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rapid acting insulins
- aspart - novolog
- lispro - humolog
- apidra - glulisine
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rapid acting insulin dose can be adjusted based on what factors
- preprandial blood glucose
- anticipated activity
- anticipated carb intake
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short acting insulin
- regular
- humulin
- novolin
- clear appearance
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intermediate insulin
- NPH
- novolin N
- humulin N
- cloudy appearance - suspension
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what is the conversion from NPH QD to lantus
equal dose
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what is the conversion from NPH BID to lantus
reduce dose by 20%, unless uncontrolled then maybe less reduction
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lantus - glargine advantages
- convenience - QD, but possible BID
- HS provides less nocturnal hypoglycemia vs NPH
- possible less weight gain vs NPH
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lantus - glargine disadvantages
- pain at injection site
- NOT t be mixed with other insulins
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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
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amylin analog
pramlintide - symlin
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pramlintide - symlin adverse effects
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pramlintide - symlin CI
gastroparesis
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pramlidine - symlin advantages
decrease A1c .5-.7%
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pramlidine - symlin MOA
- decrease gastric motility
- increase satiety = decrease wt
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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
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3 factors that can affect insulin PK
- route of administration
- site of injection
- lipodystrophy
- pt to pt deviation (25-50%)
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disease states that can affect insulin PK
- renal failure - decrease clearance
- hyperthyroidism - increases clearance
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symptoms of hypoglycemia
- blurred vision
- confusion
- hunger
- tachycardia
- tremor
- diaphoresis
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indications of unusable insulin
- clumping
- frosting
- precipitation
- change in clarity of color
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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
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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
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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
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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
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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
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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
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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
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carb counting rule for insulin
- rule of 500
- 500/total daily insulin = # grams 1 unit will cover
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