thera DM insulin

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coal
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241959
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thera DM insulin
Updated:
2013-10-29 15:18:09
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thera DM insulin
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thera DM insulin
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  1. rapid acting insulins
    • aspart - novolog
    • lispro - humolog
    • apidra - glulisine
  2. rapid acting insulin dose can be adjusted based on what factors
    • preprandial blood glucose
    • anticipated activity
    • anticipated carb intake
  3. short acting insulin
    • regular
    •   humulin
    •   novolin
    • clear appearance
  4. intermediate insulin
    • NPH
    •   novolin N
    •   humulin N
    • cloudy appearance - suspension
  5. what is the conversion from NPH QD to lantus
    equal dose
  6. what is the conversion from NPH BID to lantus
    reduce dose by 20%, unless uncontrolled then maybe less reduction
  7. lantus - glargine advantages
    • convenience - QD, but possible BID
    • HS provides less nocturnal hypoglycemia vs NPH
    • possible less weight gain vs NPH
  8. lantus - glargine disadvantages
    • pain at injection site
    • NOT t be mixed with other insulins
  9. levemir - detemir dosing
    • start QD at evening meal or HS
    • titrate dose based on prebreakfast and predinner blood glucose levels
    •   duration dose dependent

    do NOT refrigerate in-use flexpens
  10. amylin analog
    pramlintide - symlin
  11. pramlintide - symlin adverse effects
    • N/V - 40%
    • hypoglycemia
  12. pramlintide - symlin CI
    gastroparesis
  13. pramlidine - symlin advantages
    decrease A1c .5-.7%
  14. pramlidine - symlin MOA
    • decrease gastric motility
    • increase satiety = decrease wt
  15. pramlintide dosing
    • decrease mealtime insulin doses by 50%
    • T1DM
    •   start 15 mcg before all meals
    •   adjust by 15 mcg every 3 days
    •   max dose 60 mcg
    • T2DM
    •   60 mcg before meals
    •   after 3-7 days, increase to 120 mcg
    •   if nausea occurs reduce to 60mcg until symptoms go away
  16. 3 factors that can affect insulin PK
    • route of administration
    • site of injection
    • lipodystrophy
    • pt to pt deviation (25-50%)
  17. disease states that can affect insulin PK
    • renal failure - decrease clearance
    • hyperthyroidism - increases clearance
  18. symptoms of hypoglycemia
    • blurred vision
    • confusion
    • hunger
    • tachycardia
    • tremor
    • diaphoresis
  19. indications of unusable insulin
    • clumping
    • frosting
    • precipitation
    • change in clarity of color
  20. texas diabetes council dosing for QD insulin
    • morning or bedtime
    • starting dose 0.1-0.25 u/kg/day
    •   or 6-10 units if elderly or thin
    • adjust insulin based on morning FPG
    •   escalate every 2-3 days
  21. texas diabetes council multiple dose insulin schedule
    • starting dose 0.3-0.5 u/kg/day
    • total dose of all insulins added
    • 2/3 am (2/3 NPH, 1/3 R)
    • 1/2 pm (2.3 NPH, 1/2 R) of 1:1
  22. texas council changes in basal insulin dose base on FPG
    • < 80 - subtract 1 unit
    • 80-99 no change
    • 100-120 add 1 unit
    • 121-140 add 2 units
    • 141-180 add 4 units
    • > 180 add 6 units
  23. ADA insulin starting regimen
    • start with intermediate or (am or pm long acting)
    •   10 units or 0.2 u/kg/day
    • adjust bolus due to FPG
    •   increase 2 units every 3 days until FPG is w/I goal of 70 - 130 mg/dl
  24. ADA dose if hypoglycemia occurs
    • decrease dose by 4 units or 10% whichever is greater
    • recheck A1c in 2-3 months, if at target continue and retest q 3 months
  25. ADA for hyperglycemia
    • check blood glucose before lunch, dinner & bedtime
    • if high
    •   add rapid acting
    •   start dose of 4 units adjusted by 2 units q 3 days
    •   check 2 hours post meal to make adjustments to rapid acting insulin
  26. counseling points for sick day management of DM
    • T1DM - don't stop taking insulin
    • insulin requirements usually increase with infections
    • extra monitoring
    • avoid dehydration
    •   worsens impending DKA
    • contact health care provider
    •   if ill longer than 1 day
    •   development of early signs of DKA
    •     abdominal pain
    •     persistent N/V
    •     hyperglycemia
  27. carb counting rule for insulin
    • rule of 500
    • 500/total daily insulin = # grams 1 unit will cover

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