Insulin Therapy Of Type 1 Dm

Front 1

goals of intensive insulin therapy (IIT) in DM1

Back 1

-higher target glucose concentrations are recommended for pts with a hx of severe, recurrent hypoglycemia
-3-fold increase risk of hyperglycemia in the intensive insulin therapy group(IIT) and increased weight gain
-in children <7yrs, the developing brain is extremely susceptible to hypoglycemia, therefore IIT is contraindicated

Front 2

Normal subjects "basal-bolus" model of insulin secretion

Back 2

-boluses of insulin are secreted in response to snacks or meals
-between meals and during the night, small basal amts of insulin are secreted to suppress lipolysis and hepatic glucose synthesis

Front 3

the goals of conventional insulin therapy did not extend beyond ____________.

Back 3

avoidance of hypoglycemia and ketoacidosis

Front 4

First step in insulin therapy is to calculate the 1.______________ required; doses use 2.____________

Back 4

1.total daily dose (TDD)
2. actual body weight

Front 5

Doses suggested for physiological basal bolus dosing:
1. "honeymoon" phase
2. ketosis, illness, adolescents in growth phase
3. Type 2 DM with insulin resistance

Back 5

1. decreased
2. increased
3. increased

Front 6

Individualized insulin dosage:
1. basal insulin requirements
2. premeal insulin requirements

Back 6

1. approxiamtely 50% of TDD
2. approximately 50% of TDD divided into 3 portions; one for each meal

Front 7

Causes of fasting(prebreakfast, early morning, 7am) hyperglycemia during insulin use

Back 7

-"waning of circulating insulin levels"
-somogyi effect
-dawn phenomenon

Front 8

what is meant when referring to "waning of circulating insulin levels" as a cause for fasting hyperglycemia

Back 8

-insufficient insulin to suppress overnight hepatic gluconeogensis
-insufficient dose of evening basal long-acting insulin can result in excessive hepatic gluconeogenesis =>3am hyperglycemia
-requires use of more basal long-acting insulin in evening, or if NPH is being used shift dose from dinner to bedtime

Front 9

what is the somogyi effect?

Back 9

reactive hyperglycemia in response to a nocturnal hypoglycemic episode
-evokes a surge of counterregulatory hormones (cortisol, glucagon, EPI) which stimulate excessive increase in hepatic glucose production

Front 10

what is the pattern of the somogyi effect?

Back 10

-bedtime normoglycemia (10pm)
-nighttime hypoglycemia (3am)
-rebound hyperglycemia at breakfast (7am)

Front 11

possible solutions for the somogyi effect?

Back 11

-lower evening dose basal insulin
-shift evening NPH dose from predinner to bedtime

Front 12

what is referred to as the dawn phenomenon?

Back 12

-rise in blood glucose(30-40mg/dL) between 5-8am due to reduced tissue sensitivity to insulin
-attributed to spikes of GH secretion released at onset of sleep
-normally mild, unless exacerbated by the somogyi effect or waning insulin levels

Front 13

what are some possible solutions for the dawn phenomenon?

Back 13

-increase daily dose of long-acting insulin
-shift a portion of the NPH evening dose to bedtime

Front 14

what are some causes of midmorning (10am) hyperglycemia?

Back 14

-insufficient dose of rapid or short-acting insulin before breakfast
-poor timing between meal intake and insulin action
-excessive carbohydrate consumption at breakfast

Front 15

possible solutions the midmorning hyperglycemia?

Back 15

-increase prebreakfast dose of insulin
-correct timing of premeal insulin dose
-alter carbohydrate content

Front 16

what is referred to as sick day management?

Back 16

-insulin requirements are increased in the presence of infection or acute illness, even if food intake is diminished

Front 17

what are the effects of infections and fever on insuli requirements?

Back 17

-infections and fever provoke release of insulin antagonists(eg cortisol), which may increase insulin requirements

Front 18

describe dosing of sick day management

Back 18

-maintain usual dose, test blood glucose every 3-4hrs
-if elevated, then give supplemental doses of regular or lispro insulin

Front 19

what is the effect of exercise on insulin?

Back 19

-exercise increases insulin effectiveness; regular exercise improves utilization of fatsand carbohydrates

Front 20

how should insulin dosing be adjusted for moderate exercise?

Back 20

-decrease preceeding dose of regular insulin by 30-50%
-use abdominal injection site or exercise 0.5-1.0hr following injection
-injecting site furthest away from the muscles involved may help prevent exercise induced hypoglycemia