Term
| Clinical Presentation of Type 1 DM |
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Definition
peaks at age 10-14;
Polydipsia, polyphagia, polyuria;
weight loss (10-15 lbs in 2.5 wks);
fatigue;
diabetic ketoacidosis |
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Term
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Definition
A1c >= 6.5%;
FPG >= 126 mg/dL
RPG >= 200 mg/dL + Sx of diabetes
2 hr glucose >= 200 mg/dL during OGTT
Must be repeated on a different day UNLESS unequivocal hyperglycemia is present; |
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Term
| Goals of Therapy for Type 1 DM |
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Definition
Keep glucose levels as normal as possible;
Prevent microvascular and macrovascular complicattions;
Reduce mortality;
Improve QOL |
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Term
| Treatment Goals for Adults w/ DM |
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Definition
A1c < 7%;
FPG 70-130 mg/dL;
PPG <180 mg/dL;
BP: <130/80 mmHg
LDL: <100 mg/dL (optional <70 mg/dL)
HDL: >40 mg/dL
TG: <150 mg/dL |
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Term
| Non-Pharm Treatment of Type 1 DM |
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Definition
medical nutrition therapy (MNT);
exercise;
SMBG, CGMS, & Pattern Management;
General DM Education (S/Sx of hypo- & hyperglycemia, complications, sick day management);
Psychosocial Support; |
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Term
| Medical Nutrition Therapy (MNT) |
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Definition
match carb intake to insulin action:
carb counting, exchange system; |
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Term
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Definition
recommended;
enhances insulin sensitivity, increases glucose utilization, reduce risk of cardiovascular complications;
150 min/wk of moderate intensity exercise + 30 min TIW of resistance training; |
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Term
| SMBG, CGMS, and pattern management |
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Definition
recommende SMBG 3-4x/day;
Pt treatment varies, so does monitoring; |
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Term
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Definition
depression/anxiety;
eating disorders;
family dynamics;
age-specific activities: camping, driving, dating, EtOH &/or tobacco consumption |
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Term
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Definition
| lispro (Humalog), aspart (Novolog), glulisine (Apidra) |
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Term
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Definition
regular (Humulin R, Novolin R)
available OTC |
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Term
| intermediate-acting insulin |
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Definition
NPH (Humulin N, Novolin N) - cloudy;
available OTC |
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Term
| long-acting insulin analogs |
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Definition
| glargine (Lantus), detemir (Levemir) |
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Term
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Definition
hypoglycemia;
weight gain;
lipodystrophy; |
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Term
| initial dosing of insulin |
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Definition
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Term
| honeymoon dosing of insulin |
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Definition
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Term
| illness, stress, growth insulin dosing |
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Definition
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Term
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Definition
intermediate acting insulin with short acting insulin (NPH + regular);
2/3 of TDD in AM, 1/3 of TDD in HS |
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Term
| Basal-bolus Insulin Therapy |
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Definition
long-acting insulin (Basal) + rapid or short-acting insulin (bolus);
50% TDD is glargine or detemir;
50% TDD is rapid or short-acting insulin given BID-TID |
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Term
| Adjusting insulin doses on Basal Regimen |
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Definition
| Based on fasting & pre-meal blood sugars: adjust 10-20% of TDD |
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Term
| Adjusting doses on Bolus Regimen |
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Definition
Based on postprandial readings;
Changes in 1-2 unit increments;
Insulin:Carb ratios: tailor insulin dose for a specific meal, must understand how to count Carbs;
Correction doses: 'corrects' an elevated glucose reading, estimates drop in glucose with 1 unit of rapid or short-acting insulin; |
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Term
| Initial Insulin:Carb Ratio |
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Definition
| = 500/TDD = grams of carbs covered by 1 unit of rapid or short-acting insulin |
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Term
| ISF for RAPID acting insulin |
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Definition
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Term
| ISF for SHORT acting insulin |
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Definition
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Term
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Definition
hypoglycemia during night --> increased secretion of counter-reg. hormones --> hyperglycemia in AM;
3 AM glucose --> LOW;
Adjustments:
- decrease PM dose of intermediate acting insulin;
- move PM dose of intermediate to later in evening;
- switch intermediate acting to long-acting |
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Term
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Definition
morning hyperglycemia due to natural increase of glucose between 4-8 AM;
3 AM glucose --> Normal to SLIGHTLY HIGH;
Adjust:
- increase PM dose of intermediate/long-acting OR move to later in evening |
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Term
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Definition
uses rapid acting insulin (aspart, lispro, glulisine);
Continuous infusion mimics basal insulin;
Bolus doses prior to meals/snacks based on CHO amount;
Programmed by pt;
Initial pump dosing based on TDD of insulin injections; |
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Term
| Starting doses for Insulin Pump |
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Definition
Decrease TDD by 10-30%;
Basal = 50% of pump TDD/24 hr
Bolus = 50% of pump TDD, use Insulin:CHO ratio, correction factor |
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Term
| Advantages of Insulin Pump |
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Definition
improved glycemic control;
delivers very precise amounts of insulin;
different basal rates;
normalizatoin of lifestyle;
reduced hypoglycemia;
less variable absorption |
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Term
| Disadvantages of Insulin Pump |
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Definition
very expensive;
skin infections;
diabetic ketoacidosis;
poor outcomes in uneducated pts;
tethered to device 24/7 |
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Term
| Indications for Insulin Pump |
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Definition
inability to normalize blood glucose;
persistent A1c >7%;
wide glycemic ranges;
recurrent hypoglycemia;
pregnancy;
in need of more flexible lifestyle; |
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Term
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Definition
Indications: Type 1 & 2 DM already on insulin therapy but have not achieved desired glucose control;
MoA: mimics endogenous amylin --> decreases initial post-prandial glucose spike;
Injectable: 0.6 mg/mL
Dose:
Initial - 15 mcg SC prior to MAJOR MEALS
Titrate up 15 mcg if no nausea x 3 days;
Maintenance - 30-60 mcg SC prior to MAJOR MEALS;
D/C if 30 mcg dose is not tolerated;
***MUST DECREASE preprandial rapid/short acting insulin by 50%***
Administer SC into ab or thigh, rotate injection sites, do not use same injection site for insulin;
Do not mix with any type of insulin;
ADRs: HYPOGLYCEMIA, NAUSEA, VOMITING;
C/Is: gastroparesis, hypoglycemic unawareness |
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Term
| Monitoring Therapy for Type 1 DM |
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Definition
Urine ketones: glucose >300 mg/dl, illness;
SMBG: check 3-4x/day --> important to correlate with A1c
A1c: q3-6 months, goal is <7%
Est. Avg - A1c 6% = glucose 126 mg/dl
A1c 7% = glucose 154 mg/dl
CGMS: measures glucose in interstitial fluid q1-5 min, recommended for: hypoglycemic unawareness, planning for pregnancy, inability to achieve goal A1c; |
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Term
| rapid-acting insulins - lispro (Humalog), aspart (Novolog), glulisine (Apidra) |
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Definition
Onset: 15-30 min;
Peak: 1-2 hrs;
Duration: 3-6 hrs |
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Term
| short-acting insulin - regular (Humulin R, Novolin R) |
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Definition
Onset: 30-60 min;
Peak: 2-3 hrs;
Duration: 5-7 hrs |
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Term
| intermediate-acting insulin - NPH (Humulin N, Novolin N) |
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Definition
Onset: 2-4 hrs;
Peak: 4-6 hrs;
Duration: 8-18 hrs; |
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Term
| long-acting insulins - glargine (Lantus), detemir (Levemir) |
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Definition
Onset: 2-5 hrs;
Peak: flat, flat (6-9);
Duration: 22-24 hrs, 16-24 hrs |
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