Intensive Insulin Therapy Flashcards
What is intensive insulin therapy?
matching insulin to food and daily activities
What is the good thing about IIT?
45% reduction in microvascular complications of T1DM
What are 4 bad things about IIT?
- more injections
- carb counting
- frequent monitoring
- weight gain
Who cannot use IIT? (3 people)
- children
- elderly
- people with cardiovascular problems
What has to be in target in order to achieve A1C?
FPG and PPG
PPG is an independent risk factor for MI in type 1 or 2?
Type 2
What factors alter PPG?
- 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
What meal is the largest glycemic excursion of the day?
breakfast
How long does it take for the PPG to peak?
75min
What are some signs that a person had hypo during the night? (4 things)
- foggy head
- nightmares or vivid dreams
- very bad morning headache
- messed up blankets
Why is it that when someone has hypo once, they re more likely to have another and not necessarily feel it?
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.
What is included in the TDD?
50% basal
50% bolus
What insulin dosage does a T1DM need?
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
What insulin doses do T2DM need?
- 5 -> normal weight
- 7 -> overweight
- 0 -> obese, with A1C >9%
How to calculate ICR?
if TDD > 40: 500/TDD
if TDD < 40: 450/TDD
THEN compare with weight formula
5.7 x weight/TDD
How to calculate ISF?
100/TDD
How can you know if basal is adequate?
Check overnight first (bedtime vs AM glucose): score should be no more than 2mmol/L difference
How can you know if bolus is adequate?
look at mealtimes 2h post to evaluate carb ratio…no more than 3mmol/L elevation
What is lipohypertrophy?
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
In what case would the person have to inject insulin when they start eating or a little later?
if they have gastroparesis
Which insulin is super fast acting and can be injected at the start of the meal?
fiasc
When is the best time to calculate ICR?
When BG is in target before a meal and does not rise at more than 3mmol/L 2h post meal
