Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Diabetes Mellitus > Insulin Therapy > Flashcards

Insulin Therapy Flashcards

1
Q

What is the second step in designing pump therapy?

A

Add regular bolus with meals → base on carb counting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the difference between Dawn vs Somogyi phenomenons?

A

Dawn → natural phenomenon

Somogyi → caused by insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Mechanism of action of insulin at the skeletal muscle

A

increased synthesis of protein and glycogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

intermediate acting insulin type

A

NPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

insulin to carb ratio for rapid acting

A

500/TDD insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

when giving insulin injections, why is it recommended to rotate the injectino site?

A

avoid delayed absoprtion due to fibrosis or lipohypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Dosing for Afrezza

A

comes in 4, 8, and 12 units

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Insulin activates Na/K ATPase resulting in…

A

intracellular shift of K → hypokalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Short acting insulin type

A

regular insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

In a hypoglycemic patient what is the “rule of 15”

A

check → treat → check → eat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

insulin to carb ratio for regular insulin

A

450/TDD insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Two things a patient must know if they are going to get an insulin pump

A

know insulin basics

carbohydrate counting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

FBS goal when checking after a meal

A

< 180

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

1st line DOC for T2DM with ASCVD

A

GLP 1 agonist → liraglutide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If a patient is on multiple insulin injections a day and they have abnormal glucose before dinner , which dose of insulin needs to be changed?

A

morning LA or afternoon RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Insulin + GLP1 injection has high risk for ____ and low risk for ____

A

high → hypoglycemia

low → weight gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is going on in Somogyi phenomenon?

A

high at evening or bedtime → lows at 2-4 am → rebound high in the morning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Criteria that would consider an A1c of 8 - 8.5% acceptable

A 
frail elder
duration of disease > 10 years 
life expectancy < 5 years 
advanced microvascular complications
can't handle polypharmacy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

adverse cardiovascular effect due to insulin

A

edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the average time for onset for rapid acting insulin?

A

10-15 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Appropriate BP for patient over age 70

A

<150/90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which patient population MC uses insulin pumps?

A

Type 1 DM in children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How much insulin is normal released in a day?

A

~20 units

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do you calculate basal pump dose for an insulin pump - First Step ?

A

divide total # of LA units by 24 = basal rate in units/hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Mechanism of action of insulin at the liver

A

stimulates hepatic glycogen and fatty acid synthesis

FA is released into the blood as lipoproteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How does Novalin and Novalog differ?

A

onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Blood sugar in hypogylcemic patient

A

< 70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

first line therapy in Type 2 DM for lowering glucose if the patient has HF or CKD

A

SGLT2 inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Protein serving size?

A

3 oz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

1 unit of lispro covers how many grams of carbs

A

7 grams

31
Q

you should taking insulin and ___ in patient with heart failure → worsens edema and can exacerbate HF

A

thiazolidinediones (TZD)

32
Q

Type of intermediate insulin that acts as basal therapy since it has a duration of 24 hr

A

NPH

33
Q

insulin daily dose for T1DM vs T2DM

A

Type 1 → 0.5 - 0.6 units

Type 2 → 0.1 - 0.2 units (may be higher due to insulin resistance)

34
Q

Why is medical nutrition therapy important?

A

can reduce A1c and amount of insulin required

35
Q

Safer insulin dual therapy in T2DM

A

insulin + GLP1 injection

36
Q

recommended serving of non-starchy vegetables

A

3-5 servings

37
Q

causes of hyperglycemia

A 
too much food
too little insulin 
illness
reduced exercise
medications
38
Q

what is the most effective dual therapy for treating T2DM with insulin?

A

insulin + metformin

39
Q

Why is insulin used when you need to lower A1c by > 2%

A

no ceiling effect of lowering A1c

40
Q

3 endocrine/metabolic effects due to insulin

A

hypoglycemia
hypokalemia
weight gain

41
Q

4 instances where a diabetic patient might be unaware of hypoglycemia

A

long duration of DM
central neuropathy
older age
dementia

42
Q

two formulations of insulin

A

regular or NPH

43
Q

Goal A1c in normal patient population

goal A1c in geriatric patients

A

< 6.5%

< 8 - 8.5%

44
Q

If a patient is on multiple insulin injections a day and they have abnormal glucose before breakfast or overnight, which dose of insulin needs to be changed?

A

evening LA

45
Q

cleavage of what is required for the utilization of insulin

A

C-peptide

46
Q

Goals in healthy adults:
A1c
fasting/preprandial glucose
peak postprandial glucose

A

< 7-7.5%
70-130
< 180

47
Q

FBS goal range when checking in the AM

A

100-130

48
Q

Two risks of treating T2DM with insulin+metformin dual therapy

A

highest risk of hypoglycemia

high risk of weight gain

49
Q

Symptoms of hypoglycemia

A

adrenergic symptoms → tremors, sweating, palpitations, confusion, dizziness, headache, nausea

50
Q

Classic hyperglycemic symptoms

A

3 polys [polydipsia, polyphagia, polyuria]

dry skin

51
Q

Correction factor for regular insulin user

A

1,500/total daily insulin

52
Q

How many grams are in suggested carb serving size?

A

15 gm

53
Q

three long acting insulin types

A

glargine
levemir
degludec

54
Q

what should a patient do on their “sick day policy”?

A

check BG more often → likely will 1/2 their insulin

55
Q

three rapid acting human insulin analogs

A

lispro
aspart
glulisine

56
Q

inhaled rapid acting insulin, good for patients who don’t like injections

A

Afrezza

57
Q

first line therapy in Type 2 DM for lowering glucose

A

metformin + lifestyle changes

58
Q

If a patient is on multiple insulin injections a day and they have abnormal glucose before morning snack/lunch, which dose of insulin needs to be changed?

A

morning RA or morning LA

59
Q

2 adverse dermatologic effects due to insulin

A

erythema and pruritis at injection site

60
Q

4 special population you should you insulin with caution

A

hepatic failure
renal failure
elderly
pregnancy

61
Q

When you adjust insulin, how much do you adjust by?

A

10% → ~ 4 units

62
Q

If a patient is on multiple insulin injections a day and they have abnormal glucose before bedtime which dose of insulin needs to be changed?

A

evening RA

63
Q

correction factor for rapid acting insulin analogs

A

1,700 or 1,800/total daily insulin

64
Q

What is unique about Lantus?

A

won’t peak → less risk of hypoglycemia

65
Q

glycemic control dual therapy MC in elderly

A

metformin + basal insulin

66
Q

first line monotherapy in glycemic control in the elderly

A

metformin

67
Q

Who is Humulin R U500 indicated in?

A

patients on >200 units of insulin/day

insulin resistant T2DM

68
Q

How are whole grains different than regular carbs?

A

insoluble fiber → less glucose spikes

69
Q

MC medication that can induce hyperglycemia in a diabetic patient

A 
glucocorticoids (MC)
phenytoin
niacin
alpha-interferon
pentamidine
70
Q

What is going on with Dawn phenomenon?

A

natural rise in glucose in the morning

71
Q

In comparison to human insulin, why do rapid acting insulin analogs reach peak serum values faster?

A

analogs quickly dissociate into monomers and are absorbed more rapidly than regular insulin

72
Q

goals in frail elders
A1c
fasting/preprandial glucose
peak postprandial glucose

A

<8.5%
100-180
< 200

73
Q

if you want faster onset of action of insulin should you inject centrally or peripherally?

A

centrally

74
Q

mechanism of action of insulin at adipose tissue

A

stimulates circulating lipoproteins to provide free fatty acids, triglyceride synthesis and storage
inhibits hydrolysis of triglycerides

Diabetes Mellitus (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions