Diabetes Misc.

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Author:
jdonaldson
ID:
103630
Filename:
Diabetes Misc.
Updated:
2011-09-22 17:05:33
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james James donaldson Donaldson diabetes Diabetes usp USP
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  1. 1. ______ and ______ have higher absorption variabilities.
    2. Once dose of insulin exceeds ______ units, some recommend splitting doses.
    3. This site has the fastest rate of insulin absorption and is considered ideal.
    4. If a pt insists on using different body sites for insulin administration, what counseling point is most important?
    • 1. Regular insulin and NPH
    • 2. 50 units
    • 3. Abdomen (then the arm, then the thigh)
    • 4. Be consistent with the site and the time of day (ex. always use your abdomen for your breakfast dose)
  2. What is the usual starting dose for insulin?
    Weight based at about 0.6 units/kg. Then use a specific rule for splitting it throughout the day.
  3. How do you use the 2/3-1/3 rule for insulin administration in DMI?
    • Take total amount of daily insulin and:
    • 1.) 2/3 will be administered in the morning.
    • 2.) 2/3 of that will be intermediate before breakfast
    • 3.) 1/3 of that will be rapid before breakfast

    • 4.) 1/3 will be administered in the evening.
    • 5.) 1/2 of that will be rapid before dinner
    • 6.) 1/2 of that will be intermediate before bedtime
  4. How do you use the 50-50 rule for insulin administration in DMI?
    • Take total amount of daily insulin and:
    • 1.) 1/2 of that will be drawn up as long acting
    • 2.) 1/2 of that will be drawn up as short or rapid acting)
    • 3.) Of the short or rapid acting, divide it by three and administer evenly at breakfast, lunch, and dinner

    • *May give 20% more at breakfast and spread rest evenly
    • ** Long acting is taken before bedtime
  5. 1.) 1 unit of rapid or short-acting insulin typically covers _____ grams of carbs.
    2.) 1 unit of insulin will lower BG levels by roughly ____ mg/dL.
    • 1.) 10-15 grams
    • 2.) 50 mg/dL
  6. What is the Somagyi effect?
    How do you test for it?
    The Somagyi effect occurs when a pts BG dips too low overnight, causing the body to overcompensate with increased glucose production.

    Have patient wake at 2:00 AM, if BG is low, it is the Somagyi effect.
  7. What is the dawn phenomenon?
    How do you test for it?
    From 5:00 AM to 9:00 AM, increased hormone synthesis can cause the liver to produce excessive glucose.

    Have patient wake at 2:00 AM, if not low, it is the dawn phenomenon.
  8. 1.) DMI patient's post-prandial glucose levels should - optimally - be within _____ mg/dL of pre-prandial levels.
    • 1.) 50 - 60 mg/dL
    • * if above this level post-prandially, consider that the pt may not be getting enough insulin to cover their meals.
  9. How do you determine if pt is getting too much basal insulin?
    • 1.) Ask pt to skip mid-day meal
    • 2.) Check BG level just prior to when mid-day meal WOULD HAVE been eaten
    • 3.) Check BG every 2-4 hours until dinner time

    • *If BG doesn't change much, dose is good
    • *If BG drops, too much basal insulin
    • *If BG increases, too little basal insulin
  10. 1.) When will a pt with DMII be placed on insulin therapy?
    2.) What dose?
    3.) What types and when?
    • 1.) After failure to reach BG goals with A1C > 9%
    • 2.) 10 units or 0.1 - 0.25 units/kg
    • 3.) bedtime intermediate, bedtime long-acting

    *AND/OR a short or rapid-acting insulin to largest meal of the day
  11. If a pt with DMII is on a bedtime dose of intermediate acting insulin, with AM BG levels controlled but daytime BG levels elevated, what should be done?
    1.) Add AM dose of intermediate acting insulin (0.1 - 0.15 units/kg)

    OR

    2.) Switch to long-acting insulin
  12. 1.) U 500 insulin should be considered in patients who daily insulin requirements exceed ____ - ____ units/day
    2.) Neither _____ or _____ may be added to any other type of insulin.
    3.) _____, _____, and ______ may be added to NPH
    4.) Nancy Reagan, RN
    • 1.) 250 - 300 units/day
    • 2.) Neither glargine or detemir (long-acting insulins)
    • 3.) Aspart, Lispro, and regular
  13. 1.) Hypoglycemia occurs when BG levels drop below _____.
    2.) In DMII, it is especially likely with which single drug class?
    3.) How do you treat it in conscious patients?
    4.) How do you treat it in unconscious patients?
    5.) How should a diabetic handle a "sick day" when far less food is expected to be eaten?
    • 1.) < 70 mg/dL
    • 2.) Sulfonylureas
    • 3.) Rule of 15: consume 15 grams of quick carbs (peppermints, sugar candies and glucose tablets have 4-5 grams per tab.), and recheck BG level in 15 mins. Repeat until BG in range and then instruct pt to eat a full meal.
    • 4.) SubQ or IM glucagon
    • *(if pt < 20 kg, 0.5 mg dose)
    • *(if pt > 20 kg, 1 mg dose)
    • 5.) It is more important to take insulin on a sick day, even if not eating: BG will increase to a greater degree

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