Intensive Insulin Therapy

Question 1

what is intensive therapy?

Answer 1

matching insulin doses to the food, activity and life events.

Question 2

what are ways to administer basal-bolus therapy?

Answer 2

MDI or CSII

Question 3

what are some benefits of intensive therapy?

Answer 3

• 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

Question 4

what are some disadvantages to Intensive Therapy ?

Answer 4

• 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.

Question 5

fill in the blank:

in subjets with T2DM, there is evidence that [blank] is an indepedent risk factor for heart attacks

Answer 5

postprandial glucose

Question 6

Name 5 factors that alter PPG

Answer 6

• premeal BG
• timing of injection
• glycemic index of the food
• large volume rich in fat and or fiber

Question 7

when is the largest glycemic excursion of the day ?

why ?

Answer 7

breakfast

may be due to the dawn phenomenon

Question 8

why is timing of insulin important?

Answer 8

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.

Question 9

what does TDD include?

Answer 9

basal and bolus. at a % of 40-50 for basal and 50-60 for rapid insulin.

Question 10

what is the T1DM insulin dosage? 
new onset
on average
young adult  still growing 
OW

Answer 10

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

Question 11

T2DM insulin dosage?
healthy?
OW
OB

Answer 11

healthy: 0.5 u
OW: 0.7 u
OB with A1C above 9%: 1 u

Question 12

how do you estimate the insulin to carb ratio?

Answer 12

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

Question 13

how do you know that basal insulin was enough?

Answer 13

check overnight first
bedtime - AM BG
make sure it is no more than 2 mmol/L

Question 14

how do you know that bolus insulin is enough ?

Answer 14

look at mealtime 2HPP to evaluate ICR

aim for no more than 3 mmol/L elevation

Question 15

what is the ISF?

Answer 15

the drop in mmol/L that each unit of rapid insulin will provide

Question 16

how do you calculate the ISF?

Answer 16

100/ TDD= ISF

Question 17

how do you calculate the correction factor?

What does it mean ?

Answer 17

Actual BG- Target BG/ ISF= number of units needed to drop the glucose to the level you want

Question 18

how do you test your correction bolus?

Answer 18

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

Question 19

how many correction boluses should there be in a day

Answer 19

no more than 10 % of the TDD

Question 20

name 3 signs that basal insulin may need adjustment

Answer 20

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

Question 21

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)

Answer 21

if above 20: increase/decrease by 2 units at once

if below 20:
increase decrease by 1 un

Question 22

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.

Answer 22

lipodystrophy

Question 23

what is a common side effect of lipodystrophy

Answer 23

insulin does not go into the system normally because it is getting stopped by the skin and there is a risk of hypos.

Question 24

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 ?

Answer 24

+1 if hyper

-1 if hypo

Question 25

how many units of long lasting insulin do you add if you are having hyperglycemia or hypoglycemia episodes and your TDD is more than or equal to 10 u ?

Answer 25

+2 if hyper

-2 if hypo