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Flashcards in DM part 5 Insulin Deck (15)
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1

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

2

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

3

What is A1C used for?

diagnose
monitor therapy
screen patients with prediabetes
-goal: <6.5% to 7%

4

What can influence the A1c level?

diseased affecting the RBC like iron deficiency anemia or sickle cell anemia

5

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.

6

When should urine ketone testing be done?

-when patient with T1DM has glycosuria
for 2 testing periods in a row.
-during illness
-pregnancy with preexisting diabetes
-in gestational diabetes

7

What are the goals of diabetes management?

-decrease symptoms
-promote well-being
-prevent acute complications
-delay onset and progression of long-term complications
-maintain blood glucose levels as near to normal as possible

8

What are the patient teaching topics for DM?

-nutritional therapy
-drug therapy (insulin, oral therapy, noninsulin injectable agents)

9

What might be sufficient enough for someone with T2DM?

diet
exercise
weight loss

10

If someone with T2DM is maintaining glucose with diet when might they need insulin?

during times of stress like surgeries or illness

11

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

12

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

13

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

14

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

15

What is the agent, onset, peak, duration and indication for rapid acting inhaled insulin?

-Agent: Afrezza
-Onset: less than 15 minutes
-Peak: 50 minutes
-Duration: 2-3 hours
-Indications: used as rapid acting insulin