Endocrinology Type I DM
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| Name the rapid acting insulins | Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra)
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| What is the duration of rapid-acting insulin? | 3-5 hours; peak is under 1 hour
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| What type of insulin is REGULAR? | Short-acting; duration 3-6 wtih a peak of 2-3 hours
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| When should rapid acting insulin be dosed? | within 15 minutes of a meal. Glulisine can also be dosed wtihin 20 minutes after starting a meal.
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| Name the two Regular/short acting insulin options | Novolin and Humulin
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| When should short acting insulin be dosed? | It is for meal coverage, so dose within 30 minutes of a meal
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| What can be used as rescue insulin? | Short-acting or regular
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| What is the advantage of a pump | it mimics an actual pancreas's response to insulin
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| Why is regular insulin rarely given in outpatient situations? | higher risk for hypoglycemia b/c it stays in the body longer
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| NPH is what type of insulin? | Basal. High risk of hypoglycemia
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| Glargine and Determir are considered _______ insulins | long-acting peakless insulin
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| Which insulins are available OTC? | Regular and NPH
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| What type of insulin is used in insulin pumps? | Only rapid
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| IV insulin is always | regular
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| What type of insulin is NPH? | Basal, intermediate acting. Onset is 2-4 hours, so not good for acute Blood glucose lowering action
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| How is NPH dosed in T1DM? | Typically injected twice daily (breakfast and supper). Patients must eat lunch b/c that is when the peak it.
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| Which is the only insulin that is good past 30 days? | Levemir (detemir) - 42 days
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| How should Levemir (detemir) be dosed initally? | Once a day; most type I patients will need twice a day. For type II, just 1 dose.
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| Long acting insulin is often dosed when? | At night. Once a day.
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| NPH is dosed at breakfast is out of the body by ______. | Supper
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| Which insulin is the only true intermediate insulin? | NPH
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| Regular insulin is used as a _____ | bolus
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| What age group of T1DM pts requires the greates total daily dose/kg of insulin? | Pubertal. 1.5u/kg/day
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| What is the 50/50 rule? | Split total daily dose of insulin into 50% basal and 50% bolus.
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| If you are using NPH as basal, how do you adjust bolus? | Increase amount of bolus by 20% and titrate up as needed.
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| In a regular type I patient, how much does 1 unit of bolus change blood glucose? | 50mg/dL
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| In an insulin resistant patient, how much does 1 unit of bolu change blood glucose? | 25-30mg/dL
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| In an insulin sensitive patient, how much does 1 unit of bolus typically change blood glucose? | 70-100mg/dL
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| If a patient has a frequent low blood glucose, how do you adjust TDD? | decrease by .5 units
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| After insulin, diet and exercise, what can you give Type I patients? | Insulin sensitizers - Biguanide and glitazone
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| Type I patients can also take | Amyin agonist - pramlintide
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| What is the MOA of Amylin | Increases satiety
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| In a type I patient taking Pramlintide, how do they adjust their meal-time insulin? | Decrease by 50%. 15mcg of Pramlintide before every meal initially, and then increase dose every 3-7 days as tolerated to 60mcg
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| Black box warning of Pramlintide | TYPE 1: Insulin-induced severe hypoglycemia, typically occurs within 3 hours of dosing
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| AE's of Pramlintide | Nausea, Anorexia and hypoglycemia
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