Day 4 Inpatient Diabetes Flashcards
(15 cards)
What is the “alert” value in inpatient diabetes?
What is hyperglycemia in inpatient diabetes?
What are some causes of hyperglycemia in inpatient?
<70.
> 140.
Stress, uncontrolled diabetes(1 or 2), undiagnosed diabetes, medication induced, enteral nutrition.
What medications cause hyperglycemia?
What are your glycemic targets in inpatient?
What should you know about oral antidiabetic agents in inpatient setting?
Glucocorticoids, atypical antipsychotics, calcineurin inhibitors, thiazide diuretics, fluoroquinolines, oral contraceptives, phenytoin, protease inhibitors, beta blockers.
140-180, keep above 70.
insulin is preferred, oral agents stop at admission.
What is sliding scale insulin?
What are some advantages of sliding scale insulin?
What are some disadvantages of sliding scale insulin?
Insulin given in response to high blood glucose. Usually given before a meal or at set intervals. Not recommended in patients with persistent hyperglycemia.
can follow a set protocol, can be used to estimate 42 hr and in initiating insulin therapy, useful as basal.
not proactive, frequent checks, patients are often never transitioned off of this.
How do you manage ICU patients?
How do you transition from IV to SubQ?
How do you dose on transition?
IV insulin infusion preferred(short half life). SubQ not recommended in these patients.
Appropriate when patient has stable nutritional status(eating regular meals), improved clinical status(hemodynamically stable).
reduce total daily dose by 20% on flow sheet. Administer subq insulin 1-2 hours prior to discontinuing insulin infusion.
How to treat non critically ill patients?
How do you dose meal time in non critically ill patients?
How do you do correction insulin in inpatient?
Basal component is best. Weight based approach( Type 2–>0.4-0.5 units/kg, provide 50% of TDD as basal.) (Type 1–> 0.2-0.3 units/kg for basal).
0.05-1, home based, calculated from TDD(50% of TDD)., sliding scale, adjust by 10-20% every 1-2 days based on response.
Use Rule of 1700. Use carb ratio for prandial.
How do you treat non critically ill patients NPO?
How do you manage enteral nutrition in diabetes?
How do you manage parenteral nutrition in diabetes?
Start with home basal or weight based, provide correction q6h, adjust basal insulin by 10-20% every 1-2 days based on response.
If enteral–> basal insulin(home dose), 10 unites glargine once daily or 5 units NPH or detemir BID, calculated from total daily insulin dose(50% basal). 1 unit of insulin/10-15 g carbs(if using regular insulin q6h or rapid acting insulin q4h divide doses), correction insulin q4-6h, titrate regimen to response.
Add insulin to TPN and increase gradually, Start with 1 unit per 10 g carbs.
Do you increase basal and bolus if they are on steroids?
How do you treat hypoglycemia in inpatient?
What are the signs and symptoms of DKA?
Yes you can,(30-50%).
consume 15-20 g of glucose, repeat glucose test in 15 minutes. If NPO IV dextrose, if no IV access glucagon IM.
N/V, fruity breath, poly uria, hypotension.
What are the signs and symptoms of HHS?
What is the pathophysiology of DKA?
What is HHS lab findings and how do they differ vs DKA?
Coma, confused, similar to DKA.
Absolute insulin deficiency(over production of glucagon), metabolism of triglycerides for energy, glucagon stimulates conversion of FFA’s to ketones.
Glucose>600, PH >7.3, Bicarb >18, no ketones in HHS, serum osmolality >320, variable anion gap, stupor coma. DKA has >250 glucose, <7.0, yes ketones, <10 bicarb, >12 anion gap.
What is the treatment of fluids in DKA?
What is the treatment of potassium in DKA?
What is the treatment of IV insulin in DKA?
Give IV saline if severe hypovalemic, if mild do same but not as much, Switch IV fluids when glucose reaches 200-250 mg switch to 5% dextrose but .45% saline.
insulin causes intracellular shift, if K<3.3 hold insulin and replace potassium until K>3.3. If K 3.3-5.2 start insulin and give 20-30 mEq K in each liter of IV fluid. If K>5.2 start insulin, check K q2 hours replace prn.
Give IV.
What is the treatment for bicarb in DKA?
How do you transition to subQ in DKA?
How do you dose in transitioning from IV insulin in DKA?
Give bicarb if pH<6.9.
patient ready to eat, glucose <200, and 2 of the following(bicarb >15, ph>7.3, anion gap <12).
If insulin naive use 24 hour insulin requirement(reduce TDD by 20%). If on insulin regimen continue home regimen.
What are some common pitfalls when switching to subQ insulin?
What to do in sick day management?
What to do in hospital discharge?
make sure to give subQ insulin 1-2 hours before stopping insulin infusion. Stop D5W once IV insulin stopped.
Take basal insulin even if not eating well and vomiting, take blood glucose frequently, test urine for ketones if type 1.
Cross check medications at discharge, review new meds with patient, communicate follow up tests, review diabetes management.
How do you convert U-500 to U-100 and tuberculin?
What are key things to remember about a needle?
How do you draw up insulin?
divide by 5. Divide by 500.
Use smallest and thinnest possible, larger the gauge number the smaller the diameter is.
wash hands, clean vial with alcohol swab, if seperation occurs in NPH roll(DO NOT SHAKE), uncap insulin and draw back, inject air, pull back plunger, check for bubbles, pull out syringe, do not recap syringe.
How do you mix N and R?
Where can you inject insulin?
How do you afrezza?
R—> N.
Abdomen>arms>thigh>buttocks(absorption speed).
exhale then breath in
What should I know about insulin pumps?
Who is a good candidate for insulin pumps?
What are the advantages of insulin pumps?
rapid acting insulin, can give for type 1 or 2.
Able to problem solve,motivated, frequent glucose monitoring, understands carb counting,understand risks.
eliminates need for individual insulin,delivers insulin more accurately, often improves A1c, fewer swings, flexibility of food.
What are the disadvantages of insulin pumps?
What are the advantages of glucose meters?
weight gain, DKA can occur if not connected, expense, bothersome, lots of training, hypoglycemia, infection at insertion site.
alarms for hypoglycemic unawareness, nocturnal hypoglycemia,reduced finger sticking, parental monitoring, up to 288 values per day.
