Diabetes

Question 1

typical split for long acting and rapid acting insulin

Answer 1

50:50

Question 2

what are the number of units of insulin adjusted based on

Answer 2

BG readings and amount of carbs consumed each meal

Question 3

do we adjust for single elevated BG

Answer 3

not unless it severe

Question 4

how should insulin be adjusted in hyperglycemia

Answer 4

only one insulin at a time

10% change to insulin causing the effect

Question 5

how should insulin be adjusted in hypoglycemia

Answer 5

insulin causing low level decreased 10%

Question 6

how much of a decrease in BG from one unit of rapid acting insulin

Answer 6

take 100 divided by the total daily dose

Question 7

decrease in BG for 1 unit of short acting insulin

Answer 7

divide 85 by the persons total daily dose

Question 8

what is and how do you calculate insulin to carb ratio

Answer 8

divide 100 by total daily dose

gives the number of carbs that will require 1unit more of insulin

Question 9

exercise effect on insulin

Answer 9

enhance the effect of exogenous insulin by increasing glucose uptake by muscle cells and intracellular glucose metabolism
depletion of glycogen stores may occur with mod to intense or prolonged exercise

Question 10

when should exercise be avoided

Answer 10

BG >14 and ketones present

Question 11

what happens if excessive hyperglycemia is present

Answer 11

insulin levels too low and glucose cant be used by muscles
glucose and free fatty acid metabolism continue to increase plasma glucose and ketone levels
can lead to progressive hyperglycemia and ketosis

Question 12

is it better to adjust insulin or add food

Answer 12

adjust insulin when possible

young children wil likely need extra food bc often unplanned

Question 13

hypoglycemia can occur ____ hours post exercise

Answer 13

36

Question 14

disconnecting an insulin pump in exercise

Answer 14

may be disconnected during exercise for 1-2 hours

check BG before and after reconnecting

Question 15

alwyas have ___ when exercising

Answer 15

quick carb source

Question 16

which insulin should be adjusted during the activity

Answer 16

the insulin thats peaki at the time of the activity

Question 17

why do you have to adjust on sick days

Answer 17

illness allows body to release hormones to counteract insulin
circulating BG rises and circulating fat cells
more acidic and ketone bodies increase

Question 18

when should you do ketone testing

Answer 18

preprandial >14 or symptoms of DKA such as NV or ab pain

type 1 and 2

Question 19

should you omit insulin on sick days

Answer 19

no

Question 20

what cna be given safely on sick days

Answer 20

rapid or short acting every 3-4 hours

Question 21

monitoring on sick days

Answer 21

BG and ketones every 2-4 hours arond the clock and usual times as long as significant hyperglycemia and ketonuria present

Question 22

BG goals in sicknes

Answer 22

4-13 and ketones negative

Question 23

what to do if patient has difficulty eating solids in illness

Answer 23

10-15 g carbs liquid or soft every 1-2 hours

Question 24

fluid consumption in illness

Answer 24

water broth or sugar free drinks to prevent dehydration and facilitate excretion of ketones in the urine
1 cup an hour while awake

Question 25

call physician when

Answer 25

``` unable to tolerate fluid vomit more than once in 4 hours diarrhea more than 5 times a day two additional insulin and no improvement illness very sever >24hrs unable to keep BG above 6 signs of DKA< dehydration ```

Question 26

how much usually should insulin be increased or decreased in sickness

Answer 26

10-15% of TDD increased | 10-30% of TDD decreased

Question 27

problem with urine ketone testing

Answer 27

false positve and negatives less accurate urine has whats left in the bladder from the last void so ketones are detected later

Question 28

blood 3HB ketone measuring

Answer 28

3HB represents largest portion of ketone production but not measured in the urine reflects current ketonuria, detects earlier

Question 29

type 2 starting insulin dose

Answer 29

10mg HS the increasee 1 unit at a time until target reached

Question 30

causes of low BG

Answer 30

weight loss alchohol exercise diet change

Question 31

type 2 monitorin

Answer 31

initiating monitor twice a day once a day when on 2 meds on metformin a couple times a week

Question 32

major drug that causes increase in BG and management

Answer 32

prednisone | treat the high BG dont take off prednisone

Question 33

advantages of metformin

Answer 33

weight neutral less hypoglycemia risk proven to decrease complications

Question 34

disadvantage of metformin

Answer 34

need good renal function GI upset metallic taste

Question 35

disadvantages of sulfonylureas

Answer 35

``` more hypo (gliclazide less than glyburide) not shown to decrease stroke and heart attack ```

Question 36

which drugs do you discontinue when sick

Answer 36

``` sulfonylurea acei diuretics, direct renin inhibitors metformin arb nsaids ```

Question 37

what is the sick acronym stand for

Answer 37

blood sugar testin every 2-4 hr continue insulin eat/drink carbs and a cup of fluid an hour (sugar free) ketone testing

Question 38

why limit coffee, tea and pop on sick days

Answer 38

caffiene can cause dehydration

Question 39

ways to give extra insulin on sick days

Answer 39

extra with normal dose or | rapid can be given extra injection every 3-4 hours

Question 40

who with diabetes should receive low dose aspirin

Answer 40

over 50 with sig risk factor (family history, hypertension, smoking, dyslipidemia) not at increased risk of bleeding <50 with multiple CVD risk factors

Question 41

complications of hihg blood sugars in pregnancy

Answer 41

``` macrosonia shoulder dislocation and nerve damage neonatal hypoglycemia preterm delivery hyperbilirubinemia c section ```

Question 42

pregnancy targets

Answer 42

fasting <5.3 1hr post prandial <7.8 2hr post prandial <6.7

Question 43

diets for diabetes in pregnancy

Answer 43

avoid hypocaloric diet | 3 meals with 3 snacks, moderate carb restriction

Question 44

control of diabetes in pregnancy

Answer 44

if targets not met with 2 weeks on diet start on rapid acting multiple injections insulin regimen

Question 45

what to do if someone refuses injections in pregnancy

Answer 45

off label use of metformin and glyburide warn them there is no long term data and insulin is preferred glyburide may be better