insulin treatment pg 15-21 Flashcards
kania pt 2
what is a carbohydrate ratio?
a guide for how much insulin one would need to cover the amount of carbohydrate in a meal or snack
average is 1 unit:10-15 grams for adults
1 unit:20-30 grams for school-aged children
how would a carb ratio be established?
by dividing the number of grams of carbohydrate for a meal by the amount of bolus insulin given
how should a carb ratio be checked to determine effectiveness?
check blood sugar pre and post (3 hours later) meal
what is the rule of 500?
500 divided by TDD = number of grams of carbohydrates for 1 unit of insulin
example if pt is taking 40 units
500 / 40 –> 12.5gm of carbohydrate for 1 unit of insulin
so for a 60g meal divide by 12.5 and get roughly 5 units of insulin to cover
what is the rule of 1800?
used for correction factor for patients taking ultra-short acting insulins
1800 divided by TDD = number of mg/dL blood glucose will drop for every 1 units of insulin
if a patient is taking 90 units of insulin daily, how much will BS decrease with 1 unit of insulin?
20 mg/dL
1800 / 90 –> 20
when is correction factor most likely added?
used to add to a dose of prandial insulin when BS are elevated BEFORE a meal
may be used to correct hyperglycemia, but use caution when discussing with pts to avoid stacking
what is a good CF baseline?
for every 50 mg/dL over 150, add 1 unit of insulin
if a patient is taking regular insulin, what should their baseline be instead of 1800?
1500
how would you treat hyperglycemia during fasting?
find cause (bedtime eating, too small dose, somogyi effect)
if on qd long-acting or NPH –> increase dose or consider dividing into BID
if on BID –> increase pre-supper or bedtime dose
if on basal-bolus –> increase basal or PM bolus depending on night readings
what should a patient do if hyperglycemia pre-lunch?
increase short acting morning dose/breakfast
what should a pt do if hyperglycemia pre-dinner?
increase morning NPH or long insulin dose OR increase short-acting at pre-lunch
what should a pt do if hyperglycemia at bedtime?
increase short-acting dose to pre-dinner dose
what should a pt do if hypoglycemia during fasting?
decrease evening insulin dose (also check timing of morning test and dose)
if on basal-bolus regimen –> decrease basal
what should a pt do if hypoglycemia pre-lunch?
decrease/omit short-acting insulin dose in the morning
what should a pt do if hypoglycemia pre-dinner?
decrease lunch bolus dose or morning NPH/long-acting dose
what should a pt do if hypoglycemia at bedtime?
add bedtime snack
decrease pre-dinner dose of short acting
decrease pre-dinner dose of NPH if given earlier in the afternoon
what is the somogyi effect?
nocturnal hypoglycemia with rebound hyperglycemia (rollercoaster effect)
check BS at 3 am and ask about signs and symptoms
add a bedtime snack
if applicable, move NPH from dinner to bedtime or decrease long-acting dose at night
how should a pts regimen be changed when sick?
if they’re sick, they’re likely not eating –> continue insulin but decrease dose
maintain fluid (12 8oz glasses/day)
test urine for ketones (could lead to DKA)
when should a pt switch to a concentrated form of insulin?
on large dose (200-300 units/day)
what are some side effects of large insulin doses?
unpredictable absorption
increased pain/discomfort
leakage
what are some advantages of concentrated forms of insulin?
provide sustained glucose-lowering effect with less risk of hypoglycemia
lower intra-individual variability
potential for fewer injections, better adherence, less pain, and less frequent pen changes
what is afrezza?
inhaled human insulin
AE –> hypoglycemia, cough, URTI, decline in pulmonary function
what is icodec?
analogue of human insulin that is used once weekly
approved in other countries, but not really in practice in the US
what is teplizumab?
tzield
humanized anti-CD3 monoclonal antibody
may delay T1DM from stage 2 to stage 3
daily IV infusion for 14 consecutive days
