Flashcards in DM part 5 Insulin Deck (15)
The diagnosis of DM is made using 1 of what 4 methods?
1. Glycated/Glycosylated Hemoglobin A1C level: 6.5% or higher
2. Fasting plasma glucose level: higher than 126 mg/dL
3. Two hour plasma glucose level during OGTT (oral glucose tolerance test): (with glucose load of 75 g) the normal value should be less than 140 mg/dL
4. Classic symptoms of hyperglycemia (polyuria, polydipsia, polyphagia) crisis or a random plasma glucose level of 200 mg/dL or higher
-these need to be confirmed with repeat testing
What does glycated/glycosylated hemoglobin diagnostic study reflect?
the glucose levels over the past 2 to 3 months (glucose remains attached to the RBC for its life 120 days)
-glucose attaches to hemoglobin molecule; higher the glucose levels = higher the A1C
What is A1C used for?
screen patients with prediabetes
-goal: <6.5% to 7%
What can influence the A1c level?
diseased affecting the RBC like iron deficiency anemia or sickle cell anemia
What are ketones and what do they signal?
-by products of fat breakdown
-they signal there is a deficiency of insulin and control in T1DM
-When there is no efficient insulin available the body starts to break down stored fat for energy.
When should urine ketone testing be done?
-when patient with T1DM has glycosuria
for 2 testing periods in a row.
-pregnancy with preexisting diabetes
-in gestational diabetes
What are the goals of diabetes management?
-prevent acute complications
-delay onset and progression of long-term complications
-maintain blood glucose levels as near to normal as possible
What are the patient teaching topics for DM?
-drug therapy (insulin, oral therapy, noninsulin injectable agents)
What might be sufficient enough for someone with T2DM?
If someone with T2DM is maintaining glucose with diet when might they need insulin?
during times of stress like surgeries or illness
What is the agent, onset, peak, duration and indication for rapid acting insulin?
-Agent: lispro (Humalog), aspart (Novolog), glulisine (Apidra)
-Onset: 5-15 minutes
-Peak: 30 min to 1 hour
-Duration: 2-4 hours
Indication: used for rapid reduction of glucose level, to treat postprandial hyperglycemia, and/or to prevent nocturnal hypoglycemia
What is the agent, onset, peak, duration and indication for short acting insulin?
-Agent: regular (Humulin R, Novolin R, Iletin II regular)
-Onset: 30 -60 minutes
-Peak: 2 to 3 hours
-Duration: 4-6 hours
-Indication: usually given 20 to 30 minutes before a meal; may be taken alone or in combination with longer acting insulin
What is the agent, onset, peak, duration and indication for Intermediate acting insulin?
Agent: NPH (Humulin N, Iletin II Lente, Iletin II NPH, Novolin N NPH)
-Onset: 2 to 4 hours
-Peak: 4 to 12 hours
-Duration: 16 to 20 hours
-Indications: Usually taken with food
What is the agent, onset, peak, duration and indication for Very long acting insulin?
-Agent: glargine (Lantus), detemir (Levemir), glargine (Toujeo)
-Onset: 1 hour or 6 hours
-Peak: no peak, continuous
-Duration: 24 to 36 hours
-Indications: used for basal dose