Management of T1D Flashcards Preview

Endocrine 1 > Management of T1D > Flashcards

Flashcards in Management of T1D Deck (24):
1

what are the glycemic goals of therapy for a nonpregnant adult and child
-A1c
-preprandial blood glucose

ADULTS:
-A1c: < 7.0%
-preprandial blood glucose: 80-130
CHILDREN:
-Alc: < 7.5%
-preprandial blood glucose: 90-130

2

immediate treatment goals for a person with T1D

-lower BS at least below 180 in order to provide relief of sx
-regain lost weight
-patient and family education: survival skills - insulin admin, meal planning, self-monitoring BG, urine testing, ER use of glucagon, sick day rules

3

long range tx goal for a person w/ T1D

-maintain near euglycemia
-maintain nl glycosylated hgb levels
-striver for normal growth and emotional development for children
-prevent macro and microvascular dz
-absence of hypoglycemia

4

know the insulin preps as rapid acting, short acting, intermediate and long acting. And basal vs. bolus.

covered in the tx of T1D

5

given a pt on insulin, use the knowledge of the onset, peak and effective duration of each insulin to do the following to select the best insulin regimen:
-provide basal and bolus coverage
-decrease risk of hypoglycemia
-improve a pts BG control

-determine TDD
-Basal: 50-70% of TDD
-Bolus: 30-50% of TDD - based on CHO intake (start w/ 1:15)

6

Given a patient with newly diagnosed type 1 diabetes:
-Explain the concept of intensive insulin therapy

Intensive insulin therapy tries to achieve a more physiologic replacement of insulin by giving long acting insulin that provides basal insulin and by giving a rapid acting or short acting insulin before meals to provide a bolus of insulin.

7

Given a patient with newly diagnosed type 1 diabetes:
-Select the best basal/bolus insulin regimen for that person (include the amounts provided by basal and bolus insulin—percent breakdown)

50 to 70% of the total daily dose should be a basal insulin
-Basal insulins are glargine (Lantus®), detemir (Levemir®) and NPH

30 to 50% of the total daily dose should be given in divided doses before a meal with rapid-acting or short-acting insulin (bolus)
-Bolus or Preprandial insulins are Novolog®, Humalog®, Apidra®

8

Given a patient with newly diagnosed type 1 diabetes:
-select the initial TDD insulin dosing for adults, children, and adolescents

-adults: 0.5-1.0 units of insulin/kg/day
-children: 0.4-0.8 units/kg/day
-adolescents: 1.0-1.5 units/kg/day

9

Given a patient with newly diagnosed type 1 diabetes:
-Explain the rule of 500 and how to use it to establish an insulin:carb ratio

-Rule of 500 is the carbohydrate coverage ratio
-500 ÷ Total Daily Insulin Dose = 1-unit insulin covers so many grams of carbohydrate
-1:15 is common starting point

10

Given a patient with newly diagnosed type 1 diabetes:
-Explain how the rule of 1800 is used to determine an insulin sensitivity factor

-use the “1800 rule” to calculate insulin sensitivity factor for people who use the rapid-acting insulin analogs lispro (brand name Humalog), aspart (NovoLog), and glulisine (Apidra)
-this is done by dividing 1800 by TDD of rapid-acting insulin
-if the total daily insulin dose is 40 units, the insulin sensitivity factor would be 1800 divided by 40 = 45 -- 1:45
-meaning 1 unit of insulin would drop BG by 45 mg/dl

11

Given a patient with newly diagnosed type 1 diabetes:
-Explain how an insulin correction dose is used

-An insulin sensitivity factor is used to determine an insulin correction factor
-Insulin Correction factors are used to correct or adjust the premeal bolus insulin dose in order to cover the carbohydrate content in a meal plus “correct” a higher than desired blood preprandial blood glucose

12

Given a patient experiencing a hypoglycemic reaction:
-Identify common reasons for hypoglycemia

When the patient:
-skips a meal
-delays a meal
-eats less at a meal than usual and does not adjust insulin
-increases their activity
-commits a dosage error
Or medical causes:
-altered liver/kidney fxn
-hormonal def.
-rapid gastric emptying
-hypoglycemic unawareness

13

Given a patient experiencing a hypoglycemic reaction:
-Identify symptoms commonly associated with hypoglycemia

-Headache
-Shaking
-Sweating
-Feeling tired
-Weakness
-Hunger
**Rapid onset

14

Determine the severity of the hypoglycemia
-Mild hypoglycemia

-Usually manifested as adrenergic symptoms (mediated by epinephrine)
-pts capable of self tx - oral ingestion of 10-15 g CHO should tx
-These symptoms are anxiety, sweating, tremulousness, tachycardia, hunger.
-Clinically significant hypoglycemia is defined as a glucose <54 mg/dL.

15

Determine the severity of the hypoglycemia
-Moderate hypoglycemia

-Includes adrenergic symptoms plus neuroglycopenic symptoms including headache, mood change, irritability, confused thinking, and slurred speech.
-These reactions are usually longer lasting, and the patients usually require assistance in obtaining a glucose source.
-A second dose of 10 to 15 grams of a simple sugar is usually required.

16

Determine the severity of the hypoglycemia
-Severe hypoglycemia

-Characterized by unresponsiveness, unconsciousness or convulsions.
-These reactions require emergency care with an intravenous dextrose or IM glucagon injection.

17

explain the rule of 15

Check blood sugar --> eat 15 gm of carbs --> wait 15 min for sugar to get into blood

18

identify the causes of lipodystrophies secondary to insulin admin

-lipoatrophy: associated w/ animal source insulin and now more so with Humalog; loss of adipose
-lipohypertrophy: d/t many months/yrs of repeated injections into the same site
-local allergy: common w/ animal sources

19

dawn phenomenon

-nl physiologic response to awakening
-BG rises in the early morning preparing a person for the day
-in nondiabetic: insulin levels woudl rise as well w/ the increasing BG
-in pts w/ DM: insulin levels don't rise so hyperglycemia in the morning may result

20

Smogyi effect

-hyperreactive hyperglycemia in response to nocturnal hypoglycemia
-when BG falls too low (<60) the adrenal glands release catecholamines which stimulate glucagon release causing increase in glucose release from liver
-result: elevated BG in the morning

21

Identify the glycemic goals for children

-A1c goal of < 7.5%
-90 to 130 mg/dL before meals
-90 to 150 mg/dL bedtime and overnight

22

Identify the screening for other autoimmune diseases in people with T1DM

-thyroid dz: anti-TPO, antithyroiglobulin antibodies, TSH
-celiac dz: tissue transglutaminase or deaminated gliadin antibodies

23

interventions for preventing or decreasing the risk of CVD in children

-measure BP at every visit and tx w/ diet, exercise, and weight control. (ACEi if needed)
-screen lipid in children >10 and treat if abnl w/ diet (statin if needed). Goal is <100
-discourage smoking and cessation for those who do

24

screening and preventative interventions for children to prevent microvascular complications

-screen urine for albuminuria once child has had DM for 5 yrs
-normalize BP and improve glycemic control
-screen for retinopathy w/ a dilated and comprehensive eye exam age >10 or after puberty has started - whichever is early once child has had DM for 3-5 yrs