Intensive Insulin Therapy Flashcards
what is intensive therapy?
matching insulin doses to the food, activity and life events.
what are ways to administer basal-bolus therapy?
MDI or CSII
what are some benefits of intensive therapy?
- there is a reduction of microvascular complications in T1
- can be integrated into the life style of every person
- QOL is improved and better control
what are some disadvantages to Intensive Therapy ?
- injections are often.
- need to learn how to carb count
- there is frequent BG monitoring needed =4x.day
- weight gain due to the tight control (less glucose in urine), extra insulin or extra food, and over treating of reactions.
fill in the blank:
in subjets with T2DM, there is evidence that [blank] is an indepedent risk factor for heart attacks
postprandial glucose
Name 5 factors that alter PPG
- premeal BG
- timing of injection
- glycemic index of the food
- large volume rich in fat and or fiber
when is the largest glycemic excursion of the day ?
why ?
breakfast
may be due to the dawn phenomenon
why is timing of insulin important?
the insulin administered 15 min before mealtime lowers the PPG, lets there be more time in the correct range, and does not increase risk of hypos.
- PPG has a mean peak of 75 min.
- rapid acting insulin has max effect at 100min after injection.
what does TDD include?
basal and bolus. at a % of 40-50 for basal and 50-60 for rapid insulin.
what is the T1DM insulin dosage? new onset on average young adult still growing OW
0.3-1.0 kg new onset: 0.3 on average: 0.5-0.7 or 0.53 young adults: 0.7-1 OW: 1
T2DM insulin dosage?
healthy?
OW
OB
healthy: 0.5 u
OW: 0.7 u
OB with A1C above 9%: 1 u
how do you estimate the insulin to carb ratio?
1) when TDD is greater than 40 units= 500/ TDD
2) compare with weight rqmt formula= 5.7 x wt (kg)/TDD.
3) when TDD is less than 40 units= 450/TDD
how do you know that basal insulin was enough?
check overnight first
bedtime - AM BG
make sure it is no more than 2 mmol/L
how do you know that bolus insulin is enough ?
look at mealtime 2HPP to evaluate ICR
aim for no more than 3 mmol/L elevation
what is the ISF?
the drop in mmol/L that each unit of rapid insulin will provide
how do you calculate the ISF?
100/ TDD= ISF
how do you calculate the correction factor?
What does it mean ?
Actual BG- Target BG/ ISF= number of units needed to drop the glucose to the level you want
how do you test your correction bolus?
take a correction bolus
then check BG four hours later.
If the BG is below target: too much insulin taken
If the BG is above target, then too little insulin taken
how many correction boluses should there be in a day
no more than 10 % of the TDD
name 3 signs that basal insulin may need adjustment
1) BG is out of range several days and there is a trend
2) One or more hypos at night without explanation
3) insulin correction boluses are greater than 10% TDD
how will you adjust the basal insulin:
if TDD is more than 20 un
if TDD is less than 20 un
(still things to change in this one)
if above 20: increase/decrease by 2 units at once
if below 20:
increase decrease by 1 un
Name the term of the following description:
lumps or dents of varying sizes and shapes that can form after repeated insulin injections into the same site.
lipodystrophy
what is a common side effect of lipodystrophy
insulin does not go into the system normally because it is getting stopped by the skin and there is a risk of hypos.
how many units of long lasting insulin do you add if you are having hyperglycemia or hypoglycemia episodes and your TDD is less than 10 u ?
+1 if hyper
-1 if hypo
