Glycemic Control Flashcards by Daniel Allen

Inpatient hyperglycemia is BG >= __ mg/dL

140

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4 classes of medications that can cause hyperglycemia?

corticosteroids (dex, prednisone, methylprednisolone)
atypical antipsychotics (olanzapine, quetiapine, risperidone)
immunosuppressants (tacrolimus, sirolimus, cyclosporine)
catecholamines (epinephrine, norepinephrine)

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The ADA recommends a BG range of __ top __ in noncritically ill pts

140, 180

NICE sugar trial

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The ADA recommends insulin therapy in all pts with BG levels consistently above ___ mg/dL

180

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Two rapid acting insulins?

aspart (Novolog)
lispro (Humalog)
glulisine (Apidra)

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Humulin R and Novolin R are what type of insulin?

a. rapid acting
b. short acting
c. intermediate acting
d. long acting

b. short acting

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Humulin N and Novolin N are what type of insulin?

a. rapid acting
b. short acting
c. intermediate acting
d. long acting

c. intermediate acting

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Glargine (Lantus) and Levemir (Detemir) are what type of insulin ?

a. rapid acting
b. short acting
c. intermediate acting
d. long acting

d. long acting

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What class of insulin is given for DKA?

a. rapid acting
b. intermediate acting
c. long acting
d. short acting

d. short acting

Humulin R
Novolin R

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Sliding scale insulin can help determine the best initial dose in naive pts and should remain the sole treatment

a. true
b. false

b. false

should NOT remain the sole Tx

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What is the only type of insulin use in IV drips in the ICU?

regular insuline

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How often is basal only regiment BG monitored?

once daily with morning labs

ex. BMP

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What is monitored with basal bolus regimen?

BMP

point of care: before each meal and at bedtime

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How often is BG checked with sliding scale insulin inpatient?

point of care: before each meal and at bedtime

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Insulin stacking can occur in renal injury/failure.

a. true
b. false

a. true

keep an eye on SCR/CrCl

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What should be increased if BG is high at breakfast?

a. rapid acting insulin
b. long acting insulin

b. long acting insulin

basal insulin
Levemir, etc

If BG is high at lunch, dinner, bedtime increase rapid acting

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Inpatient hypoglycemia is BG <= __ mg/dL

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Rescue Tx of hypoglycemia:

Dextrose 50% __ mL if BG < 70mg/dL

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Rescue Tx of hypoglycemia:

Dextrose 50% _mL if BG < 50mg/dL

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Rescue Tx of hypoglycemia:

Use glucagon if BG < __ mg/dL and no IV access

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How often should BG be checked for hypoglycemia rescue Tx?

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every 15mins until resolved

Dehydration is associated with __

a. DKA
b. HHS

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b. HHS

hyperosmolar hyperglycemic syndrome

Which has more severe hyperglycemia ?

a. DKA
b. HHS

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b. HHS

BG > 600mg/dL

Hypotension is associated with __

a. HHS
b. DKA

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a. HHS

Kussmaul breathing is associated with __ a. HHS b. DKA

b. DKA

How often is monitoring performed with DKA/HHS?

every 2 to 4 hours

DKA insulin Tx: Decrease insulin to 0.02-0.05 units/kg/hr when glucose is < __mg/dL

200

HHS insulin Tx: Decrease insulin to 0.02-0.05 units/kg/hr when glucose is < __ mg/dL

300

What fluid is recommended with treatment/resolution of DKA/HHS?

D5W with 1/2NS

RR received an initial IV insulin bolus of 0.1 units/kg/hr. What is an appropriate initial insulin drip rate for RR? a. 1.21 units/hr b. 1.69 units/hr c. 12.1 units/hr d. 16.9 units/hr

c. 12.1 units/hr

RR's most recent BG has come back at 196mg/dL. Which would be an acceptable insulin drip rate for RR? a. 1.5 units/hr b. 3.5 units/hr c. 6.5 units/hr d. 7.5 units/hr

b. 3.5 units/hr

Why does sodium look low when blood sugar is high?

water goes toward extracellular space to dilute blood and causes dilution hyponatremia use corrected sodium

Corrected sodium formula: corrected sodium =

measured NA + [0.016 x glucose - 100)] use if BG is very high

If a pt has a Na of 132 and BG of 496, what is the corrected Na?

138 mEq/L measured Na + [0.016 x (glucose - 100)]

Serum potassium looks artificially ___ with insulin deficiency a. higher b. lower

a. higher after treating with insulin will see a shift intracellularly (hypokalemia)

Upon initiation of insulin therapy there is a/an ___ shift of potassium a. intracellular b. extracellular

a. intracellular

Hold insulin and give 20-30mEq/hr if potassium is < __ mEq/L a. 3.3-5.2 b. 5.2 c. 3.3

c. 3.3

Give 20-30mEq/hr of K in each L of fluid if potassium is ___ mEq/L a. 3.3-5.2 b. < 3.3 c. > 5.2

a. 3.3-5.2

Do not give any potassium and check level every two hours if > __ mEq/L

5.2

Normal anion gap is < __ mEq/L

12 Na - (Cl + HCO3)

Which fluid will we use if the corrected sodium looks good? a. 1/2NS b. NS

b. NS

1/2NS is __ a. isotonic b. hypertonic c. hypotonic

c. hypotonic

Fluid management in DKA: Use NS if sodium is < __

135

Fluid management in DKA: Use 1/2 NS if sodium is > __

135

Criteria for Resolution of DKA: Patients with a BG of < __ mg/dL AND two of the following serum bicarb >= __ mEq/L venous pH > __ anion gap <= __

200, 15, 7.3, 12

In DKA/HHS post resolution subQ insulin should be started 3-4 hours before stopping IV a. true b. false

b. false 1-2 hours before stopping IV

2 factors for resolution of HHS:

- restoration of normal osmolality | - return to baseline mental status

Glycemic Control Flashcards

(47 cards)