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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
Q

Advantages to Two Daily Injections

A

Easier to learn the MDI
Cheaper
No shots at school
Less chances of forgeting

26
Q

Disadvantages to Two Daily Injections

A 
Requires meals to be at certain times
Requires constant carb intake
Snacks needed
Overnight hypoglycemia risk
Difficult to achieve treatment goals
27
Q

Advantages to Three Daily Injections

A

Decrease risk for overnight hypo
Less than four injections
Better control of Dawn Phenomenon

28
Q

Disdvantages to Three Daily Injections

A 
Require meals to be at certain times
Requires constant carb intake
Snack needed
More than 2 injections
Difficult to achieve treatment goals
29
Q

Advantages to Four Daily Injections

A

Meal times, carb intake can vary
Less insulin overlap
Best option for blood glucose control

30
Q

Disadvantages to Four Daily Injections

A

Multiple injections each day
Difficult for some to do math
More costly

31
Q

Consideration for selecting a regimen?

A 
ADA recommend basal-bolus
Daily schedule
Activity level
Meal and snack intake
Education level
Pt preference
Insurance
32
Q

Total Daily Dose for Type 1

A

Initially 0.3-0.5 u/kg/d

Use the amount of insulin required per day to obtain blood sugar control from hospital

33
Q

Total Daily Dose for Type 2

A

Initially 0.2-0.6 u/kg/d

34
Q

NPH regimen

A

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
Q

Basal-Bolus Dosing

A

Basal: 40-60% of total daily dose
Bolus: divide the remaining between meals or use insulin to carb ratio with insulin sensitivity factor

36
Q

Carb counting

A

Helps pts with diabetes plan meals
Allows for better blood glucose control
Regardless of type, pts should be away

37
Q

Carb Exchange System

A

Estimates the number of grams of carbs contained in a product based on a common exchange (15g)

38
Q

Carb Gram Counting

A

Counts the exact number of grams of carbs contained in a product

39
Q

Insuling to Carb ratio

A

The amount, in grams of carbs, that is covered by 1 unit of insulin
Used to calculate bolus

40
Q

Insulin Sensitivity Factor

A

The amount of reduction in blood glucose per 1 unit of insulin

41
Q

Flexible dosing

A

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
Q

I:CHO Rule

A

Rule of 500

500/total daily insulin dose = grams covered by 1 unit of short acting insuline

43
Q

ISF Rule

A

Rule of 1800
1800/total daily insulin dose = mg/dl covered by 1 unit of rapid acting insulin
(1500 for regular)

44
Q

Goals of Management

A

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
Q

Type 1 <6 yrs Goal BG and A1c

A

Fasting: 100-180
Bedtime: 110-200
A1c 7.5-8.5%

46
Q

Type 1 6-12 yrs Goal BG and A1c

A

Fasting: 90-180
Bedtime: 100-180
A1c <8%

47
Q

Type 1 13-19 yrs

A

Fasting 90-130
Bedtime 90-150
A1c <7.5%

48
Q

Type 1 >19 or Type 2

A

Fasting 70-130
Bedtime 110-150
PP <7%

49
Q

Assessment of Plan

A

Evaluate daily blood glucose records (A1c)
Assess ability of pt to perform ADLs
Condiser pt comfort and satsifcation
Adjust to any issues

50
Q

AM Rapid/Short Insulin affects

A

NOON blood sugar

51
Q

PM Rapid/Short Insulin Affects

A

HS blood sugar

52
Q

AM Intermediate affects

A

PM blood sugar

53
Q

Bedtime Intermediate or long acting affects

A

AM blood sugar

54
Q

Somogyi Phenomenon

A

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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