22 Questions
What was the primary focus of the initial attempt to teach patients to adjust their insulin doses?
To teach patients to evaluate their treatment by comparing their blood glucose values against a visual target range
What was a common issue with the initial method of adjusting insulin doses based on blood glucose values?
It resulted in inconveniently timed hypoglycemia due to exercise and dietary deviations
What is an essential aspect of insulin dosing, according to evidence-based advice?
Varying insulin doses based on carbohydrate intake and other factors
Why is the old advice for a fixed dose of insulin deemed unacceptable?
It does not take into account individual variations in carbohydrate intake and exercise
What is a useful suggestion for managing insulin doses during large meals?
Splitting the insulin injection
What is the ultimate goal of the diabetes management program discussed in the chapter?
To achieve euglycemia
What is the primary consequence of not considering caloric drift in patients?
Increased risk of weight gain and related complications
What is the primary purpose of using a 10% correction in insulin dosing?
To adjust for changes in blood glucose levels above 10 mmol/l or below
What is the primary factor affecting the Carbohydrate Ratio?
Post-meal hyperglycemia
What is the key factor in successfully matching insulin dose to the likely blood glucose outcome of a meal?
Accurate carbohydrate counting
What is the recommended Carbohydrate Ratio for patients on intensive therapy?
10-15g CHO per 1 unit insulin
What is the main difference between fixed-dose insulin therapy (FIT) and multiple daily injections of insulin?
FIT involves a set dose of insulin with each meal, whereas multiple daily injections involve adjusting insulin dose based on blood glucose levels
What percentage of daily insulin dose comes from the Carbohydrate Ratio?
40-60%
What is the consequence of not refining patient education on the implications of food choices on disease factors?
Patients may be more likely to experience weight gain and related complications
Why do girls tend to have a higher Carbohydrate Ratio than boys?
Due to increased physical activity
What is the primary advantage of using carbohydrate ratio and fixed-dose insulin therapy (FIT) over rule-of-thumb approaches?
They allow for more accurate insulin dosing calculations
What is the phenomenon seen in patients with type 1 DM and type 2 DM on insulin, involving unintended increases in HbA1c and total daily insulin?
Caloric drift
What is the hypothesis that suggests a small genetically or epigenetically determined increase in fatness due to a minute and chronic excess of energy intake over expenditure?
Drifty hypothesis
What is the alternative hypothesis to the drifty hypothesis?
Settling point hypothesis
What is the term used to describe a mismatch between energy intake and energy expenditure, resulting in a small but significant increase in weight and an increase in the levels of circulating insulin?
Caloric flux
Why do individuals with type 2 DM tend to have a higher caloric requirement (CR) compared to those of the same body weight with type 1 DM?
Due to caloric drift
What is the strategy that allows patients to match a unit of insulin to a certain amount of carbohydrates?
Insulin-to-carbohydrate ratio
Learn about the diabetes management program developed from the DCCT study, focusing on teaching patients to adjust insulin doses based on blood glucose values to achieve euglycemia. Understand how patients evaluate treatment success and make adjustments accordingly.
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