Siu -- T1DM Carb Calculations

describe the pathophysiology of T1DM

when glucose levels are high, the pancreas fails to release insulin. The beta cells in islet of langerhans are destroyed with also prevents insulin release

What are the symptoms of T1DM?

polyuria, polydipsia, polyphagia, wt loss, lethargy

what are the major goals of T1DM therapy?

near normal blood glucose and HbA1c, prevent DKA/hypoglycemia, normal quality of life, nutritional education and psych support, prevent DM related complications

What are the glucose and HbA1c % goal levels for pediatric patients?

premeal: 80-130mg/dL

after meal: <180

HbA1c: <7%

What is the complication with treating children with T1DM?

it is highly individualized and children <6 yrs aren’t able to recognize their symptoms or communicate them properly.

What type of T1DM therapy is often neglected?

medical nutrition therapy (carbs 50%, protein 20%, fat 30%) since the ADA does not recommend specific diets

What are examples of ideal carbohydrates?

fruits, vegetables, whole grains, legumes, low fat milk, high fiber foods

humalog, admelog (lispro), novolog, fiasp (aspart), and apidra (glulisine) are what type of insulin?

rapid acting

novolin R and humulin R (regular) are what type of insulin?

short acting

Novolin N, Humulin N (NPH) are what type of insulin?

intermediate

lantus, basalar, toujeo (glargine), levemir (determir), and tresiba (degludec) are what type of insulin?

long acting

PK properties of insulins

What are the 4 common insulin regimens for T1DM?

1. multiple daily dose (basal): rapid acting with meal + long acting at night

2. BID (conventional): NPH with rapid/short acting

3. continuous SUBQ (insulin pump): rapid acting with continuous basal infusion, deliver when eating/need correction

4. continuous IV infusion: DKA in PICU setting

what does the target glucose represent?

an individuals ideal blood glucose level

basal insulin

single dose of insulin given during meals (rapid acting) or when blood glucose is too high

What is CHO counting?

dietary method that involves consistent intake with meals and snacks, moderate consumption of CHO, keeping daily logs of flood intake and blood glucose, reading food labels.

How do you calculate the total daily dose?

0.5-1 units/kg/day

what is rule of 500 CHO factor?

500/TDD = grams of CHO covered by 1 unit of insulin

lispro, aspart, glulisine (rule of 400 for regular insulin)

What is the rule of 1800 correction factor (for insulin sensitivity)?

1800/TDD = mg/dL of blood glucose will fall per unit of insulin

normalizes hyper/hypoglycemia premeal readings

lispro, arpart, glulisine (rule of 1500 for regular insulin)

what is the meal calculation?

CHO factor (units of insulin for CHIO consumed) ± correction factor (units of insulin for hyper/hypoglycemia before meals)

DOUBLE CHECK ANSWER

AS is an 8 year old female (wt = 30kg) newly diagnosed with T1DM. Calculate the TDD, CHO Factor, and Correction Factor if she takes lispro.

TDD = 15-30 units

CHO Factor: 16-33

Correction Factor: 60-120

CHECK SLIDE 35

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What should you consider when adjusting insulin? What’s first, what is basal and bolus insulin dosing based on, what is prioritized?

1. correcting hypoglcemia first

2. basal insulin based on fasting control

3. bolus insulin based on postprandial and correctional control (ISF)

4. dose of insulin responsible for area of poor control changed 10-20%

FASTING CONTROL > PRANDIAL > CORRECTIONAL CONTROL

Why is pump therapy not used for every T1DM patient?

expensive, high risk of DKA, complexity, lifestyle intrusion, preference, under/overdose and pump failure

Describe insulin pump therapy

allows both continuous and non-continuous bolus doses of insulin at a programmed unit/hr basal rate and programmed carbohydrate and correction ratios. Administered SUBQ using single rapid acting insulin. INCREASED USE IN CHILDREN

what are the advantages of insulin pump therapy?

small dose increments vs injections, able to have different basal rates throughout the day, only rapid acting, allows flexible lifestyle, effective glycemic control, better metabolic control with CSII than with MDI due to reduction in HbA1c

What is the criteria for pump therapy?

≥4 injections, >4 blood glucose test/day, family/pt interest, fail to achieve HbA1c goals, recurrent hypoglycemic evets, changing eating and and lifestyle habits, recurrent DKA

What is the OmniPod Tubeless System

water proof pod attached to skin to deliver insulin with a built in cannula and reservoir holding 200 units of insulin. Basal rates range from 0.5 to 30 units/hr in 0.05 unit increments. USED IN ADULTS AND CHILDREN