Care of the Diabetic Patient Flashcards
What is the total daily amount of insulin typically used in diabetics?
0.5-1 unit/kg/day
Up to 1.5 unit/kg/day
What are some advantages and disadvantages of NPH and Regular insulin
Advantages: 2-3 shots/day, with none at school; easier dosing and cheaper
Disadvantages: less flexible and less physiologic
What drugs are typically used in the Basal/Bolus treatment of diabetes?
Basal (or long acting): glargine or detemir (50% of total intake)
Bolus: Novolog/aspart (sum of all the boluses is 50% of total intake)
How do you figure out the bolus dosing?
Insulin=Carbs/insulin:carbs ratio+ [(BG-Target BG) / Correction factor].
Don’t worry, we’ll break it down now
How do you figure out the insulin:carb ratio?
You take 450 (random constant) and divide it by the total daily dose (TDD) of insulin.
If you had a 20kg child and were giving them 10 units of insulin/day (0.5units/kg), your insulin:carb ratio would be 450/10=45 (this means for every 45g of carbs she eats, she gets 1 unit of insulin)
How do you figure out the correction factor?
1800 rule: 1800/TDD
In the example we used above, correction factor would be 1800/10 units=180
Now putting it all together, if our little girl has a blood glucose of 330 and has 90 carbs for breakfast, how much Novolog should she get with breakfast?
Insulin=Carbs/insulin:carbs ratio+ [(BG-Target BG) / Correction factor].
So: Using 150 as the default target BG
Insulin=90/45+[(330-150)/180]= 2+1=3 units
How long should you wait before giving Novolog before a meal?
10-15 minutes before eating
What are the advantages and disadvantages of Basal/Bolus dosing?
Advantages: more physiologic, more flexible, less hypoglycemia
Disadvantages: math (carb counting and insulin calculations), at least 4 injections a day (3 meal boluses and 1 basal injection before bed)
What would you give a diabetic that is hypoglycemic
IM/SQ glucagon.
Can cause n/v
Should you omit insulin from a kid that is home sick? What if they’re not eating much…I don’t need to give insulin then, right?
NO! Never omit insulin.
What is the “honeymoon” phase of diabetes?
When pts present with diabetes initially, they may actually have some functioning beta cells left so they might become hypoglycemic from their starting insulin dose. At this point you may reduce their insulin. But eventually those beta cells will be destroyed as well and they will have to go back on insulin.
When should a diabetes pt check their BG
qAC (before meals), qHS (before sleeping)
What is deal with a glucose log? What do you put in this thing?
BG, carbs/meal, insulin given
If you notice that your patient has high BG at lunch time, how should you adjust her insulin dosing (if lack of insulin is actually the problem and not excess snacking between breakfast and lunch)?
Increase insulin at BREAKFAST. Can decrease the carb:insulin ratio at breakfast so that BG is lower at lunch time
