T1DM 2 Flashcards
Insulin
- General Considerations
Schedule II
- Can be sold without prescription, just have to do a pharmacist assessment and document
Insulin
- Adverse Effects
Weight Gain
Hypoglycemia
Lipohypertrophy
Lipoatrophy
What is Lipohypertrophy
Thickened area of tissue from accumulation of fat at injection sites
- Causes insulin release from injection site to be delayed and unpredictable
What is Lipoatrophy
Loss of subcutaneous fat at injection site
- Immune response
- Less common now with recombinant human DNA formulation of insulin
What to consider when tailoring insulin regimen
Age
Lifestyle/Activity Level
Diet
General Health
Treatment Goals
Hypoglycemia Awareness
Ability to self-manage treatment
Motivation
Financial Consideration
Insulin (Children)
- General Considerations
When children start insulin they only need minimal insulin (<0.5 units/kg/day)
- Lasts weeks to months, but can last up to 2 years
Which insulins are preferred for patients with no drug coverage
Bolus (Short)
- Regular
Basal (Intermediate)
- NPH
How much insulin should be used for Basal and Bolus?
- Round Weight to a whole workable number
- Select a starting dose
- 0.4, 0.5, 0.6, 1.0 - Calculate Proportions
40% Basal/60% Bolus
50% Basal/50% Bolus - Split Bolus into 3 doses
Where to use insulin
Abdomen
Lateral Thigh
Upper Arms
Superior Buttocks
Where to use insulin
- Abdomen
Fast and Consistient Absorption
Where to use insulin
- Lateral Thigh
Slow and Variable Absorption
Where to use insulin
- Upper Arms
Slow and Variable Absorption
- Hard to reach (need help from someone else)
Where to use insulin
- Superior Buttocks
Slowest Absorption
- Hard to reach
How to Rotate Site of Insulin Injection
Inject in one area for one week, then rotate to next site
- Each injection in the area should be 2-3 cm apart
Why do we have to Rotate Site of Insulin Injection
Prevent Lipohypertrophy and Maintain a consistient insulin absorption
Injection Technique
Inject needle into subcutaneous (fatty) tissue.
- Needles are thin and short so no need for deep pinching
What influences Blood Glucose
Diet
Physical Activity
Insulin Regimen
Targets to achieve A1c<=7%
FPG: 4.0-7.0 mmol/L
2-Hour Post Prandial BG: 5.0-10.0 mmol/L
Steps for Insulin Dose Adjustment
- Look for lows (<4.0)
- Start the day well
3a. Look for consistient highs
3b. Any explanations (exercise, extra meals, missed dose) - Change one insulin by one or two units
Adjusting Basal Doses
If morning levels are low then decrease nightly basal dose
If morning levels are high then increase nightly basal dose
Adjusting Bolus Doses
Change the last recent bolus dose
- If noon levels are high then increase morning bolus dose
Hypoglycemia Symptoms
- Disturbed Sleep
- Weird Dreams
- Drowsiness
- Anxiety
- Sweating
- Trembling
- Palpitations
- Tingling
- Hunger
- Nausea
- Headache
- Vision Changes
- Difficulty Speaking
- Weakness/Dizziness
- Difficulty Concentrating
- Unconsciousness
Management of Hypoglycemia (Fast acting sugar)
15 g of glucose
1 tbsp (15 mL) of sugar in water
1 tbsp (15 mL) of honey
2/3 cup (150 mL) of regular soft drink/juice
15 g of fast acting sugar
Management of Hypoglycemia (More severe symptoms)
If able to swallow: 20 g of fast acting sugar
If not able to swallow:
- 3mg intranasal glucagon
- 1mg SC/IM glucagon
Management of Hypoglycemia (Rule of 15)
- Feeling symptoms of hypoglycemia
- Check blood glucose (If levels below 4.0 continue)
- 15g of simple carbohydrate (no protein)
- Recheck in 15 minutes
5a. If blood glucose is still below 4.0, repeat 15g of simple carbohydrate
5b. If blood glucose is above 4.0, consume snack containing protein
