Type 1 Diabetes Flashcards
(22 cards)
How often should T1DM be monitored
Atleast 4x a day
Before each meal and before bed
What are the target BGs for T1DM
5-7 on waking/fasting
4-7 fasting before meals
5-9 90 mins after eating
Where is recommended admin site for insulin
Abdomen - fastest absorption rate
Outer thighs and buttocks slow
Arms not recommended
Why do we rotate injection sites
Prevent lipohypertrophy which can lead to delayed eratic absorption
What are the 3 insulin regimens
- Basal bolus - long acting + short acting
- Biphasic mixture - short/intermediate mix
- Continuous SC insulin pump
What is 1st and 2nd line for basal bolus long acting insulin
1st Detemir BD
2nd Detemir OD, Glargine OD
What are the rapid acting insulins
Lispro
Aspart
Glulisine
What is onset and duration of rapid acting insulins
Onset less than 15 mins
Duration 2-5 hours
What are the soluble insulins
Human and bovine
Human and porcine
When to inject soluble insulin
What is onset and duration
When is peak acting
Inject 15-30mins before meals
Onset 30-60mins
Duration up to 8hrs
Peak action 1-4hrs
What are the intermediate acting insulin
Biphasic isophane +
Biphasic aspart/lispro
What is the onset, duration and peak of intermediate acting insulins
Onset 1-2hrs
Duration 11-24hrs
Peak effects 3-12hrs
What are the long acting insulins
Detemir
Degludec
Glargine
What is the onset to reach steady state and duration of long acting insulins
2-4 days to reach steady state
Duration 24hrs but degludec 42hrs
How long can insulin be stored at room temp for
28 days
Administration/storage instructions for insulin
Take out of fridge 15-20mins before injecting to avoid pain
What is insulin plan for elective minor procedure surgery with good glycaemic control
Reduce OD long acting dose by 20% the day before
What is the insulin plan for major procedure surgery or poor glycaemic control surgery pts
Reduce long acting OD dose by 20% the day before
Stop all other insulins
IV infusion of KCl NaCl Glucose
Start VRIII
What is the post-op monitoring and precaution for major surgery or poor glycaemic control surgery
Hrly BG for first 12 hours
IV glucose 20% if BG drops below 6
Post surgery when to restart for basal bolus regimen
With first meal
Post surgery when to restart insulins for long acting regimen
Carry on at 20% reduced dose until patient leaves hospital
Post surgery when to restart insulin plan for twice daily regimens
Restart at breakfast or evening meal
