167 Insulin Dosing (L15)
Terms in this set (56)
hypoglycemic BG level:
BG <70 mg/dL
but some pts will have symptoms at higher levels
S/sx of mild hypoglycemia:
- excessive hunger
S/sx of moderate hypoglycemia:
S/sx of severe hypoglycemia:
How should hypoglycemia be managed?
1. Eat/drink something equal to 15 gm of carbs
2. Rest for 15 min, then re-check BG
3. If BG still low <70, eat/drink another 15 gm of carbs
4. If next meal is more than 1 hour away, eat another snack/complex carbs to keep BP from going low
-- Always carry something to treat hypoglycemia!
Examples of 15-gm carb foods:
- 3 glucose tablets
- 4 dextrose tablets
- 5-6 ounces (1/2 can) of regular soda
- 7-8 gummy or regular Life Savers
- 1 tbsp of sugar or jelly
What type of carbs: fruit, glucose, fructose, sucrose?
What type of carbs: soda, candy, juice, cookies?
What type of carbs: potatoes, rice, pasta, bread?
What type of carbs: beans, corn, tortillas, oatmeal?
How should carbs be consumed in case of hypoglycemia?
Simple carbs immediately, then complex carbs once BG is normalized
What s/b administered if pt passed out from hypoglycemia?
Comments for glucagon injection:
- Place pt on the side b/c may cause vomiting
- Pt should awaken within 10 minutes
- When awaken, give pt PO carbs to restore liver glycogen
Adult glucagon dose
1 mg IV, IM, or SC
Child glucagon dose and weight requirement:
0.5 mg for children weighing less than 44 lbs
T/F: glucagon needs to be dissolved
True, it is provided as a powder
What are the best sites for glucagon injection?
Buttocks, thighs, and upper arms
How long should the needle remain in the body once glucagon is injected?
5 seconds (count to 5)
____ is the primary target for glycemic control
Glycemic goals are individualized based on what?
- duration of DM
- age/life expectancy
- co-morbid conditions
- known CVD or advanced microvascular conditions
- hypoglycemic unawareness
- individual pt considerations
A1c goal for most pts:
Preprandial BG goal:
Postprandial BG goal:
< 180 mg /dL
(within 2 hours of the meal)
If pt is on multiple-dose insulin or insulin pump, when should they monitor SMBG?
- prior to meals and snacks
- occasionally postprandially
- when they suspect low BG
- after treating hypoglycemia and until they are normoglycemic
- at bedtime
- prior to exercise
- prior to critical tasks such as driving
How often should A1c be checked?
At least 2x per year for pts meeting treatment goals
4 times per year in pts whose therapy changes or who are not meeting goals
What type of complications are decreased with intensive therapy to reach A1c <7%?
If pt has a consistent diet, what insulin injection regimen may be preferred?
2 injections (NPH + rapid/short)
If pts wants flexibility in eating schedule, which insulin injection regimen is preferred?
4 injections (1 basal + 3 rapid)
What is the initial total daily dose for insulin in Type 1 DM?
total daily dose
How much of TDD is administered with breakfast in type 1 DM in 2-injection regimen?
(2/3 NPH + 1/3 rapid or short)
Type 1 DM, 2-injection regimen fixed dose:
AM (before breakfast) dose: 2/3 of TDD
- 2/3 NPH + 1/3 Rapid/short
PM (before dinner) dose: 1/3 of TDD
- 1/2 NPH + 1/2 Rapid/short
What % of TDD is basal insulin in the 4-injection regimen for Type 1 DM?
Type 1 DM, 4-injection regimen fixed dose:
Basal insulin: 1/2 of TDD
Meal coverage: 1/2 of TDD
- 1/3 breakfast + 1/3 lunch + 1/3 dinner
When is basal insulin usually injected?
Sliding scale formula for total bolus dose:
total bolus dose = carb coverage + correction factor
For sliding scale, how is carb coverage calculated?
Rule of 500 for rapid insulin (450 for regular insulin)
500/TDD = 1 unit of insulin covers X grams of carbs
Rule of "500"
Calculating carb coverage for rapid-insulin in sliding scale regimen
Rule of "1800"
BG correction factor for rapid-insulin in sliding scale regimen
Rule of "1500"
BG correction factor for regular insulin in sliding scale regimen
Rule of "450"
Carb coverage for regular insulin in sliding scale regimen
For sliding scale, how is correction factor calculated?
Rapid: 1800/TDD = 1 unit of insulin will reduce BG by X amount
What is the ratio for converting insulins?
except NPH bid --> glargine QD
What is the rule about converting pt from NPH to glargine?
Decrease total NPH daily dose by 20% for glargine dose
Steps for converting insulins:
1. Add up total basal dose
2. Add up total meal-time dose
3. Convert to new insulin (unit-to-unit conversion except NPH --> glargine)
When assessing pattern/trend in pt's current response to insulin, how many days should be considered?
Trend over 3 or more days
Steps for insulin dose adjustment:
1. Average BG at each given time
2. Determine whether at goal, if not by how much
3. Determine which dose affects BG that is not at goal
4. Determine how much to increase/decrease dose
5. Determine whether increasing/decreasing dose will put pt at risk of hypoglycemia and adjust
1 unit of insulin will decrease BG by ____ in type 1 DM
~ 50 mg/dL
1 unit of insulin will decrease BG by ____ in type 2 DM
~ 30 mg/dL
Which insulin dose needs to be changed: SMBG too high before lunch (rapid/short insulin)?
Which insulin dose needs to be changed: SMBG too high before supper (rapid/short insulin)?
Which insulin dose needs to be changed: SMBG too high 2-3 hours after supper or bedtime (rapid/short insulin)?
Which insulin dose needs to be changed: SMBG too high before supper (intermediate insulin)?
Which insulin dose needs to be changed: SMBG too high before breakfast (intermediate insulin)?
Which insulin dose needs to be changed: SMBG too high throughout the day?
Long-acting before bedtime
When adjusting insulin dose, target pre-prandial BG is ____ and target postprandial is ____.
Pre-prandial(fasting) - 110
Post-prandial (within 2 hours of eating) < 180