Type 1 Diabetes Management Flashcards
(34 cards)
What is the total daily insulin dose per kg/day for Type 1
0.5 units/kg/day
or 0.3-1 units/kg
What is the MOA of basal insulin in normal people
Secreted in small amounts during sleep or long-fasting hours
- suppresses gluconeogenesis + lipolysis
Describe the 2 phases of bolus insulin in normal people
Phase 1
- release of pre-formed insulin within 1 min of glucose consumption and lasts about 10 min
Phase 2:
- synthesis and release of newly formed insulin
- released until normoglycemic state restored
Who are premixed insulins for?
Someone with set meal/exercise times (nursing home)
What is the longest acting insulin? What is the benefit of it?
Degludec (tresiba)
- causes less nocturnal hypos
What is the benefit of Humalog U-200?
For patients requiring 20+ units of rapid insulin
(double the unit per pen)
What is the benefit of using entuzity U-500?
- For patients requiring 200+ units of rapid insulin
- delivers dose in 5 unit increments
Differentiate between endogenous and exogenous insulin absorption
Endogenous insulin is secreted into portal vein
- undergoes first-pass metabolism
- released in small bursts in response to glucose
Exogenous
- higher peripheral exposure than hepatic
- release is pre-determined via a time-action profile
What are benefits of insulin therapy?
- delay microvascular (retinopaty, nephropathy, neuropathy) and CV complications
- prevent ketoacidosis
- prevent overt hyperglycemia symptoms
What are adverse effects of insulin
Hypoglycemia: more common with regular insulin than rapid-acting insulin
Weight gain: ~4-5kg
Allergic reactions: 0.1-3% (rare)
Lipohypertrophy: 49-64% prevalence
Is there evidence for adjunctive therapy in type 1 diabetic patients?
No
Metformin: did not provide sustained metabolic or CV benefits
SGLT2 inhibitors: some metabolic benefits, risk of DKA needs more study
Liraglutide: some metabolic benefits, NO indication for use in T1DM
What is the preferred insulin injection site?
Abdomen
When would you consider using an insulin pump in T1DM
- Not able to reach targets despite optimized basal-bolus regimen
- sig glucose variability
- frequent severe hypoglycemia or hypoglycemic unawareness
- Sig dawn phenomenon: release of GH and cortisol is early morning stimulates glucose release
- Low insulin requirements
- suboptimal treatment satisfaction and quality of life
- women contemplating pregnancy
What factors influence insulin action?
- Route of admin (IV > IM > SC)
- Renal function (lowers clearance, intensifies action)
- insulin antibodies (delays effect)
- Thyroid function
- Site of injection (stomach fastest, arm intermediate, thigh slowest)
- Exercise, massaging inj site, higher temp (faster absorption)
- insulin prep (cloudy -> gently rolled or tipped)
- insulin dose and concentration
- Lipohypertrophy (delay absorption)
Differentiate between conventional and intensive insulin therapy in T1DM
Conventional (not preferred)
- Use of premixed or self-mixed int and short or rapid acting insulin
- BID injections
- Fixed amount of insulin and consistent food and activity
Intensive therapy
- system of matching insulin doses to food, activity, and life events
- basal-bolus insulin injections or pumps
- requires patient self-management behaviours
Differentiate between human (short acting) and analogue (rapid acting) insulin
Human insulin
- slower onset
- delayed peak
- longer duration
Analogue insulin
- more closely mimics endogenous secretion
- lower risk of hypoglycemia
Why are BID mixed insulin regimens not preferred (NPH)?
NPH in AM results peak at lunch (must eat lunch on time)
NPH at dinner results in peak during middle of night (inc risk of nocturnal hypoglycemia)
What is the typical insulin dosing for T2DM
0.3-0.5 units/kg/day
What is the honeymoon phase insulin dosing?
0.2-0.5 units/kg/day
- type 2 usually on the lower side since they already make insulin
How do you dose adjust for basal insulin?
If high fasting levels in the morning
- increase dose by 1 unit
If pattern of hypoglycemia in the morning (under 4)
- decrease dose by 10-20%
- always check injection technique
How do you dose adjust for bolus insulin dosing if they have a consistent carb consumption?
Give more insulin to the meals that raise BG more
ex. instead of 5-5-5 switch to 5-4-6
How do you dose adjust for bolus insulin dosing if they have a variable bolus dose + advanced carbohydrate counting for type 1?
Use insulin to carb ration 1:C (consult dietician)
Use “500 rule”
- 500/TDD = # of grams of CHO that will be covered by 1 unit of insulin
What other factors beyond CHO should be considered for insulin dosing?
Pre-meal glucose
Physical activity after the meal
What is the correction factor? when is it used?
aka insulin sensitivity factor ISF
Used to correct for pre-meal HIGH BG levels
Rule of 100
100/TDD = 1 unit of insulin will lower BG by x mmol/L
- used for rapid-acting analogue
