Intensive Insulin Therapy

Question 1

What is intensive insulin therapy?

Answer 1

matching insulin to food and daily activities

Question 2

What is the good thing about IIT?

Answer 2

45% reduction in microvascular complications of T1DM

Question 3

What are 4 bad things about IIT?

Answer 3

• more injections
• carb counting
• frequent monitoring
• weight gain

Question 4

Who cannot use IIT? (3 people)

Answer 4

• children
• elderly
• people with cardiovascular problems

Question 5

What has to be in target in order to achieve A1C?

Answer 5

FPG and PPG

Question 6

PPG is an independent risk factor for MI in type 1 or 2?

Answer 6

Type 2

Question 7

What factors alter PPG?

Answer 7

• carb composition of meal
• meal composition (pro, fat)
• GI
• type of carb
• portion
• pre-meal BG + timing of injection
• time of the day
• stress, illness
• gastroparesis
• is there adequate basal

Question 8

What meal is the largest glycemic excursion of the day?

Answer 8

breakfast

Question 9

How long does it take for the PPG to peak?

Answer 9

75min

Question 10

What are some signs that a person had hypo during the night? (4 things)

Answer 10

• foggy head
• nightmares or vivid dreams
• very bad morning headache
• messed up blankets

Question 11

Why is it that when someone has hypo once, they re more likely to have another and not necessarily feel it?

Answer 11

They are more likely to have another episode of hypo because the glucagon stores are depleted and they might not feel it because the stress hormones stores are depleted as well.

Question 12

What is included in the TDD?

Answer 12

50% basal

50% bolus

Question 13

What insulin dosage does a T1DM need?

Answer 13

0.3-1 U/kg/d
on average use 0.5
if young adult (insulin resistant), use 0.7-1
if newly diagnosed, use 0.3

Question 14

What insulin doses do T2DM need?

Answer 14

0. 5 -> normal weight
1. 7 -> overweight
2. 0 -> obese, with A1C >9%

Question 15

How to calculate ICR?

Answer 15

if TDD > 40: 500/TDD
if TDD < 40: 450/TDD

THEN compare with weight formula

5.7 x weight/TDD

Question 16

How to calculate ISF?

Answer 16

100/TDD

Question 17

How can you know if basal is adequate?

Answer 17

Check overnight first (bedtime vs AM glucose): score should be no more than 2mmol/L difference

Question 18

How can you know if bolus is adequate?

Answer 18

look at mealtimes 2h post to evaluate carb ratio…no more than 3mmol/L elevation

Question 19

What is lipohypertrophy?

Answer 19

a lump under the skin caused by accumulation of extra fat at the site of many subcutaneous injection of insulin
**it may change the timing or completeness of insulin action

Question 20

In what case would the person have to inject insulin when they start eating or a little later?

Answer 20

if they have gastroparesis

Question 21

Which insulin is super fast acting and can be injected at the start of the meal?

Answer 21

fiasc

Question 22

When is the best time to calculate ICR?

Answer 22

When BG is in target before a meal and does not rise at more than 3mmol/L 2h post meal