Therapy intensification: Technology & Pattern Management Flashcards
True or false: Higher A1c protects against hypoglycemia?
False; glycemic variability is likely more responsible for severe hypoglycemia
In what order should oral DM medications be added/intensified?
- Metformin
- If goals not met in 3 months, add GLP-1 RA
- Add SGLT inhibitor as third therapy
Which SU is the most “renal friendly”
Glimepiride
What is the Beers criteria?
List for potentially inappropriate med use for older adults > 65
Which SU is on the Beers criteria?
Glyburide
Contribution of ___ glucose measurements approached 70% of overall glucose mean as A1c neared 10% whereas ____ glucose contributes to about 70% to overall glucose profile when A1c value drops below 8.4%
fasting; postprandial
How is basal insulin initiated in pt with DM2?
10 u/day or 0.2 u/kg/day. Titration in based on checked fasting BG, and increasing basal dose 2u every 3 days until FBG 70-110 mg/dL. A simpler method is to increase basal by 1 unit/day until FBG is <100 mg
Initial dose closer to the kg method is by basking starting dose on 10% of pt’s TBW
How long do ultra long basals use to reach a steady state?
3-4 days; therefore, Degludec should not be titrated any more often than 3-7 days
If BG is above or below target, but how much should NPH, DET, and U100 GLAR by adjusted?
BG above target: + 10% to 20%
BG at target: no change
BG below target: - 10% to 40%
If BG is above or below target, by how much should U-300 glargine be adjusted?
Above: +3-6 units
Target: no change
Below: - 3 units
By how much should U-100 or U-200 Degludec be adjusted if BG is above/below target?
Above: + 2 units
Target: no change
Below: - 2 units
how should prandial insulin be dosed for pt’s with DM2?
Varies from 4-10 units/meal or 0.1 u to 0.15 u/kg/meal based on which meal is the largest
If both basal and prandial insulin is initiated, the prandial should over about ___% of the daily dose
50%
Meal doses could be divided among the three meals, for ex:
Bkft: 30-40%
Lunch: 30%
Dinner: 30-40%
True or false: Novolin R is available w/out a Rx
True; check good Rx for pricing
When is correction dose insulin usually given?
Before meals (as adjunct to scheduled insulin)
What is an ISF?
Used to calculate the amount of insulin needed to bring BG into target range and is used as a correction or supplemental amount of insulin when glucose levels are too high
What is the iCR?
Based on matching rapid acting insulin to CHO/calorie content of food to be eaten
For pump users, by how much should basal rates be adjusted (in terms of % per hour) depending on the type physical activity (light vs moderate vs weight lifting)
Light: 10-20% reduction for one hr before/after activity
Moderate/short duration (1-2 hrs): 30-50% reduction in basal for 1 hr before/after activity, including duration of activity itself
Isometric exercises such as weight lifting usually do not require an adjustement
Insulin deficiency will likely occur after ____ hours of being disconnected from an insulin pump.
2 hours; to prevent hypo during short workout, consider reducing the pre meal bolus for pre meal exercise, lowering overnight basal by 10-20% following late afternoon/evening exercise, or consuming quick CHO before workout
what antibody is positive in ~80% of pt’s with DM1 and LADA?
Anti GAD 65; can be run alone to confirm diagnosis
How should an ICR be calculated?
By taking a pt’s TDD and divide by 500 this will determine how many g of CHO are covered by 1 unit of insulin
How is ISF calculated?
To determine the mg/dL that 1 unit of insulin decreased the blood glucose value by, divide 1700 by the TDD
How might ETOH effect blood glucose?
May cause glucose to spike at time of consumption, but 5-6 hours later hypo is seen. This is due to ETOH being detoxed in the liver which impairs liver’s ability to release glycogen stores
True or false: ICR can change throughout the day
True
