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Therapeutics II > Block 3: Diabetes IV-T1DM > Flashcards

Block 3: Diabetes IV-T1DM Flashcards

1
Q

What are the treatment options of T1DM?

A

Lifestyle mod: diet and exercise
Insulin due to inability to produce insulin

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2
Q

How do you iniitiate multi-dose insulin?

A

Total daily dose: 0.6 units/kg
Basal dose = 50% of total daily insulin dose
Pre-breakfast = 20% of total daily insulin dose
Pre-lunch = 15% of total daily insulin dose
Pre-supper = 15% of total daily insulin dose

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3
Q

What is basal insulin?

A

Controls hepatic glucose production

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4
Q

What is prandial/bous insulin?

A
  1. Based on meal carb content
  2. Controls post-prandial glucose levels
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5
Q

What is correction insulin?

A
  1. Treats acute elevations in blood glucose
  2. Amount of insulin needed to correct a high blood glucose level
  3. Change in insulin dose based on a single event such as Thanksgiving dinner or a single out of target glucose level
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6
Q

What is the carb:insulin ratio?

A

Amount of rapid or short acting insulin needed to cover the carb content of a meal

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7
Q

What are the methods of calculating carb:insulin ratio?

A

Rule of 450 (Regular Insulin)
450/Total daily insulin dose in units = carb : insulin ratio

Rule of 500 (Rapid Acting Insulin):
500/Total daily insulin dose in units = carb : insulin ratio

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8
Q

What do you do if carb:insulin ratio is correct?

A

PPG will be in target range by 2 hours after the meal

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9
Q

What do you do if a patient has too frequent lows?

A

Too much insulin
Solution: increase the carb: insulin ratio

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10
Q

What do you do if a patient has too frequent high?

A

Too little insulin
Solution: decrease the carb : insulin ratio

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11
Q

What are the methods of using a correction dose?

A

Consistent carbohydrate intake:
1. Pre-meal insulin dose determined by algorithm based on pre-meal blood glucose values
2. Fixed pre-meal insulin dose with algorithm to determine additional (correction/supplemental) insulin dose based on pre-meal blood glucose level
3. Fixed pre-meal insulin dose with ISF used to determine additional (correction/supplemental) insulin dose

Flexible carbohydrate intake:
Carb:insulin ratio used to determine pre-meal insulin dose AND ISF used to determine additional (supplemental) insulin dose

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12
Q

How do you calculate correction dose?

A
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13
Q

What is ISF?

A

The amount that one unit of rapid- or short-acting insulin will lower blood glucose

Used to calculate correction dose

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14
Q

What is the insulin/blood glocose formula?

A

One unit of rapid or short acting insulin per 50 mg/dl increase or decrease in blood glucose level from goal (ISF = 50)

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15
Q

What do you do in pattern management?

A
  1. Make insulin adjustments using a least a 3 day average
  2. Determine if dietary intake or insulin dose is affecting blood glucose levels or if something else is causing the alteration
  3. Change one thing at a time
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16
Q

Insulin dose adjustment is based on?

A

A1C and BGM taking into account the peak and duration of the insulins used

17
Q

What factors do you need to consider prior to insulin adjustment?

A
  1. Compliance
  2. Technique
  3. Timing of meals and exercise
  4. Rotation of injection site
  5. Over insulization
18
Q

How do you manage diabetes in adolescents?

A

Obesity is on the rise in adolescents and children

Treatment options:
1. Lifestyle mod
2. Metformin, SU
3. Injectables: GLP1 (>10YO), insulin

19
Q

What is the preconception care for diabetes?

A

Need to have glood glucose control prior to pregnancy to help prevent problems

Use insulin for control during pregnancy:
1. No PO
2. Need more diet and exercise

Eliminate potentially teratogenic medications prior to conception, i.e., ACE, ARB, Statin

20
Q

How do you treat gestational diabetes?

A

Important for the health of both infant and mother:
1. Diet
2. Insulin

21
Q

How does diabetes affect elderly?

A

Renal function decreases with age:
1. Increased risk of hypoglycemia
2. Increased risk of lactic acidosis

Higher blood glucose and A1c goals may be appropriate in some elderly patients.

22
Q

What are the diabetes tx for eldrely?

A
  1. Low dose sulfonylureas, short-acting insulin secretagogues, alpha-glucosidases, TZDs, etc.
  2. Simple insulin regimens
  3. Less aggressive, simplified regimens in certain situations
23
Q

What are sick days in T1DM?

A

More insulin is needed to control blood sugar during illness

24
Q

What are tips to overcome T1DM sick days?

A
  1. Take usual insulin dose
  2. Monitor blood glucose levels and use rapid-acting insulin based on the results
  3. Monitor for ketones when FSBS > 250
  4. Additional insulin may be needed for ketonuria
  5. Gatorade (sports drinks)
25
Q

What are sick days in T2DM?

A

Usually not a major problem because most patients with Type 2 DM have some insulin production

26
Q

How do you overcome T2DM sick days?

A
  1. Monitor BG levels closely
  2. Sugar free drinks
27
Q

What are the BG levels of hospitalized patients?

A

Hyperglycemia: >140 mg/dl
Hypoglycemia: <70 mg/dl
Severe Hypoglycemia: <40 mg/dl

28
Q

How do you manage hospitalized patients on insulin?

A

Scheduled insulin plus additional short-acting as needed

Avoid reactionary dosing

29
Q

How do you manage hospitalized patients on PO diabetes agents?

A

May need insulin to control blood sugar during hospitalization

Avoid reactionary dosing

30
Q

What are the diabetic goals in crit ill patients?

A

140-180 mg/dl for most critically ill patients
110-140 mg/dl if tolerated
Targets <110 mg/dl NOT recommended

31
Q

How do you manage crit ill diabetics?

A

Treat hyperglycemia if > 180 mg/dl

Once insulin is started, goal 140-180 mg/dl

32
Q

What are the diabetic goals in non-crit ill hospitalized patients?

A

Target fasting <140 mg/dl
Target random <180 mg/dl

33
Q

How do you manage diabetes in surgeries?

A
  1. May need to give reduced doses of insulin until eating normally
  2. On insulin: scheduled or continuous
  3. On PO: May need insulin temporailty to control blood sugar
34
Q

What are the risk factors of fasting?

A
  1. Hypoglycemia
  2. Hyperglycemia
  3. Diabetic ketoacidosis
  4. Dehydration and thrombosis
35
Q

How do you manage diabetes in religious or cultural fastings?

A

Frequently monitor glucose and breakfast immediately if:
Hypoglycemia
* SMBG <70 mg/dL while taking insulin or sulfonylureas
* SMBG <60 mg/dL while on other therapies
Hyperglycemia: >300 mg/dL

Healthful eating before and after each fasting period:
* Complex carbohydrates prior to fast
* Avoid ingesting high-carbohydrate, high-fat foods when breaking fast

Avoid excessive physical activity but maintain normal exercise routines

Avoid fasting while ill

Therapeutics II (30 decks)

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