Diabetes Flashcards
How often should a patient with Type 1 diabetes check their blood glucose level
6 - 10 times daily (Preprandial, 2 hr postprandial, pre-bedtime, pre-exercise, before critical tasks such as driving, when suspecting and after treating hypoglycemia, middle of night {once a month})
Where are the injection sites for insulin?
● Injection sites → Upper lateral arms, abdomen, buttocks, upper lateral thighs
What activities should be avoided after insulin injection?
Avoid exercising muscles or massage in the area of the injection (Guest slides)
What increases absorption of insulin?
Increase absorption → heat (ambient or local), abdomen > leg and arm, exercise in general and/or exercising muscles near injection site (Gladson slides)
when should ultra short acting insulin be taken
Ultra short acting: take 5 min before meal, duration 3-5 hours, peaks at one hour (Lispro, Aspart)
when should regular insulin be taken
take 30 min before meal, duration 6-8 hours. Often used with intermediate. Peaks in 2 hours
when should intermediate insulin be taken
NPH (neutral protamine hagedo insulin); Onset is 1-4 hours, peaks in 6-12 hours, duration 14-24 hours.
when should peakless long acting insulin be taken
mean onset of action is within 1 hour with a duration of close to 24 hr; has no peak and instead mimics continuous infusion of rapid-acting regular insulin from a pump (Glargine)
Split and mixed insulin regimen
Split and Mixed: regular or short-acting insulin mixed with intermediate, given before breakfast and dinner (2 injections)
split and mixed with intermediate at bedtime
Split and mixed with bedtime intermediate: For purposes of improving morning fasting reading control the second intermediate-acting insulin can be held until bedtime (9:00PM) (3 injections-1 at breakfast, 1 at dinner, 1 intermediate at bedtime)
normal glucose level
80-120
if morning blood glucose is low
decrease insulin at bedtime
if morning blood glucose is high
need to increase insulin
Multiple pre-meal injections and Bedtime Long Acting regimen
good for maintaining blood glucose level (best is continuous insulin pump) (The more injections the person takes, the more controlled blood glucose should be)
What are the adverse effects of insulin?
● Hypoglycemia-if amt of insulin is too high, missed meal, strenuous exercise.
● Lipohypertrophy or lipoatrophy at injection site
● Rebound hyperglycemia
● Weight gain