Transitional care

Question 1

At what age should a transition plan to an adult health care provider begin for an adolescent

Answer 1

14 years old

Transfer and/or integration into adult centered care should begin between ages 18-21

Question 2

Why do teens and young adults continue to have the lowest use of technologies such as insulin pumps and CGM?

Answer 2

Hassle of wearing devices and dislike of the devices on their bodies

Question 3

Upon hospital admission, when should A1c be obtained?

Answer 3

On admit if one has not been performed in the previous 3 months

Question 4

True or false: during acute illness, insulin therapy is the preferred method to treat hyperglycemia in hospitalized patients?

Answer 4

True

Question 5

What is the preferred insulin management regimen for a non critically ill patient who is NPO or having poor PO intake?

Answer 5

Basal + bolus correction insulin regimen

Question 6

Hospitalized patients with good PO intake should follow what type of insulin regimen?

Answer 6

basal, prandial, and correction component

These patients should receive a total date dose of insulin which is divided int 50% basal and 50% bolus components to match their CHO intake. An additional correction dose of insulin should be utilized to cover elevation in the patient’s blood glucose

Question 7

Why are sliding scale regimens strongly discouraged in the hospital setting?

Answer 7

they provide suboptimal blood glucose

Question 8

What should patients who present to the hospital on mixed insulin regimens be converted to?

Answer 8

Basal plus bolus regimens

Question 9

True or false: Insulin use in the hospital means the patient should be transitioned to a home insulin regimen?

Answer 9

False

Question 10

In a critical care setting, which method is best for achieving glycemic targets?

Answer 10

Continuous insulin infusion

Question 11

When transitioning from IV insulin drip to SC insulin injections, what % of the 24 hour insulin requirement should the SC dose be?

Answer 11

80%

For example, if TDD is 5 units/hr of rapid acting insulin IV over the previous 24 hours

1. 80% of (5 units/hr x 24) =96 units
2. Basal dose is 50% of SC TDD: 96 units x 50% =48 units of long acting insulin
3. Bolus total dose is the other 50% divided among meals: 48 units/3 meals daily= ~16 units with each meal

Question 12

What should the starting insulin dose be for patients >70 years and/or GFR <60 mL/min/1.73 m

Answer 12

0.2-0.3 units/kg/day

Question 13

What should the starting insulin dose be in patients with normal body weight and kidney function who have blood glucose concentrations of 140-200 mg/dL?

Answer 13

0.4 units/kg/day

Question 14

What should the starting insulin dose be in patients with obesity, a GFR > 60 mL/min/1.73 m and/or a blood glucose concentration of 201-400 mg/dL?

Answer 14

0.5 units/kg/day

Question 15

When should subq insulin be given in relation to when an insulin drip is planned to be d/c’d?

Answer 15

SC insulin should be given before the drip is d/c’d in order to allow an overlap that takes into consideration the onset of action. The first dose of basal insulin should be given 1-2 hours before the insulin drip is d/c’d

Question 16

When is outpatient follow up recommended with a provider, endocrinologist, or DCES upon d/c for patients who had hyperglycemia in the hospital?

Answer 16

Within 1 month; patients are more likely to engage with their post hospital f/w appts if they are given a set appointment that is reviewed at or before d/c

Question 17

What is the definition of clinical inertia?

Answer 17

Failure to initiate or intensify therapy when clinically indicated

Question 18

For pt’s d/c on oral agents, when should basal insulin be d/c’d?

Answer 18

12-24 hrs before discharge; use bolus insulin when starting oral agents if extra coverage is needed

Question 19

If BG is checked before exercise a value less than ___ mg/dL requires a modified plan

Answer 19

100 mg/dL

Question 20

Persons with diabetes should be educated to check their blood glucose how long after exercise?

Answer 20

15 minutes after the exercise session; hypoglycemia can occur 24-48 hour after exercise