Pharmacology-Diabetic Patient Flashcards
Total daily requirement for daily insulin in kids
0.5-1 unit/kg/day. Note that it could go up to 1.5 units/kg/day in puberty.
Typical regimens for insulin therapy in kids
NPH + regular insulin or basal before bed (glargine/detemir) + bolus with meals (novolog).
When do you see physiologic insulin secretions throughout the day?
Breakfast, lunch and dinner
Advantages and disadvantages of utilizing NPH and regular insulin for type I diabetics
2-3 shots/day, less carb counting and cheap. Strict diet, less flexible and less physiologic.
What methods are used in dosing novolog?
Carbs consumed:insulin administered ratio. Correction factor: blood glucose - target/ correction factor.
How do you dose a starting regimen of basal/bolus treatment?
Insulin:CHO ration = 450/total daily insulin dose. 1800 rule = 1800/total daily dose
How do you start a dosing regimen on this girl? How many units does she get before breakfast?
1) Start low at 0.5 units/kg/day = 20 * 0.5 = 10 units 2) Long-acting insulin (glargine) = 1/2 of TDD = 5 units. 3) Insulin:CHO (450/TDD) = 1:45 (1 unit of insulin for every 45g of carbs) 4) 1800 rule = 1800/TDD = 180 for every 180mg/dL her BG is over 150, she gets another 1 unit of insulin.
What are the advantages and disadvantages of basal/bolus therapy for type I diabetes?
More physiologic, more flexible and less hypoglycemia. Labor intensive (CHO counting and insulin calculations) and at least 4 shots per day.
Recommended diet for kids with type I diabetes?
50% carbs, 30% fat, 20% protein. A normal, healthy, well-balanced diet.
Exercise guidelines for kids with type I diabetes?
Try to be at least 100mg/dL. Have snacks available. Check blood sugar every 30 minutes. Don’t exercise if ketones are present.
How do you teach a type I diabetic patient to recognize hypoglycemia?
BG < 70mg/dL. GIve 15g fast acting CHO and check BG in 15 minutes, and glucagon pen for gluc and puke conditions.
Treatment of a sick kid who also had type I diabetes?
Test sugar every 2-4 hours and check urine ketones. They are at higher risk for hyperglycemia because EPI, cortisol and NE will all be elevated. If hyperglycemic, drink lots of water to pee out extra glucose and give extra insulin to clear ketones. ER if vomiting.
What about the honeymoon of type I diabetes?
Insulin requirements decrease within first 3 months of diagnosis. Pancreas recovers and produces more of its own insulin from resolution of glucotoxicity. Some patients can even go off of insulin for months or even a year.
If a kid is having high blood glucose levels at lunch, what can you do to help them?
Give more insulin at breakfast or decrease carbs to 1:30 ratio.
What other complications are kids with type I diabetes at risk for?
Hashimoto’s thyroiditis, Grave’s, celiac disease, Addison’s nephropathy, neuropathy, retinopathy, CVD and lipohypertrophy (insulin induces adipocyte growth) at shot sites.
