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Diabetes Mellitus > Insulin Therapy > Flashcards

Insulin Therapy Flashcards

(74 cards)

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1
Q

What is the second step in designing pump therapy?

A

Add regular bolus with meals → base on carb counting

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2
Q

what is the difference between Dawn vs Somogyi phenomenons?

A

Dawn → natural phenomenon

Somogyi → caused by insulin

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3
Q

Mechanism of action of insulin at the skeletal muscle

A

increased synthesis of protein and glycogen

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4
Q

intermediate acting insulin type

A

NPH

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5
Q

insulin to carb ratio for rapid acting

A

500/TDD insulin

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6
Q

when giving insulin injections, why is it recommended to rotate the injectino site?

A

avoid delayed absoprtion due to fibrosis or lipohypertrophy

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7
Q

Dosing for Afrezza

A

comes in 4, 8, and 12 units

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8
Q

Insulin activates Na/K ATPase resulting in…

A

intracellular shift of K → hypokalemia

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9
Q

Short acting insulin type

A

regular insulin

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10
Q

In a hypoglycemic patient what is the “rule of 15”

A

check → treat → check → eat

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11
Q

insulin to carb ratio for regular insulin

A

450/TDD insulin

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12
Q

Two things a patient must know if they are going to get an insulin pump

A

know insulin basics

carbohydrate counting

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13
Q

FBS goal when checking after a meal

A

< 180

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14
Q

1st line DOC for T2DM with ASCVD

A

GLP 1 agonist → liraglutide

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15
Q

If a patient is on multiple insulin injections a day and they have abnormal glucose before dinner , which dose of insulin needs to be changed?

A

morning LA or afternoon RA

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16
Q

Insulin + GLP1 injection has high risk for ____ and low risk for ____

A

high → hypoglycemia

low → weight gain

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17
Q

what is going on in Somogyi phenomenon?

A

high at evening or bedtime → lows at 2-4 am → rebound high in the morning

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18
Q

Criteria that would consider an A1c of 8 - 8.5% acceptable

A 
frail elder
duration of disease > 10 years 
life expectancy < 5 years 
advanced microvascular complications
can't handle polypharmacy
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19
Q

adverse cardiovascular effect due to insulin

A

edema

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20
Q

What is the average time for onset for rapid acting insulin?

A

10-15 min

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21
Q

Appropriate BP for patient over age 70

A

<150/90

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22
Q

Which patient population MC uses insulin pumps?

A

Type 1 DM in children

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23
Q

How much insulin is normal released in a day?

A

~20 units

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24
Q

How do you calculate basal pump dose for an insulin pump - First Step ?

A

divide total # of LA units by 24 = basal rate in units/hour

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25
Mechanism of action of insulin at the liver
stimulates hepatic glycogen and fatty acid synthesis | FA is released into the blood as lipoproteins
26
How does Novalin and Novalog differ?
onset
27
Blood sugar in hypogylcemic patient
< 70
28
first line therapy in Type 2 DM for lowering glucose if the patient has HF or CKD
SGLT2 inhibitor
29
Protein serving size?
3 oz
30
1 unit of lispro covers how many grams of carbs
7 grams
31
you should taking insulin and ___ in patient with heart failure → worsens edema and can exacerbate HF
thiazolidinediones (TZD)
32
Type of intermediate insulin that acts as basal therapy since it has a duration of 24 hr
NPH
33
insulin daily dose for T1DM vs T2DM
Type 1 → 0.5 - 0.6 units | Type 2 → 0.1 - 0.2 units (may be higher due to insulin resistance)
34
Why is medical nutrition therapy important?
can reduce A1c and amount of insulin required
35
Safer insulin dual therapy in T2DM
insulin + GLP1 injection
36
recommended serving of non-starchy vegetables
3-5 servings
37
causes of hyperglycemia
``` too much food too little insulin illness reduced exercise medications ```
38
what is the most effective dual therapy for treating T2DM with insulin?
insulin + metformin
39
Why is insulin used when you need to lower A1c by > 2%
no ceiling effect of lowering A1c
40
3 endocrine/metabolic effects due to insulin
hypoglycemia hypokalemia weight gain
41
4 instances where a diabetic patient might be unaware of hypoglycemia
long duration of DM central neuropathy older age dementia
42
two formulations of insulin
regular or NPH
43
Goal A1c in normal patient population | goal A1c in geriatric patients
< 6.5% | < 8 - 8.5%
44
If a patient is on multiple insulin injections a day and they have abnormal glucose before breakfast or overnight, which dose of insulin needs to be changed?
evening LA
45
cleavage of what is required for the utilization of insulin
C-peptide
46
Goals in healthy adults: A1c fasting/preprandial glucose peak postprandial glucose
< 7-7.5% 70-130 < 180
47
FBS goal range when checking in the AM
100-130
48
Two risks of treating T2DM with insulin+metformin dual therapy
highest risk of hypoglycemia | high risk of weight gain
49
Symptoms of hypoglycemia
adrenergic symptoms → tremors, sweating, palpitations, confusion, dizziness, headache, nausea
50
Classic hyperglycemic symptoms
3 polys [polydipsia, polyphagia, polyuria] | dry skin
51
Correction factor for regular insulin user
1,500/total daily insulin
52
How many grams are in suggested carb serving size?
15 gm
53
three long acting insulin types
glargine levemir degludec
54
what should a patient do on their "sick day policy"?
check BG more often → likely will 1/2 their insulin
55
three rapid acting human insulin analogs
lispro aspart glulisine
56
inhaled rapid acting insulin, good for patients who don't like injections
Afrezza
57
first line therapy in Type 2 DM for lowering glucose
metformin + lifestyle changes
58
If a patient is on multiple insulin injections a day and they have abnormal glucose before morning snack/lunch, which dose of insulin needs to be changed?
morning RA or morning LA
59
2 adverse dermatologic effects due to insulin
erythema and pruritis at injection site
60
4 special population you should you insulin with caution
hepatic failure renal failure elderly pregnancy
61
When you adjust insulin, how much do you adjust by?
10% → ~ 4 units
62
If a patient is on multiple insulin injections a day and they have abnormal glucose before bedtime which dose of insulin needs to be changed?
evening RA
63
correction factor for rapid acting insulin analogs
1,700 or 1,800/total daily insulin
64
What is unique about Lantus?
won't peak → less risk of hypoglycemia
65
glycemic control dual therapy MC in elderly
metformin + basal insulin
66
first line monotherapy in glycemic control in the elderly
metformin
67
Who is Humulin R U500 indicated in?
patients on >200 units of insulin/day | insulin resistant T2DM
68
How are whole grains different than regular carbs?
insoluble fiber → less glucose spikes
69
MC medication that can induce hyperglycemia in a diabetic patient
``` glucocorticoids (MC) phenytoin niacin alpha-interferon pentamidine ```
70
What is going on with Dawn phenomenon?
natural rise in glucose in the morning
71
In comparison to human insulin, why do rapid acting insulin analogs reach peak serum values faster?
analogs quickly dissociate into monomers and are absorbed more rapidly than regular insulin
72
goals in frail elders A1c fasting/preprandial glucose peak postprandial glucose
<8.5% 100-180 < 200
73
if you want faster onset of action of insulin should you inject centrally or peripherally?
centrally
74
mechanism of action of insulin at adipose tissue
stimulates circulating lipoproteins to provide free fatty acids, triglyceride synthesis and storage inhibits hydrolysis of triglycerides

Diabetes Mellitus (4 decks)

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