type one Flashcards
for a new patient assume 1-2 units of insulin will decrease FBG by
40-50 mg/dL
adjust one doe at a time unless
all glucose levels are greater than 200
initial dose of insulin
0.4-0.6 units/kg/day
honeymoon phase dose of insulin
0.1-0.4 units/kg/day
ketosis/infection insulin dose
1.0-1.5 units/kg/day
type two daily dose of insulin
0.7-1.5 units/kg/day
honeymoon phase
time period shortly after initiating insulin therapy when totally daily dose decreases
onset of honeymoon phase
within days to weeks after initial diagnosis
how long can the honeymoon phase last?
up to a year
TDD
insulin in a 24 hour period; half should be basal and the other half bolus
meal bolus
500 rule (500 divided by TDD
insulin sensitivity factor determines
how the patient responds to 1 unit of insulin
1800 rule
1800/TDD = how much one unit will lower BG
pattern management
- review several days of home BG readings
- do not react to single high or low
- nutrition education
- review all variables
simplest regimen for type one
2 injections a day (breakfast and supper)
2/3rd of total dose injected prior to
breakfast
1/3rd dose prior to
supper
first injection may be split
2/3rds NPH with 1/3rd regular or rapid insulin
can the second injection be split?
yes
which goes first, clear or cloudy?
clear before cloudy
regimen of two injections a day allows for
adjustment based on home BG readings
dawn phenomenon
rise in blood glucose levels between 4 and 8 am
is dawn phenomenon caused by counter regulatory hormones secondary to hypoglycemia
no
does dawn phenomenon happen in type one or type two
both
dawn phenomenon means there is not enough insulin..
in the evening
four injections a day
calculate TDD and divided 50/50 for basal and bolus
best regimen without a pump
basal insulin with the patient CHO counting and correcting
toujeo and Tresiba stability at room temp
56 days
Novolog stability at room temp
14 days
Humalog stability at room temp
10 days
side effects of insulin
weight gain, nodules, lipohypertrophy, lipatrophy
preferred site of injection
abdomen - most consistent rate of absorption
where has the slowest rate of absorption
buttocks and thighs
3/10 cc for doses
30 units or less
1/2 cc for doses
31-50 units
1 cc for doses
51 to 100 units
typical length of needles
6 mm or short 8 mm
typical gauge used
31 gauge
nano pen needles
4mm, 32 gauge
mini pen needles
5mm, 31 gauge
6mm needles
6mm, 30 gauge
short pen needles
8mm, 31 gauge
monitoring therapy
home blood glucose readings, post prandial levels, A1C, hypoglycemic events, adherence
LADA
slow onset T1DM or type 1.5
LADA usually happens to those over age
30
LADA is initially diagnosed as
type 2 DM
treatment for LADA
may respond to oral agents, but will need insulin
pramlintide
synthetic analog of amylin, deficient in diabetes
MOA of pramlintide
inhibits postprandial glucagon secretion, slows gastric emptying, promotes satiety and reduces caloric intake
when is pramlintide dosed
before meals, so reduce mealtime insulin by half initially
increase dose of pramlintide if
no significate nausea for 3-7 days
pramlintide type 1 dosing
15 mcg with a maintenance dose of 60mcg
pramlintide type 2 dosing
60 mcg with a maintenance dose of 120 mcg
contraindications of pramlintide
diagnosis of gastroparesis or hypoglycemia unawareness
