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PHR 938 Endocrine B1 > T5 Diabetes PPT > Flashcards

T5 Diabetes PPT Flashcards

1
Q

What is the typical concentration of U-100 insulin?

A

100 units/mL (~3.6 mg/mL).

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2
Q

Which insulin concentration is used for patients with high insulin requirements?

A

U-500, which is 500 units/mL.

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3
Q

What are the different types of insulin formulations based on their duration of action?

A

Rapid-acting, short-acting, intermediate-acting, long-acting, and ultra-long-acting.

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4
Q

What is the onset time for regular insulin (Humulin R, Novolin R)?

A

Effects begin after ~30 minutes.

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5
Q

What is the peak time for regular insulin?

A

Between 2 and 3 hours.

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6
Q

What is the duration of action for regular insulin?

A

5-8 hours.

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7
Q

What are some examples of rapid-acting insulin analogs?

A

Aspart, Glulisine, Lispro.

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8
Q

When should rapid-acting insulin be administered?

A

15 minutes or less before a meal.

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9
Q

How does insulin lispro differ from regular human insulin?

A

Two residues are reversed to prevent self-association and allow quicker absorption.

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10
Q

What is the duration of action for rapid-acting insulin?

A

Approximately 3-6 hours.

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11
Q

What are examples of long-acting insulin?

A

Insulin glargine (Lantus), Insulin detemir (Levemir).

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12
Q

What is the duration of action for insulin glargine?

A

11-24 hours.

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13
Q

What modification allows insulin detemir to have a longer duration of action?

A

Addition of myristic acid, which increases reversible binding to albumin.

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14
Q

What is insulin degludec (Tresiba) known for?

A

Ultra-long-acting insulin with a half-life of 25 hours.

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15
Q

What are the symptoms of mild hypoglycemia?

A

Sweating, palpitations, tremor, anxiety.

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16
Q

What are the symptoms of severe hypoglycemia?

A

Difficulty concentrating, confusion, weakness, drowsiness, blurred vision.

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17
Q

How should mild hypoglycemia be treated?

A

Dextrose tablets, glucose gel, or any sugar-containing food.

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18
Q

What is the treatment for severe hypoglycemia in unconscious patients?

A

1 mg of glucagon injected SC or IM, or 50% glucose IV infusion.

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19
Q

What is diabetic ketoacidosis (DKA)?

A

A life-threatening complication of untreated diabetes involving a lack of insulin and excessive ketone production.

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20
Q

What are the key features of DKA?

A

Severe hyperglycemia, ketosis, and acidosis.

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21
Q

What is the primary treatment for DKA?

A

IV insulin administration, IV fluids, and electrolyte replacement.

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22
Q

What is the difference between DKA and hyperglycemic hyperosmolar state (HHS)?

A

HHS involves hyperglycemia without ketosis, primarily in type 2 diabetes.

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23
Q

What are the glucose levels in HHS?

A

Glucose levels >600 mg/dL.

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24
Q

How is HHS treated?

A

IV insulin, IV fluids, and electrolyte replacement.

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25
Q

What is the onset of action for rapid-acting insulin analogs like insulin lispro?

A

Onset within 15 minutes.

26
Q

What is the duration of action for intermediate-acting insulin (NPH)?

A

10-16 hours.

27
Q

How often should long-acting insulin like glargine be administered?

A

Once daily.

28
Q

What is a basal-bolus insulin regimen?

A

A regimen using long-acting insulin for basal control and rapid-acting insulin for meal coverage.

29
Q

What percentage of total daily insulin dose is typically given as basal insulin in a basal-bolus regimen?

A

Approximately 50%.

30
Q

What are the benefits of basal-bolus insulin regimens?

A

Improved postprandial glucose control and greater flexibility with meals.

31
Q

What is continuous subcutaneous insulin infusion (CSII)?

A

An insulin pump delivering rapid-acting insulin continuously.

32
Q

How often should the infusion set of an insulin pump be changed?

A

Every 2-3 days.

33
Q

What is the main advantage of insulin pumps over multiple daily injections?

A

Better control of glucose levels with fewer hypoglycemic episodes.

34
Q

When should insulin be initiated in patients with type 2 diabetes?

A

When oral medications fail to achieve target A1C.

35
Q

What is the typical starting dose of basal insulin for type 2 diabetes?

A

0.1-0.2 units/kg per day.

36
Q

What is the primary goal of basal insulin in type 2 diabetes?

A

To control fasting blood glucose levels.

37
Q

What is the Somogyi effect?

A

Rebound hyperglycemia following an episode of nocturnal hypoglycemia.

38
Q

What is the Dawn phenomenon?

A

An early morning rise in blood glucose due to increased insulin resistance.

39
Q

How can the risk of hypoglycemia be minimized in patients on insulin therapy?

A

By adjusting insulin doses, timing meals, and monitoring blood glucose levels.

40
Q

How should basal insulin doses be adjusted?

A

Increase the dose by 2-4 units every 3-4 days until fasting glucose is within the target range.

41
Q

When should prandial insulin doses be adjusted?

A

Based on postprandial glucose levels or carbohydrate intake.

42
Q

What is insulin resistance?

A

Reduced sensitivity to insulin, requiring higher doses to achieve glucose control.

43
Q

What are common causes of insulin resistance?

A

Obesity, sedentary lifestyle, and certain medications like steroids.

44
Q

How is insulin resistance managed in patients with diabetes?

A

By increasing insulin doses or using insulin-sensitizing agents like metformin.

45
Q

What is the main difference between insulin pens and vials?

A

Pens are pre-filled and easier to use, while vials require syringes.

46
Q

What is the benefit of using insulin pens?

A

Convenience, more accurate dosing, and portability.

47
Q

What are the storage requirements for insulin pens?

A

Store unopened pens in the refrigerator, and opened pens at room temperature for up to 28 days.

48
Q

How should rapid-acting insulin be titrated?

A

Increase dose by 1-2 units based on postprandial glucose levels.

49
Q

What factors should be considered when titrating insulin doses?

A

Carbohydrate intake, physical activity, and blood glucose levels.

50
Q

What are common complications of insulin therapy?

A

Hypoglycemia, weight gain, and lipodystrophy.

51
Q

What is lipodystrophy in insulin therapy?

A

Abnormal distribution of fat at injection sites due to repeated insulin injections.

52
Q

How can lipodystrophy be prevented?

A

By rotating injection sites and avoiding repeated injections in the same area.

53
Q

What is the role of insulin degludec in diabetes management?

A

It provides ultra-long-acting basal insulin coverage with a half-life of 25 hours.

54
Q

How often is insulin degludec administered?

A

Once daily, regardless of the timing of meals.

55
Q

What are key clinical considerations when initiating insulin therapy?

A

Patient education on proper injection techniques, glucose monitoring, and hypoglycemia management.

56
Q

What are the signs of insulin overdose?

A

Severe hypoglycemia, confusion, seizures, and coma.

57
Q

How is insulin overdose treated?

A

Administration of glucagon or intravenous glucose.

58
Q

What is the role of metformin in insulin therapy?

A

It reduces insulin resistance and may allow for lower insulin doses.

59
Q

How does physical activity affect insulin sensitivity?

A

Exercise increases insulin sensitivity and may reduce the need for insulin.

60
Q

What is the effect of stress on blood glucose levels in patients with diabetes?

A

Stress increases cortisol and adrenaline levels, leading to higher blood glucose.

PHR 938 Endocrine B1 (13 decks)

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