Insulin Therapy Flashcards
What is the second step in designing pump therapy?
Add regular bolus with meals → base on carb counting
what is the difference between Dawn vs Somogyi phenomenons?
Dawn → natural phenomenon
Somogyi → caused by insulin
Mechanism of action of insulin at the skeletal muscle
increased synthesis of protein and glycogen
intermediate acting insulin type
NPH
insulin to carb ratio for rapid acting
500/TDD insulin
when giving insulin injections, why is it recommended to rotate the injectino site?
avoid delayed absoprtion due to fibrosis or lipohypertrophy
Dosing for Afrezza
comes in 4, 8, and 12 units
Insulin activates Na/K ATPase resulting in…
intracellular shift of K → hypokalemia
Short acting insulin type
regular insulin
In a hypoglycemic patient what is the “rule of 15”
check → treat → check → eat
insulin to carb ratio for regular insulin
450/TDD insulin
Two things a patient must know if they are going to get an insulin pump
know insulin basics
carbohydrate counting
FBS goal when checking after a meal
< 180
1st line DOC for T2DM with ASCVD
GLP 1 agonist → liraglutide
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?
morning LA or afternoon RA
Insulin + GLP1 injection has high risk for ____ and low risk for ____
high → hypoglycemia
low → weight gain
what is going on in Somogyi phenomenon?
high at evening or bedtime → lows at 2-4 am → rebound high in the morning
Criteria that would consider an A1c of 8 - 8.5% acceptable
frail elder duration of disease > 10 years life expectancy < 5 years advanced microvascular complications can't handle polypharmacy
adverse cardiovascular effect due to insulin
edema
What is the average time for onset for rapid acting insulin?
10-15 min
Appropriate BP for patient over age 70
<150/90
Which patient population MC uses insulin pumps?
Type 1 DM in children
How much insulin is normal released in a day?
~20 units
How do you calculate basal pump dose for an insulin pump - First Step ?
divide total # of LA units by 24 = basal rate in units/hour
Mechanism of action of insulin at the liver
stimulates hepatic glycogen and fatty acid synthesis
FA is released into the blood as lipoproteins
How does Novalin and Novalog differ?
onset
Blood sugar in hypogylcemic patient
< 70
first line therapy in Type 2 DM for lowering glucose if the patient has HF or CKD
SGLT2 inhibitor
Protein serving size?
3 oz
1 unit of lispro covers how many grams of carbs
7 grams
you should taking insulin and ___ in patient with heart failure → worsens edema and can exacerbate HF
thiazolidinediones (TZD)
Type of intermediate insulin that acts as basal therapy since it has a duration of 24 hr
NPH
insulin daily dose for T1DM vs T2DM
Type 1 → 0.5 - 0.6 units
Type 2 → 0.1 - 0.2 units (may be higher due to insulin resistance)
Why is medical nutrition therapy important?
can reduce A1c and amount of insulin required
Safer insulin dual therapy in T2DM
insulin + GLP1 injection
recommended serving of non-starchy vegetables
3-5 servings
causes of hyperglycemia
too much food too little insulin illness reduced exercise medications
what is the most effective dual therapy for treating T2DM with insulin?
insulin + metformin
Why is insulin used when you need to lower A1c by > 2%
no ceiling effect of lowering A1c
3 endocrine/metabolic effects due to insulin
hypoglycemia
hypokalemia
weight gain
4 instances where a diabetic patient might be unaware of hypoglycemia
long duration of DM
central neuropathy
older age
dementia
two formulations of insulin
regular or NPH
Goal A1c in normal patient population
goal A1c in geriatric patients
< 6.5%
< 8 - 8.5%
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?
evening LA
cleavage of what is required for the utilization of insulin
C-peptide
Goals in healthy adults:
A1c
fasting/preprandial glucose
peak postprandial glucose
< 7-7.5%
70-130
< 180
FBS goal range when checking in the AM
100-130
Two risks of treating T2DM with insulin+metformin dual therapy
highest risk of hypoglycemia
high risk of weight gain
Symptoms of hypoglycemia
adrenergic symptoms → tremors, sweating, palpitations, confusion, dizziness, headache, nausea
Classic hyperglycemic symptoms
3 polys [polydipsia, polyphagia, polyuria]
dry skin
Correction factor for regular insulin user
1,500/total daily insulin
How many grams are in suggested carb serving size?
15 gm
three long acting insulin types
glargine
levemir
degludec
what should a patient do on their “sick day policy”?
check BG more often → likely will 1/2 their insulin
three rapid acting human insulin analogs
lispro
aspart
glulisine
inhaled rapid acting insulin, good for patients who don’t like injections
Afrezza
first line therapy in Type 2 DM for lowering glucose
metformin + lifestyle changes
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?
morning RA or morning LA
2 adverse dermatologic effects due to insulin
erythema and pruritis at injection site
4 special population you should you insulin with caution
hepatic failure
renal failure
elderly
pregnancy
When you adjust insulin, how much do you adjust by?
10% → ~ 4 units
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?
evening RA
correction factor for rapid acting insulin analogs
1,700 or 1,800/total daily insulin
What is unique about Lantus?
won’t peak → less risk of hypoglycemia
glycemic control dual therapy MC in elderly
metformin + basal insulin
first line monotherapy in glycemic control in the elderly
metformin
Who is Humulin R U500 indicated in?
patients on >200 units of insulin/day
insulin resistant T2DM
How are whole grains different than regular carbs?
insoluble fiber → less glucose spikes
MC medication that can induce hyperglycemia in a diabetic patient
glucocorticoids (MC) phenytoin niacin alpha-interferon pentamidine
What is going on with Dawn phenomenon?
natural rise in glucose in the morning
In comparison to human insulin, why do rapid acting insulin analogs reach peak serum values faster?
analogs quickly dissociate into monomers and are absorbed more rapidly than regular insulin
goals in frail elders
A1c
fasting/preprandial glucose
peak postprandial glucose
<8.5%
100-180
< 200
if you want faster onset of action of insulin should you inject centrally or peripherally?
centrally
mechanism of action of insulin at adipose tissue
stimulates circulating lipoproteins to provide free fatty acids, triglyceride synthesis and storage
inhibits hydrolysis of triglycerides
