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Endocrine Test 2 > Outpatient DM Management > Flashcards

Outpatient DM Management Flashcards

1
Q

Basal Component

A

Homeostatic glucose release by liver

Increased nocturnal glucose release (dawn phenomenon)

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2
Q

Bolus (Prandial) Component

A

Elevated glucose (PP& excursions)

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3
Q

Short Acting Insulin Products

A

Aspart
Glulisine
Lispro
Regular

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4
Q

Aspart Brand Name

A

Novolog

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5
Q

Glulisine Brand Name

A

Apidra

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6
Q

Lispro Brand Name

A

Humalog

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7
Q

Aspart Onset and Duration

A

O: 5-15 min
D: 3-5 hr

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8
Q

Glulisine Onset and Duration

A

O: 5-15 min
D: 3-5 hrs

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9
Q

Lispro Onset and Duration

A

O: 15-20 min
D: 4-5 hr

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10
Q

Regular Onset and Duration

A

O: 30-60 min
D: 4-8 hr

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11
Q

Longer Acting Insulin

A

Detemir
Glargine
NPH

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12
Q

Detemir Brand Name

A

Levemir

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13
Q

Glargine Brand Name

A

Lantus

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14
Q

Detemir Onset and Duration

A

O: 2 hr
D: 20-24+ hr

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15
Q

Glargine Onset and Duration

A

O: 1-2 hr
D: 10-24 hr

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16
Q

NPH Onset and Duration

A

O: 1-2 hr
D: 10-16 hr

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17
Q

When do you use once daily insulin?

A

When oral meds fail and you need more (add to)

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18
Q

When do you 2+ injections daily/mutliple types of insulin?

A

Contraindication to oral meds

High baseline FBG or A1c

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19
Q

Once daily insulin

A

As second or third agent when A1c >9%
Oral agent failure
Continue oral +/- SU

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20
Q

Once daily insulin starting dose

A

0.1-0.25 u/kg (0.3-0.4 for increased BG)
6-10u elderly/thin
Then titrate up a little at a time

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21
Q

Short acting insulin pealrs

A 
Lower PP (bolus)
Timing before meals is important 
Rapid acting preferred over regular (unless picky eaters)
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22
Q

NPH pearls

A

Cloudy

Can be mixed

23
Q

Glargine pearls

A 
Improved glucose control
Decrease hypoglycemic events
Low does = BID
Cannot be mixed
Acidic so can burn
24
Q

Detemir pearls

A

Dose dependent duration of action
Less weight gain
Decreased hypoglycemia
Binds to albumins

25
Advantages to Two Daily Injections
Easier to learn the MDI Cheaper No shots at school Less chances of forgeting
26
Disadvantages to Two Daily Injections
``` Requires meals to be at certain times Requires constant carb intake Snacks needed Overnight hypoglycemia risk Difficult to achieve treatment goals ```
27
Advantages to Three Daily Injections
Decrease risk for overnight hypo Less than four injections Better control of Dawn Phenomenon
28
Disdvantages to Three Daily Injections
``` Require meals to be at certain times Requires constant carb intake Snack needed More than 2 injections Difficult to achieve treatment goals ```
29
Advantages to Four Daily Injections
Meal times, carb intake can vary Less insulin overlap Best option for blood glucose control
30
Disadvantages to Four Daily Injections
Multiple injections each day Difficult for some to do math More costly
31
Consideration for selecting a regimen?
``` ADA recommend basal-bolus Daily schedule Activity level Meal and snack intake Education level Pt preference Insurance ```
32
Total Daily Dose for Type 1
Initially 0.3-0.5 u/kg/d | Use the amount of insulin required per day to obtain blood sugar control from hospital
33
Total Daily Dose for Type 2
Initially 0.2-0.6 u/kg/d
34
NPH regimen
Give 2/3 of total daily dose in the morning (2/3 NPH, 1/3 rapid) Give 1/3 of total daily dose in the evening (2/3 NPH, 1/3 rapid or 50/50)
35
Basal-Bolus Dosing
Basal: 40-60% of total daily dose Bolus: divide the remaining between meals or use insulin to carb ratio with insulin sensitivity factor
36
Carb counting
Helps pts with diabetes plan meals Allows for better blood glucose control Regardless of type, pts should be away
37
Carb Exchange System
Estimates the number of grams of carbs contained in a product based on a common exchange (15g)
38
Carb Gram Counting
Counts the exact number of grams of carbs contained in a product
39
Insuling to Carb ratio
The amount, in grams of carbs, that is covered by 1 unit of insulin Used to calculate bolus
40
Insulin Sensitivity Factor
The amount of reduction in blood glucose per 1 unit of insulin
41
Flexible dosing
Dosing technique that allows patient to adjust short acting insulin dose based on predicted needs Offers proactive adjustments Gives pt more control and freedom
42
I:CHO Rule
Rule of 500 | 500/total daily insulin dose = grams covered by 1 unit of short acting insuline
43
ISF Rule
Rule of 1800 1800/total daily insulin dose = mg/dl covered by 1 unit of rapid acting insulin (1500 for regular)
44
Goals of Management
Maintain daily ranges so as not to inhibit ADL's Prevent te occurrence and/or progression of longterm macro/microvascular complications Prevent acute complications Control other comorbidities Incorporate and foster self-management
45
Type 1 <6 yrs Goal BG and A1c
Fasting: 100-180 Bedtime: 110-200 A1c 7.5-8.5%
46
Type 1 6-12 yrs Goal BG and A1c
Fasting: 90-180 Bedtime: 100-180 A1c <8%
47
Type 1 13-19 yrs
Fasting 90-130 Bedtime 90-150 A1c <7.5%
48
Type 1 >19 or Type 2
Fasting 70-130 Bedtime 110-150 PP <7%
49
Assessment of Plan
Evaluate daily blood glucose records (A1c) Assess ability of pt to perform ADLs Condiser pt comfort and satsifcation Adjust to any issues
50
AM Rapid/Short Insulin affects
NOON blood sugar
51
PM Rapid/Short Insulin Affects
HS blood sugar
52
AM Intermediate affects
PM blood sugar
53
Bedtime Intermediate or long acting affects
AM blood sugar
54
Somogyi Phenomenon
Nocturnal hypoglycemia followed by early AM hyperglycemia Results of too much PM insulin Can lead to ketone formation and spilling of glucose into urine

Endocrine Test 2 (6 decks)

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