Lecture 12 Flashcards
General dosing principles
- for all pts on insulin, increase/decrease dose every ___ days until goals are met
- target FBG initially, then ___
- A1C > 10% , 70% of the problem involves ___
- A1C < 7.5%, 70% of the problem involves ___
- 2-4
- PPG
- FBG
- PPG
adjusting/individualizing insulin doses
insulin to carbohydrate ratio
- avg adults: 1 unit: ___ gm of carbs
- avg kids: 1 unit: ___ gm
- 10-15
- 20-30
adjusting/individualizing insulin doses
1 carb serving is approx ___ gm
- divide number of CHO grams for a meal by the amount of ___ insulin given
- check BG pre and post meal about ___ hours later to determine effectiveness
15 gm
- bolus
- 3
Rule of 500 (carb ratio)
take 500 / ___ (basal and bolus) = gm carbs for 1 unit of insulin
individual prandial doses can then be adjusted based on change in CHO per meal
TDD
Rule of 1800 (CF/ISF)
- for pts taking ___ acting insulin
- 1800 / TDD = # of ___ that will drop for every 1 unit of insulin
- used to add a dose of ___ insulin when BG are elevated before a meal
- can also use rule of ___
- use rule of ___ if pt is on regular insulin
CF = correction factor, ISF = insulin sensitivity factor
- ultra-short
- mg/dL BG
- prandial
- 1650
- 1500
if you use a correction factor dose before ___, consider only giving ___ % of the dose (this is ___ utilized)
- Bedtime
- 50%
- rarely
Adjusting Insulin Doses General Principles
- empiric starting point - type 1: an increased insulin dose by about ___ units decreases BG by about ___ mg/dL
- empiric starting point - type 2: a increased insulin dose by about ___ units decreases the BG by ___ mg/dL
- if you need to decrease the dose due to low BG, decrease by ___ units or ___ %
- 2 units, 50 mg/dL
- 4 units, 50 mg/dL
- 2-4 units, 10%
Somogyi Effect
___ hypoglycemia with ___ hyperglycemia
- check BG at ___ AM and ask about signs/symptoms (sweating, nightmares)
- add a ___ snack
- if applicable, move ___ from dinner to bedtime or decrease ___ dose at bedtime
nocturnal, rebound
- 3 am
- bedtime
- NPH, long-acting
T or F: T2DM has highest risk for ketoacidosis
F; T1DM
when to change to concentrated forms
- large doses of insulin can lead to unpredictable ___, increased pain/discomfort, and ___
- consider when pt’s TDD is ___ units/day
- absorption, leakage
- 200-300
Special Situations - being sick
- Continue insulin even if food intake is decreased. Stress of illness often ____ insulin requirements
- maintains fluid intake
- test blood glucose every ___ hours at minimum
- test urine for ___ with each urination
- increases
- 4 hrs
- ketones
