Type 1 Diabetes Management Flashcards
(92 cards)
1
Q
Insulin is a hormone secreted from ____ that helps to regulate ____
A
Pancreatic beta-cells to help regulate blood glucose
2
Q
Human insulin was created using…
A
Recombinant DNA technology
3
Q
Basal insulin refers to…
A
Secretion of small amounts of insulin throughout the day
4
Q
Bolus insulin refers to…
A
Insulin that is rapidly released in response to food
5
Q
The types of insulins that can be used to replace bolus doses are…
A
Rapid-acting insulin analogues and short-acting insulins
6
Q
Short-acting insulins that are used are…
A
Insulin regular
7
Q
Short-acting insulins are administered ____ prior to meals
A
30-45 minutes prior to meals
Cover for mealtime glucose excursions
8
Q
Insulin regular U-500 is different from others, because…
A
Entirely different PK profile, used for those with extreme insulin resistance
Those who require >200 units per day
9
Q
Rapid acting insulin analogues (RAIA’s) include the following…
A
Lispro, Aspart, and Glulisine
10
Q
RAIA’s are administered ____ prior to meals
A
0-15 minutes prior to meals
11
Q
Are bolus insulins clear or cloudy?
A
Clear
12
Q
Onset of action for RAIA’s is usually…
A
10-15 minutes
Faster-acting insulin aspart is 4min
13
Q
Peak of RAIA’s are reached around…
A
1-1.5 or 2 hours
14
Q
Duration of RAIA’s last for about…
A
3-5 hours
15
Q
Onset of action for insulin regular is…
Regular U-500 differs by…
A
30 minutes
U-500 - 15 minutes
16
Q
Peak of insulin regular is reached in…
U-500 differs by…
A
2-3 hours
U-500: 4-8 hours
17
Q
Duration of insulin regular lasts for…
U-500 differs by…
A
6.5 hours
U-500 - 17-24 hours
18
Q
Advantages of RAIA’s over short acting insulin include the following…
A
More rapid absorption (faster onset, peak, shorter duration)
Convenience in administration timing
Better PPG, lower risk of hypoglycemia
But cost more
19
Q
Is effectiveness of RAIA’s comparable to short-acting insulins?
A
YES, similar effectiveness in function
20
Q
Types of insulins used for basal dosing include…
A
Intermediate-acting and Long-acting insulin
21
Q
Intermediate acting insulin includes:
A
Insulin NPH
22
Q
Insulin NPH is unique in its formulation, in that they appear…
A
Cloudy, because they are a suspension; must hand-roll and invert before use to re-suspend
23
Q
Onset for insulin NPH is…
A
1-3 hours
24
Q
Peak of insulin NPH is…
A
5-8 hours
25
Duration of insulin NPH lasts for...
Up to 18 hours
26
Long-acting Insulin Analogues include...
Glargine, Detemir, and Degludec
27
Onset for LAIA's is...
90 minutes
28
Peak for LAIA's is...
N/A - no peak obtained
29
Duration of LAIA's is...
| Different for each...
U-100 glargine 24h
U-300 glargine >30h
Detemir 16-24h
Degludec 42h
30
Advantages of LAIA's over intermediate acting insulins are...
More consistent/less variable BG - "peakless"
Less hypoglycemia; mainly nocturnal
| Use of intermediate acting is declining
31
Degludec and glargine U-300 have shown ____ compared to insulin glargine.
Lower risk of hypoglycemia (mainly nocturnal) and less glucose variability
32
Effectiveness of LAIA's vs intermediate acting insulin is...
Similar efficacy
| LAIA's cost more money
33
Basal insulins are usually administered...
| regimen?
Once daily, at the same time of day
| NPH is twice daily. Detemir or glargine U100 may also be used BID
34
Traditional method of insulin delivery is via...
Syringe + vial
35
Some people may still prefer syringe + vial, for some reasons...
Least expensive
Familiarity
Prefer less injections and want to combine some insulins in same syringe
36
A continuous subcutaneous insulin infusion (CSII) is a...
Small computerized device that delivers insulin continuously 24 hours a day
36
Insulin pens have largely replaced syringe + vial, due to...
Portability, convenience, and ease of use
Precision dosing
37
The insulin cannula that feeds the insulin pump is changed...
| How often?
Every 3 days
38
The type of insulin used in CSII is...
RAIA, delivered continuously, with increased amounts when a bolus is required
39
CSII rates of insulin delivery can be adjusted...
Manually, or some have the ability to correct the amount of basal insulin via closed loop system
40
Insulin pumps could be considered for those who...
| Population?
Are poorly controleld with optimized injections
Significant glucose variability + frequent severe hypoglycemia
Pregnancy
41
Benefits of insulin pumps include...
Possible A1C benefit, when used with CGM
Improved QoL vs insulin injections
42
The most common adverse effect with insulin is ____ and occurs more frequently in ____
Hypoglycemia; occurs most frequently in those trying to achieve tight control
43
Weight gain can occur from insulin usage because...
Insulin promotes glucose uptake by target cells, and is an anabolic hormone that promotes glycogen, protein, and lipid synthesis
| Depends on amount taken, and often result of "over-correcting"
44
Other adverse effects that can occur with insulin usage are...
Lipodystrophy
Blurry vision
Allergic reactions (rare)
45
Factors that may increase insulin absorption are...
Exercise of injected area
Massage
Heat
| Consider absorption site as well
46
Factors that may delay insulin absorption are...
Lipodystrophy
Larger doses (short acting, NPH)
| Consider site of injection as well
47
Preferred injection sites for insulin (SC) include...
Abdomen, upper thigh, buttocks, back of arm
48
Site of injection can influence rate of absorption for insulin; from fast to slow is...
Abdomen, arm, thigh, buttocks
| Not much of an issue for RAIA or LAIA
49
Lipodystrophy can be minimized by...
Rotating injection sites
50
SC injection with syringe and vial can vary because of...
Different size of syringes
51
The most recommended syringe size for insulin injection is...
6mm
52
6mm insulin syringe injection can be done via...
With/without skin left, preferentially at a 90 degree angle
| May need to inject at 45 degree angle if lean
53
8mm insulin syringe injection can be done via...
Skin left and injection at 90 degree angle
| May need to inject at 45 degree angle if lean
54
12mm insulin syringe injection is...
Not recommended
55
After insulin injection, the needle should...
| Duration?
Be held in place for 10 seconds, then removed
| Skin should look normal
56
When doing a skin lift, the needle should be inserted...
| Directions?
Completely into the skin lift, plunger depressed completely, and removed at the same angle it was inserted
57
For insulin pens, a new needle...
Needs to be used every time
58
Priming an insulin pen means that before injecting...
The pen should be primed as per manufacturer specs (2 units); with needle pointing up, press plunger and see if a stream of insulin is released
59
When using an insulin pen, it should be injected...
| How?
At a 90 degree angle with no skin lift; press injection button, count to 10, then release and remove
| Dose window should say 0
60
Unopened insulin should remain
| Environment?
Refridgerated
61
In-use insulin can remain...
| Environment?
At room-temperature
62
In-use insulin should be discarded...
After 28 days, up to 56 days (whatever the manufacturer recommends)
63
In order to preserve insulin, the following should be avoided...
| Environment?
Freezing, extreme heat, direct sunlight
64
If clear insulin appears cloudy, or without particles, it needs to be...
Discarded
| EXCEPT for NPH
65
The following insulins could be mixed together:
R + NPH - pre-mixed + stored together
RAIA + NPH - mix together in same syringe and administer immediately
| LAIA's cannot be mixed with any other insulins
66
67
Daily insulin requirements for a patient initially diagnosed with T1DM is usually...
0.5-0.6 units/kg
68
Daily insulin requirements for a patient in the honeymoon phase of T1DM is usually...
0.1-0.4 units/kg
69
Daily insulin requirements for a T1DM in ketosis or acute illness is usually...
0.5-1.0 units/kg
70
Daily initial dosing for a T2DM patient starting initial dosing is usually...
10 units of basal insulin HS, or 0.1 units/kg
71
Insulin resistance can cause T2DM patient's daily insulin requirements to increase up to...
2.5 units/kg, or greater
72
To try and mimic physiologic release, insulin should be administered via...
Multiple daily injections (MDI) or via CSII
73
Multiple daily injections consists of...
| Regimen?
A regimen of bolus injections of insulin before each meal, and an evening basal insulin
74
The total daily dose (TDD) of insulin should be...
| How much basal? How much prandial?
Basal: >40% (40-50%)
Prandial: <60% (50-60%)
75
It is important to remember that the regimen and dose of insulin will often chang,e based on individual...
Age, goals, general health, glucose levels, and physical activity
76
The carbohydrate to insulin (C:I) ratio is used to estimate...
How many grams of carbs each unit of meal-time insulin will cover
77
A typical C:I ratio is...
15g to 1 unit
| May be higher or lower
78
An initial C:I ratio can be estimated by dividing...
500 or 550 by the total daily dose of insulin
79
A correction factor is the expected amount that...
The expected amount that 1 unit of insulin will normally decrease BG by
80
An initial CF can be estimated by dividing...
100 by the total daily dose (TDD) of insulin
80
For someone who is counting carbs, utilizing a correction factor...
Can help to bring down high BG detected before meals
81
The equation that can be used to correct a high BG reading is as follows...
Current glucose - target glucose/CF
81
This should be prioritized when interpreting BG/adjusting doses:
Fixing the lows first (risk of hypoglycemia)
| ADJUST 1 DOSE AT A TIME
82
We should adjust by 1-2 units at a time, because one unit of insulin can be expected to drop BG by...
2-3 mmol/L
83
The cause unexplained morning hyperglycemia can be uncovered by...
Checking glucose levels while one is sleeping for several nights
| Either via 3am CBG or via CGM
84
If night-time glucose is <4 mmol/L while investing unexplained morning hyperglycemia, this suggests ____ effect.
Somogyi effect
85
If night-time glucose is >4mmol/L when investigating unexplained morning hyperglycemia, this suggests _______
The dawn phenomenon
86
The somogyi effect is when the body experiences...
Unrecognized nocturnal hypoglycemia that the patient sleeps through - body increases production of counter-regulatory hormones and rebound hyperglycemia occurs
87
The somogyi effect could be rectified by...
Fixing excess/ill-timed insulin
Consider bedtime snack and evaluate meals/alcohol/exercise
88
The dawn phenomenon is when the body experiences...
Fasting hyperglycemia, resulting from growth hormones, cortisol, and glucagon being released before waking
89
Possible ways to rectify the dawn phenomenon are...
Avoid eating carbs after dinner, or eat earlier
Be active after dinner
Adjust basal insulin type/dose/time
Consider insulin pump
