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57 Cards in this Set
- Front
- Back
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4 Stages
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Preclinical
Hyperglycemia Honeymoon Phase Established Disease |
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Fasting Plasma Glucose (FPG)
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No caloric intake for >/= 8 hours
>/= 126mg/dl |
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Random Plasma Glucose (RPG)
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Taken at anytime, no regards to meal
>/= 200mg/dl AND symptoms of diabetes |
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Oral Glucose Tolerance Test (OGTT)
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Given 75mg oral glucose and taken 2 hours after
>/= 200mg/dl |
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Post Prandial Glucose (PPG)
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2 hours after beginning of last meal
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Hemoglobin A1C
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Average glucose over 2-3 months.
*Gold standard for long term monitoring |
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Presentation peak
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Ages 10-14 years (puberty)
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Signs and Symptoms
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3P's
1. Polydipsia 2. Polyphagia 3. Polyuria 4. Weight loss 5. Fatgue 6. DKA |
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Goals of Therapy
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Keep glucose levels normal
Prevent vascular complications Reduce mortality Improve quality of life |
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Treatment Goal for A1C
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<7%
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Treatment Goal for FPG
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70-130mg/dl
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Treatment Goal for PPG
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<180mg/dl
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Treatment Goal for BP
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<140/80mmHg
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Treatment Goal for LDL
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<100mg/dl ( opt <70 mg/dl)
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Treatment Goal HDL
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>40mg/dl (men ) >50mg/dl (women )
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Treatment Goal TG
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<150mg/dl
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Why are goals different for children vs. adults?
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1. Vulnerability
2. Low risk of complications before puberty 3. Psychological/developmental issues |
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Rapid acting insulins (analog)
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Lispro (Humalog)
Aspart (Novolog) Glulisine (Apidra) |
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Rapid acting insulin characteristics
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Timing of injection: </= 15 minutes
OA: 15-30minutes Peak: 1-2 hours Duration: 3-6 hours Appearance: clear |
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Humalog
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Lispro
Rapid acting Timing of injection: </= 15 minutes OA: 15-30minutes Peak: 1-2 hours Duration: 3-6 hours Appearance: clear |
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Novolog
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Aspart
Rapid acting Timing of injection: </= 15 minutes OA: 15-30minutes Peak: 1-2 hours Duration: 3-6 hours Appearance: clear |
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Apidra
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Glusine
Rapid acting Timing of injection: </= 15 minutes OA: 15-30minutes Peak: 1-2 hours Duration: 3-6 hours Appearance: clear |
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Short Acting
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Regular (Humlin R, Novolin R)
*available OTC |
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Humulin R
Novolin R |
Regular
intermediate acting Timing of injection: 30-45 mins OA: 30-60 mins Peak: 2-3 hours Duration: 4-8 hours Appearance: clear |
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Intermediate acting
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NPH (Humulin N, Novolin N)
*available as OTC |
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Humulin N
Novolin N |
NPH
Intermediate acting Timing of injection: 1-2 x per day OA: 2-4 hours Peak: 4-8 hours Duration: 8-18 hours Appearance: cloudy |
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Long Acting (analog)
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Glargine (Lantus)
Detemir (Levemir) *onset of action and duration is different |
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Levemir
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Long acting (analog)
Timing of injection: 1-2 x per day OA: 2 hours* Peak: Flat Duration: 14-24 hours* Appearance: clear |
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Lantus
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Long acting analog
Timing of injection: 1-2 x per day OA: 4-5 hours* Peak: Flat Duration: 22-24 hours* Appearance: Clear |
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Ultra Long Acting
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Degludec (Tresiba)
*not FDA approved |
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Tresiba
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Degludac
Ultra Long acting Timing of injection: OA: --------- Peak: Flat Duration: 42 hours |
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Intravenous Only
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Rapid: Lispro, Aspart, Glulisine
Short: Regular |
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Available OTC
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Regular
NPH Combination Humulin and Novolin 70/30 (70 NPH/ 30 regular) |
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ADE
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1)Hypoglycemia
2) Weight gain 3) Lipodystrophy |
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Basal insulin
What kind? When give basal insulin? |
Background insulin
Intermediate or long acting (qd or bid) |
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Bolus/prandial insulin
What Kind? When to give? |
Mealtime insulin to correct hyperglycemia (prevent post prandial )
Rapid or short acting Bid to tid with meals |
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Initial dosing
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0.5- 1 units/kg
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Illness, stress growth insulin dosing
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1-1.5 Units/kg
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Regular insulin unit decreases plasma glucose by?
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30-50 mg/dl
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Split-mix regimen
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2/3 TDD given in morning
1/3 TDD given in evening 2:1 Intermediate: Short acting ratio |
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Basal-bolus regimen
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*Preferred method
50% Basal--> long acting glargine (once) detemir (1-2x) OR NPH 2/3 morning and 1/2 evening AND 50% Bolus Rapid OR short acting bid-tid 20% B, 15% L, 15% D OR equally between all meals |
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Dosing adjustments for basal regimen
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Based on fasting and pre-meal glucose
Adjust by 10-20% TDD |
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Dosing adjustments for bolus regimen
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Based on post prandial readings
Usually in 1-2 units |
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Insulin::Carbohydrate ratio
Calculation |
Allows to tailor insulin dose to specific meal
--count carbs 500/TDD= grams carbohydrate covered by 1 unit of rapid or short acting insulin |
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Insulin Sensitivity Factor (ISF) or Sliding Scale
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Corrects elevated glucose reading
Estimates drop in blood glucose by 1 unit of rapid or short acting insulin |
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ISF for rapid acting insulin
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1800/TDD
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ISF for short acting insulin
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1500/TDD
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Insulin Pump Insulin
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Rapid acting
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Dosing of CSII
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Decrease TDD by
50% Basal TDD/ 24, for units/hr 50% Bolus TDD for I:C ratio and ISF |
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Pramlintide Brand?
Dosage form? |
Symlin
1000mcg/ml pen injection |
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pramlintide indicated for what type?
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Both type I and type II for those already on insulin therapy but not desired BG control
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pramlintide MOA
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mimics amylin
(decrease glucagon secretion slows gastric emptying increases satiety reduces initial post prandial spike in glucose) |
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pramlintide dosing (TYPE I)
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Initial: 15 mcg prior to meals
Titrate up in 15mcg increments (if no nausea) x 3 days Maintenance: 30-60mcg prior to meals *If 30mcg dose not tolerate, consider d/c drug *if d/c for ANY reason, must re-titrate *if forgotten, wait until next meal for dose |
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What do you need to decrease if adding pramlintide?
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Pre-prandial rapid or short acting insulin by****
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Administration of pramlintide
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*SQ through abdomen or thigh before meal
*rotate injection sites *DO NOT use same injection site as insulin and DO NOT mix with insulin |
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pramlintide ADE
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hypoglycemia (usually within 3 hours)
N/V decreased appetite stomach pain localized injection site reaction |
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pramlintide C/I
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gastroparesis
hypoglycemic unawareness |
