Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Diabetes > Type 1 Diabetes Management > Flashcards

Type 1 Diabetes Management Flashcards

1
Q

Insulin is a hormone secreted from ____ that helps to regulate ____

A

Pancreatic beta-cells to help regulate blood glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Human insulin was created using…

A

Recombinant DNA technology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Basal insulin refers to…

A

Secretion of small amounts of insulin throughout the day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Bolus insulin refers to…

A

Insulin that is rapidly released in response to food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The types of insulins that can be used to replace bolus doses are…

A

Rapid-acting insulin analogues and short-acting insulins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Short-acting insulins that are used are…

A

Insulin regular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Short-acting insulins are administered ____ prior to meals

A

30-45 minutes prior to meals

Cover for mealtime glucose excursions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Insulin regular U-500 is different from others, because…

A

Entirely different PK profile, used for those with extreme insulin resistance

Those who require >200 units per day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Rapid acting insulin analogues (RAIA’s) include the following…

A

Lispro, Aspart, and Glulisine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

RAIA’s are administered ____ prior to meals

A

0-15 minutes prior to meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Are bolus insulins clear or cloudy?

A

Clear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Onset of action for RAIA’s is usually…

A

10-15 minutes

Faster-acting insulin aspart is 4min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Peak of RAIA’s are reached around…

A

1-1.5 or 2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Duration of RAIA’s last for about…

A

3-5 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Onset of action for insulin regular is…

Regular U-500 differs by…

A

30 minutes

U-500 - 15 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Peak of insulin regular is reached in…

U-500 differs by…

A

2-3 hours

U-500: 4-8 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Duration of insulin regular lasts for…

U-500 differs by…

A

6.5 hours

U-500 - 17-24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Advantages of RAIA’s over short acting insulin include the following…

A

More rapid absorption (faster onset, peak, shorter duration)
Convenience in administration timing
Better PPG, lower risk of hypoglycemia

But cost more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Is effectiveness of RAIA’s comparable to short-acting insulins?

A

YES, similar effectiveness in function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Types of insulins used for basal dosing include…

A

Intermediate-acting and Long-acting insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Intermediate acting insulin includes:

A

Insulin NPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Insulin NPH is unique in its formulation, in that they appear…

A

Cloudy, because they are a suspension; must hand-roll and invert before use to re-suspend

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Onset for insulin NPH is…

A

1-3 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Peak of insulin NPH is…

A

5-8 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Duration of insulin NPH lasts for…

A

Up to 18 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Long-acting Insulin Analogues include…

A

Glargine, Detemir, and Degludec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Onset for LAIA’s is…

A

90 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Peak for LAIA’s is…

A

N/A - no peak obtained

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Duration of LAIA’s is…

Different for each…

A

U-100 glargine 24h
U-300 glargine >30h
Detemir 16-24h
Degludec 42h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Advantages of LAIA’s over intermediate acting insulins are…

A

More consistent/less variable BG - “peakless”
Less hypoglycemia; mainly nocturnal

Use of intermediate acting is declining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Degludec and glargine U-300 have shown ____ compared to insulin glargine.

A

Lower risk of hypoglycemia (mainly nocturnal) and less glucose variability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Effectiveness of LAIA’s vs intermediate acting insulin is…

A

Similar efficacy

LAIA’s cost more money

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Basal insulins are usually administered…

regimen?

A

Once daily, at the same time of day

NPH is twice daily. Detemir or glargine U100 may also be used BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Traditional method of insulin delivery is via…

A

Syringe + vial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Some people may still prefer syringe + vial, for some reasons…

A

Least expensive
Familiarity
Prefer less injections and want to combine some insulins in same syringe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

A continuous subcutaneous insulin infusion (CSII) is a…

A

Small computerized device that delivers insulin continuously 24 hours a day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Insulin pens have largely replaced syringe + vial, due to…

A

Portability, convenience, and ease of use
Precision dosing

37
Q

The insulin cannula that feeds the insulin pump is changed…

How often?

A

Every 3 days

38
Q

The type of insulin used in CSII is…

A

RAIA, delivered continuously, with increased amounts when a bolus is required

39
Q

CSII rates of insulin delivery can be adjusted…

A

Manually, or some have the ability to correct the amount of basal insulin via closed loop system

40
Q

Insulin pumps could be considered for those who…

Population?

A

Are poorly controleld with optimized injections
Significant glucose variability + frequent severe hypoglycemia
Pregnancy

41
Q

Benefits of insulin pumps include…

A

Possible A1C benefit, when used with CGM
Improved QoL vs insulin injections

42
Q

The most common adverse effect with insulin is ____ and occurs more frequently in ____

A

Hypoglycemia; occurs most frequently in those trying to achieve tight control

43
Q

Weight gain can occur from insulin usage because…

A

Insulin promotes glucose uptake by target cells, and is an anabolic hormone that promotes glycogen, protein, and lipid synthesis

Depends on amount taken, and often result of “over-correcting”

44
Q

Other adverse effects that can occur with insulin usage are…

A

Lipodystrophy
Blurry vision
Allergic reactions (rare)

45
Q

Factors that may increase insulin absorption are…

A

Exercise of injected area
Massage
Heat

Consider absorption site as well

46
Q

Factors that may delay insulin absorption are…

A

Lipodystrophy
Larger doses (short acting, NPH)

Consider site of injection as well

47
Q

Preferred injection sites for insulin (SC) include…

A

Abdomen, upper thigh, buttocks, back of arm

48
Q

Site of injection can influence rate of absorption for insulin; from fast to slow is…

A

Abdomen, arm, thigh, buttocks

Not much of an issue for RAIA or LAIA

49
Q

Lipodystrophy can be minimized by…

A

Rotating injection sites

50
Q

SC injection with syringe and vial can vary because of…

A

Different size of syringes

51
Q

The most recommended syringe size for insulin injection is…

A

6mm

52
Q

6mm insulin syringe injection can be done via…

A

With/without skin left, preferentially at a 90 degree angle

May need to inject at 45 degree angle if lean

53
Q

8mm insulin syringe injection can be done via…

A

Skin left and injection at 90 degree angle

May need to inject at 45 degree angle if lean

54
Q

12mm insulin syringe injection is…

A

Not recommended

55
Q

After insulin injection, the needle should…

Duration?

A

Be held in place for 10 seconds, then removed

Skin should look normal

56
Q

When doing a skin lift, the needle should be inserted…

Directions?

A

Completely into the skin lift, plunger depressed completely, and removed at the same angle it was inserted

57
Q

For insulin pens, a new needle…

A

Needs to be used every time

58
Q

Priming an insulin pen means that before injecting…

A

The pen should be primed as per manufacturer specs (2 units); with needle pointing up, press plunger and see if a stream of insulin is released

59
Q

When using an insulin pen, it should be injected…

How?

A

At a 90 degree angle with no skin lift; press injection button, count to 10, then release and remove

Dose window should say 0

60
Q

Unopened insulin should remain

Environment?

A

Refridgerated

61
Q

In-use insulin can remain…

Environment?

A

At room-temperature

62
Q

In-use insulin should be discarded…

A

After 28 days, up to 56 days (whatever the manufacturer recommends)

63
Q

In order to preserve insulin, the following should be avoided…

Environment?

A

Freezing, extreme heat, direct sunlight

64
Q

If clear insulin appears cloudy, or without particles, it needs to be…

A

Discarded

EXCEPT for NPH

65
Q

The following insulins could be mixed together:

A

R + NPH - pre-mixed + stored together
RAIA + NPH - mix together in same syringe and administer immediately

LAIA’s cannot be mixed with any other insulins

66
Q
A
67
Q

Daily insulin requirements for a patient initially diagnosed with T1DM is usually…

A

0.5-0.6 units/kg

68
Q

Daily insulin requirements for a patient in the honeymoon phase of T1DM is usually…

A

0.1-0.4 units/kg

69
Q

Daily insulin requirements for a T1DM in ketosis or acute illness is usually…

A

0.5-1.0 units/kg

70
Q

Daily initial dosing for a T2DM patient starting initial dosing is usually…

A

10 units of basal insulin HS, or 0.1 units/kg

71
Q

Insulin resistance can cause T2DM patient’s daily insulin requirements to increase up to…

A

2.5 units/kg, or greater

72
Q

To try and mimic physiologic release, insulin should be administered via…

A

Multiple daily injections (MDI) or via CSII

73
Q

Multiple daily injections consists of…

Regimen?

A

A regimen of bolus injections of insulin before each meal, and an evening basal insulin

74
Q

The total daily dose (TDD) of insulin should be…

How much basal? How much prandial?

A

Basal: >40% (40-50%)
Prandial: <60% (50-60%)

75
Q

It is important to remember that the regimen and dose of insulin will often chang,e based on individual…

A

Age, goals, general health, glucose levels, and physical activity

76
Q

The carbohydrate to insulin (C:I) ratio is used to estimate…

A

How many grams of carbs each unit of meal-time insulin will cover

77
Q

A typical C:I ratio is…

A

15g to 1 unit

May be higher or lower

78
Q

An initial C:I ratio can be estimated by dividing…

A

500 or 550 by the total daily dose of insulin

79
Q

A correction factor is the expected amount that…

A

The expected amount that 1 unit of insulin will normally decrease BG by

80
Q

An initial CF can be estimated by dividing…

A

100 by the total daily dose (TDD) of insulin

80
Q

For someone who is counting carbs, utilizing a correction factor…

A

Can help to bring down high BG detected before meals

81
Q

The equation that can be used to correct a high BG reading is as follows…

A

Current glucose - target glucose/CF

81
Q

This should be prioritized when interpreting BG/adjusting doses:

A

Fixing the lows first (risk of hypoglycemia)

ADJUST 1 DOSE AT A TIME

82
Q

We should adjust by 1-2 units at a time, because one unit of insulin can be expected to drop BG by…

A

2-3 mmol/L

83
Q

The cause unexplained morning hyperglycemia can be uncovered by…

A

Checking glucose levels while one is sleeping for several nights

Either via 3am CBG or via CGM

84
Q

If night-time glucose is <4 mmol/L while investing unexplained morning hyperglycemia, this suggests ____ effect.

A

Somogyi effect

85
Q

If night-time glucose is >4mmol/L when investigating unexplained morning hyperglycemia, this suggests _______

A

The dawn phenomenon

86
Q

The somogyi effect is when the body experiences…

A

Unrecognized nocturnal hypoglycemia that the patient sleeps through - body increases production of counter-regulatory hormones and rebound hyperglycemia occurs

87
Q

The somogyi effect could be rectified by…

A

Fixing excess/ill-timed insulin
Consider bedtime snack and evaluate meals/alcohol/exercise

88
Q

The dawn phenomenon is when the body experiences…

A

Fasting hyperglycemia, resulting from growth hormones, cortisol, and glucagon being released before waking

89
Q

Possible ways to rectify the dawn phenomenon are…

A

Avoid eating carbs after dinner, or eat earlier
Be active after dinner
Adjust basal insulin type/dose/time
Consider insulin pump

Diabetes (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions