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DB Therapeutics > Lecture 3 (Management of T1D) > Flashcards

Lecture 3 (Management of T1D) Flashcards

1
Q

What are the ways you can take insulin via?

A

syringes
pen needles
continuous subcutaneous insulin infusion (CSII)

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2
Q

Explain basal

A

beta cells secrete small amounts of insulin throughout the day

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3
Q

Explain bolus

A

at mealtime, insulin is rapidly released in response to food

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4
Q

What are the categories that fall under bolus?

A

rapid acting
short acting

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5
Q

List the rapid acting genetic

A

aspart
glulisine
lispro
faster acting insulin aspart

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6
Q

List the short acting genetic

A

regular
regular U-500

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7
Q

When is short acting admin?

A

30-45 prior to meals to cover mealtime glucose excursions

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8
Q

When is regular U-500 used?

A

it is more concentrated version for those with extreme insulin resistance

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9
Q

When is RAIA administered?

A

with meals or just prior (15 min) to cover mealtime

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10
Q

What is the timeline for regular?

A

onset ~30 min
peak ~2-3 hr
DoA ~ 6 hr

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11
Q

What is the timeline for RAIA?

A

onset ~4-20 min
peak ~0.5-2 hr
DoA ~ 3-5 hr

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12
Q

What are some advantages of RAIA?

A

more rapid absorption
convenience
better PPG control
lower risk of hypoglycemia

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13
Q

What are some disadvantages of RAIA?

A

cost more
for the similar effectiveness

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14
Q

What is the caution about some humalog kwikpen?

A

it can come in 200U/ml instead of 100U/ml so be careful which one

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15
Q

What is the timeline for regular U500?

A

onset ~15 min
peak ~4-8 hr
DoA ~ 17-24 hr

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16
Q

What is the guideline for the need of U-500?

A

for those who require > 200 U/d

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17
Q

List the intermediate insulin genetic

A

neutral protamine hagedorn

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18
Q

What is the major difference to be aware of for intermediate acting?

A

they are cloudy when all other are clear looking

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19
Q

List the long acting insulin genetic

A

detemir
glargine (U-100 & U-300)
degludec (U-100 & U-200)

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20
Q

What is the timeline for intermediate?

A

onset ~1-3 hours
peak ~ 5-8 hrs
DoA up to 18 hr

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21
Q

What is the timeline for long acting?

A

onset ~90 min

DoA ~ based on type
glargine U100 24hr
glargine U300 >30 hr
degludec 42 h
detemir 16-24 hr

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22
Q

What is the administration of Intermediate?

A

once or twice daily to provide a background amount of insulin

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23
Q

What is the special prep instructions for intermediate?

A

since they are in suspension must be hand roll and inverted before used to re-suspend

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24
Q

What is the advantages of LAIA?

A

peakless
more consistent/less variable BG
less hypoglycemia

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25
Q

What is the disadvantages of LAIA?

A

cost more for similar efficacy

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26
Q

What are the subtypes of basal insulin?

A

intermediate
long acting

27
Q

What are the reasons for syringes?

A

least expensive
used to it (familiarity)
prefer less injections and want to combine some insulins in same syringe

28
Q

What the pros of insulin pens?

A

portable/convenient/easier to use
advantageous if dexterity/visually impaired
allows for precision dosing

29
Q

Explain what a CSII is?

A

insulin pump
small computerized device that delivers insulin continuously 24 hr/day
the pump is worn on the outside of the body and delivers insulin via a tube which is attached a cannula placed under the skin

30
Q

How often is the insulin pump cannula changes?

A

3 days

31
Q

What type of insulin is in the pump?

A

only one type of insulin (RAIA) and delivers more when a bolus is required

32
Q

Can rates be manually adjusted?

A

yes it can but also some have the ability to adjusted based on basal insulin via a closed loop system

33
Q

Who is pumps best for?

A

those who
poorly controlled with optimized injections
significant glucose variability
frequent severe hypoglycemia
pregnancy

34
Q

How can insulin pumps work with CGMS?

A

A closed loop system – the pump and CGM automatically communicate to one another via a computer program to create somewhat of an ‘artificial pancreas’

35
Q

Insulin Adverse Effects

A

hypoglycemia
weight gain
blurry vision
localized fat hypertrophy

36
Q

List some factors that affect insulin absorption

A

exercise of injected area
massage
temperature
lipohypertrophy
dose
renal function
depth of injection

37
Q

What are some tips for injection technique?

A

Wash your hands
Alcohol swabs: use to clean cartridge/vial – not the body
Rotate injections systematically within the same anatomical region
Rates of absorption
Lipohypertrophy effects
Avoid moles, scars, etc.
Use a quick, smooth movement

38
Q

At what length is a skin lift needed?

A

at 8 mm

39
Q

How to use a pen device?

A

General tips
Wash hands. Remove the pen cap
Wipe pen tip with alcohol swab. Attach the needle (screw on). Use a new needle every time
Safety test (priming): Before injecting, the pen should be primed as per the manufacturer specs (e.g. 2 units). With needle pointing up, press plunger and if see a stream ofinsulin, it is ready
Dial up amount of insulin required (i.e. 20U)
Inject at 90o angle with no skin lift for most. Press injection button, count to 10, release button and remove
Remove the needle; dose window should say 0

Just talk through it, doesnt have to be perfect

40
Q

How to mixing and admin of insulin N + R in same syringe?

A

Draw up
If manually mixing 2 insulins in the same syringe, always draw up the quick-acting insulin first
Fill
Fill the syringe with air up to the # of units needed of NPH
Insert
Insert the needle into the vial, expel air, remove the needle (Do NOT draw up insulin)
Fill
Fill syringe with air to the # of units needed of R
Insert
Insert needle into vial, expel air, draw up desired # of units of R, remove needle from vial
Insert
Insert needle back into NPH vial and draw up desired units of NPH
Inspect
Make sure there are no air bubbles (tapping). Check at eye level
Insert
Quickly insert at a 900 angle (with or without a skin pinch). Push on plunger
Count
Count to 10. Remove needle

41
Q

How long can most insulins be out of the fridge?

A

28 days to 56 days

42
Q

What can be premixed and stored together?

A

R + NPH

43
Q

How many injections do most people need every day?

A

one daily for basal
three times (each meal) for bolus

44
Q

What can not be mixed with any other insulins?

A

LAIA

45
Q

What can be mixed but needs to be used right away?

A

RAIA + NPH

46
Q

What is the average daily requirements for T1B initial, honeymoon, and ketosis dose?

A

Initial 0.5-0.6 U/kg
Honey 0.1-0.4 U/kg
Ketosis or acute illness 0.5-1.0 U/kg

47
Q

What is the average daily requirements for T2B initial dose?

A

0.1U/kg

48
Q

What is the average daily requirements for T2B with insulin resistance?

A

up to 2.5 U/kg

49
Q

What is the normal split between basal and bolus for T1DM or MDI with T2DM?

A

basal 40-50%
Bolus 50-60%

50
Q

What are some factors of adjustment of dosing?

A

age
goals
general health
glucose levels
physical activity

51
Q

T/F Once the dose is figured out it tends to stay the same

A

False, it is always being adjusted based on life changes and disease state changes

52
Q

What is needed to be make it easier to have the best control?

A

they will need to be able to count carbs

53
Q

What is the C:I ratio?

A

Carbs to insulin ratio
how many grams of carbs to give insulin
normally about 15:1

54
Q

How do figure out the individual C:I?

A

take an estimation that is need all day and count the carbs for a whole day that they are in range

55
Q

Do you fix highs or low first?

A

lows because they are more dangerous

56
Q

If Jane’s CBG is 8mmol/L (goal 5.5mmol/L) before supper and she planned to eat 75g CHO, how much insulin would she take?

Suppertime: Jane has a C:I ratio of 12:1 and a CF of 2.5 and her typically consumption is 75g of CHO

A

about 7

(8-5.5)/2.5 = 1

75/12 =6.25

So give 7.25

57
Q

Do you make change based on trends or moments?

A

trends

58
Q

If glucose is <4mmol/l what effect is that?

A

somogyi effects

59
Q

If glucose is >4 mmol/L, what effect is that?

A

dawn phenomenon

60
Q

Explain what somogyi effect

A

Unrecognized nocturnal hypoglycemia that patient sleeps through; as a result the body ↑’s prod’n of counter-regulatory hormones & see rebound hyperglycemia

61
Q

How can you fix somogyi effect?

A

Fix the excess/ ill-timed insulin
↓ dose of insulin
Shift pre dinner basal (NPH) to hs (change when the peak is)
Consider a LAIA if on NPH
Consider a bedtime snack, evaluate meals/alcohol/exercise
The key is to prevent overnight lows

62
Q

How can you fix dawn phenomenon?

A

Avoid eating CHO after dinner/eat earlier
Be active after dinner
Adjust basal insulin type / dose / time
Consider an insulin pump

63
Q

Explain what dawn phenomenon

A

This is fasting hyperglycemia that is the result of growth hormones, cortisol, glucagon being released in early am before waking (usually between 3-8am)

64
Q

What are the three things that are needing to balance with diabetes mainment?

A

good glycemic control
no hypoglycemia
no burden

DB Therapeutics (5 decks)

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