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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)
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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.
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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
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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
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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
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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.
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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.
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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.
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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
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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
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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
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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
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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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