the dawn phenomenon.
How do you dose insulin?
- Depends on patient’s weight
2. Estimate the total daily dosage (TDD) and how it’s being administered (shots vs. pump)
Calculating Dosage
Rule of 500: (carb:insulin ratio) 500/TDD
Rule of 1800: (sensitivity/correction factor) 1800/TDD
What does the Rule of 500 tell us?
Can use for calculating amount of meal-time insulin needed
What does the Rule of 1800 tell us?
(When Jose is missing, 1800 is where it’s at)
Tells the amount of change in blood glucose from 1 unit of insulin
What are the goals of treating DM
- Getting A1C below 7%
2. Less/Shorter Glycemic Excursions
If this condition associated with DM is untreated it could be fatal.
Diabetic Ketoacidosis
What causes DKA (Diabetic Ketoacidosis)?
Non-compliance
Infection
Trauma
