T5 Diabetes PPT Flashcards
What is the typical concentration of U-100 insulin?
100 units/mL (~3.6 mg/mL).
Which insulin concentration is used for patients with high insulin requirements?
U-500, which is 500 units/mL.
What are the different types of insulin formulations based on their duration of action?
Rapid-acting, short-acting, intermediate-acting, long-acting, and ultra-long-acting.
What is the onset time for regular insulin (Humulin R, Novolin R)?
Effects begin after ~30 minutes.
What is the peak time for regular insulin?
Between 2 and 3 hours.
What is the duration of action for regular insulin?
5-8 hours.
What are some examples of rapid-acting insulin analogs?
Aspart, Glulisine, Lispro.
When should rapid-acting insulin be administered?
15 minutes or less before a meal.
How does insulin lispro differ from regular human insulin?
Two residues are reversed to prevent self-association and allow quicker absorption.
What is the duration of action for rapid-acting insulin?
Approximately 3-6 hours.
What are examples of long-acting insulin?
Insulin glargine (Lantus), Insulin detemir (Levemir).
What is the duration of action for insulin glargine?
11-24 hours.
What modification allows insulin detemir to have a longer duration of action?
Addition of myristic acid, which increases reversible binding to albumin.
What is insulin degludec (Tresiba) known for?
Ultra-long-acting insulin with a half-life of 25 hours.
What are the symptoms of mild hypoglycemia?
Sweating, palpitations, tremor, anxiety.
What are the symptoms of severe hypoglycemia?
Difficulty concentrating, confusion, weakness, drowsiness, blurred vision.
How should mild hypoglycemia be treated?
Dextrose tablets, glucose gel, or any sugar-containing food.
What is the treatment for severe hypoglycemia in unconscious patients?
1 mg of glucagon injected SC or IM, or 50% glucose IV infusion.
What is diabetic ketoacidosis (DKA)?
A life-threatening complication of untreated diabetes involving a lack of insulin and excessive ketone production.
What are the key features of DKA?
Severe hyperglycemia, ketosis, and acidosis.
What is the primary treatment for DKA?
IV insulin administration, IV fluids, and electrolyte replacement.
What is the difference between DKA and hyperglycemic hyperosmolar state (HHS)?
HHS involves hyperglycemia without ketosis, primarily in type 2 diabetes.
What are the glucose levels in HHS?
Glucose levels >600 mg/dL.
How is HHS treated?
IV insulin, IV fluids, and electrolyte replacement.
What is the onset of action for rapid-acting insulin analogs like insulin lispro?
Onset within 15 minutes.
What is the duration of action for intermediate-acting insulin (NPH)?
10-16 hours.
How often should long-acting insulin like glargine be administered?
Once daily.
What is a basal-bolus insulin regimen?
A regimen using long-acting insulin for basal control and rapid-acting insulin for meal coverage.
What percentage of total daily insulin dose is typically given as basal insulin in a basal-bolus regimen?
Approximately 50%.
What are the benefits of basal-bolus insulin regimens?
Improved postprandial glucose control and greater flexibility with meals.
What is continuous subcutaneous insulin infusion (CSII)?
An insulin pump delivering rapid-acting insulin continuously.
How often should the infusion set of an insulin pump be changed?
Every 2-3 days.
What is the main advantage of insulin pumps over multiple daily injections?
Better control of glucose levels with fewer hypoglycemic episodes.
When should insulin be initiated in patients with type 2 diabetes?
When oral medications fail to achieve target A1C.
What is the typical starting dose of basal insulin for type 2 diabetes?
0.1-0.2 units/kg per day.
What is the primary goal of basal insulin in type 2 diabetes?
To control fasting blood glucose levels.
What is the Somogyi effect?
Rebound hyperglycemia following an episode of nocturnal hypoglycemia.
What is the Dawn phenomenon?
An early morning rise in blood glucose due to increased insulin resistance.
How can the risk of hypoglycemia be minimized in patients on insulin therapy?
By adjusting insulin doses, timing meals, and monitoring blood glucose levels.
How should basal insulin doses be adjusted?
Increase the dose by 2-4 units every 3-4 days until fasting glucose is within the target range.
When should prandial insulin doses be adjusted?
Based on postprandial glucose levels or carbohydrate intake.
What is insulin resistance?
Reduced sensitivity to insulin, requiring higher doses to achieve glucose control.
What are common causes of insulin resistance?
Obesity, sedentary lifestyle, and certain medications like steroids.
How is insulin resistance managed in patients with diabetes?
By increasing insulin doses or using insulin-sensitizing agents like metformin.
What is the main difference between insulin pens and vials?
Pens are pre-filled and easier to use, while vials require syringes.
What is the benefit of using insulin pens?
Convenience, more accurate dosing, and portability.
What are the storage requirements for insulin pens?
Store unopened pens in the refrigerator, and opened pens at room temperature for up to 28 days.
How should rapid-acting insulin be titrated?
Increase dose by 1-2 units based on postprandial glucose levels.
What factors should be considered when titrating insulin doses?
Carbohydrate intake, physical activity, and blood glucose levels.
What are common complications of insulin therapy?
Hypoglycemia, weight gain, and lipodystrophy.
What is lipodystrophy in insulin therapy?
Abnormal distribution of fat at injection sites due to repeated insulin injections.
How can lipodystrophy be prevented?
By rotating injection sites and avoiding repeated injections in the same area.
What is the role of insulin degludec in diabetes management?
It provides ultra-long-acting basal insulin coverage with a half-life of 25 hours.
How often is insulin degludec administered?
Once daily, regardless of the timing of meals.
What are key clinical considerations when initiating insulin therapy?
Patient education on proper injection techniques, glucose monitoring, and hypoglycemia management.
What are the signs of insulin overdose?
Severe hypoglycemia, confusion, seizures, and coma.
How is insulin overdose treated?
Administration of glucagon or intravenous glucose.
What is the role of metformin in insulin therapy?
It reduces insulin resistance and may allow for lower insulin doses.
How does physical activity affect insulin sensitivity?
Exercise increases insulin sensitivity and may reduce the need for insulin.
What is the effect of stress on blood glucose levels in patients with diabetes?
Stress increases cortisol and adrenaline levels, leading to higher blood glucose.
