Insulin management Flashcards
(36 cards)
What meds lower A1c the most
Metformin: 1.5-2%
GLP: 0.9-1.1%
SGLT2: 0.91-1.16%
Insulin is considered an
anabolic steroid- causes weight gain
What is your insulin starting point for T1DM
Basal-Bolus insulin (basal for fasting, bolus for mealtime)
+/- mealtime pramlintide w/ uncontrolled postprandial glycemia
+.- metformin, GLP1, or SGLT2
What is your insulin starting point for T2DM
Basal insulin + Metformin (+/- GLP-1)
Add bolus insulin if A1c target nt met and BG still increasing
What are the different insulins (time onset and by name)
Rapid (bolus): Humalog (lispro), Novolog (aspart), Apidra (glulisine)
Short (bolus): Humilin R, Novolin R
Intermediate (basal-NPH): Humilin N, Novolin N, Novolin 70/30
Long (basal): Lantus (glargine), Levemir (detemir), Tresiba (degludec)
When do you take different insulins
Rapid acting: Before each meal
Short acting: Before breakfast (also covers lunch), before dinner
Intermediate: AM and PM, or AM and evening meal
Long: once daily (HS)
What are common premixed insulin/GLP
Decludec/Liraglutide
Glargine/Lixisenatide
How should you store insulin
Open vials at room temp, discard opened vials after recommended interval
Unopened vials, refrigerate 36-46 F (expiration date still applies)
Durable pens and dosing devices: do NOT refrigerate after open
In T2DM, if A1c is not met and blood sugar is still rising, consider
Dosing insulin for basal and bolus coverage
start bolus with 1, 2, or 3 meals a day
Hyperglycemia can be due to
too little insulin
rebound from low glucose and over treatment with excess carbs
Where should all insulin injections be taken
in the abdomen- most consistent absorption
If unwilling to follow, do systemic site rotation BUT- always give insulin injection in same region at same time of day
If you are concerned about the patient not being able to afford their insulin, which should you prescribe
Traditional insulins- NPH (intermediate) and R (short)
What is TDD (total daily dose)
A way to calculate the total amount of insulin a patient needs per day
- 4 units/kg in normal patients
- 5 units/kg in overweight
alternate: weight in lbs/4
PEARLS on how many carbs insulin covers
1 unit of insulin covers appx 15g carbs
PEARLS on how much insulin lowers blood glucose
T1DM: 1 unit lowers BG 50 mg
T2DM: 1 unit lowers BG 30 mg
What is “background” or “basal” insulin replacement
replacing insulin overnight when you are fasting between meals (40-50% of TDD)
What is the “bolus insulin replacement”
The remaining 50-60% of TDD of insulin should be given to cover carbs and high blood sugar correction
What is ideal basal:bolus ration
50:50
If it is not close to this, reassess
*Basal is further broken down into biggest dose (20%) at Bfast, then 15% at lunch and dinner
How can you instruct a patient to titrate insulin
increase LONG acting 1 unit each day until FBS is 80-120
OR
increase LONG acting 1 unit q2-3 days until FBS is 80-120
How can you tell a patient to relieve Sx of hypoglycemia
Eat 15 g of glucose (carbs)
Recheck your BG after 15 minutes
If still hypoglycemia, repeat until your BG normalizes
-If your next meal is >2 hrs away, eat a small snack after your blood glucose is normalized
What are examples of “15g” of carbs
glucose tablets, gel tube 2 tbsp raisins 4 oz (1/2 cup) of juice/regular soda (not diet) 1 tbsp sugar, honey, or corn syrup 8oz nonfat or 1% milk hard candies, jelly beans, gumdrops
What are good resources for diet planning
ChooseMyPlate.gov
Carb Counting book
What should bolus insulin be based on
amount of carbs to be consumed
-Pts can self adjust their dose of bolus insulin based on what they’ll be eating (insulin:carb ratio)
Per her ppt (not her PEARLS), how do we calculate how many carbs insulin covers
500/TDD
If TDD is 76 units insulin, 500/76= 7g
1 unit insulin covers 7g carbs (but you should round to like 10)
Insulin:Carb= 1:10
