CMN 572 UNIT 3 2025
ANSWER ALL QUESTIONS IN THIS SECTION
QUESTION 1
Premixed insulin preperations - ANSWERS-Premixed insulin provides
convenience for the patient, covering basal and meal requirements:
70/30 insulin: 70% NPH/ 30% regular
50/50 insulin: 50% NPH/ 50% regular
Humalog mix: 50/50: 50% neutral protamine lispro (NPL: very similar to NPH)/
50% insulin lispro (Humalog)
Humalog mix 75/25: 75% neutral protamine lispro (NPL: very similar to NPH)/
25% insulin lispro (Humalog)
Novolog 70/30: 70% neutral protamine aspart (very similar to NPH)/ 30% insulin
aspart (Novolog)
QUESTION 2
Common to all insulin - Facts - ANSWERS-All insulin comes in a concentration of
U100, meaning that they have 100 units/ml. Also available in U200 & U300
Insulin should be refrigerated for long-term storage, but can be left at room
temperature for up to 30 days. Recommend that patients store extra vials in frig,
but can leave the vial/ pen that they are using at room temp
END OF
PAGE 1
, CMN 572 UNIT 3 2025
Titration of insulin dosage is based on self blood glucose monitoring. The more
complex the regime, the most frequent monitoring needs to be done (up to 4-6x
day)
All patients on insulin and their families need to learn the signs, symptoms and
treatment of hypoglycemia.
All patients should get a Rx for Glucogon injection for treatment of severe
hypoglycemia
Patients should be encouraged to wear a Medic-alert bracelet
Usual Total daily dose of insulin can range from 0.2 - >1.5 units/kg depending on
diet, exercise, degree of insulin resistance, oral medications, and beta cell
functioning.
QUESTION 3
Tests of thyroid function - ANSWERS-TSH- ultra sensitive assay. Most sensitive
test to screen for hyper/hypo thyroid. Normal range 0.4-4.0.
TSH >4 with normal free T4=subclinical hypothyroid, usually asymptotic. Monitor
closely for development of hypothyroidism.
Tsh is elevated in hypothyroid and low in hyperthyroidism.
END OF
PAGE 2
, CMN 572 UNIT 3 2025
QUESTION 4
Free T4 - ANSWERS-Measures free (unbound) thyroxine which is he
metabolically active form of T4
Increased in hyperthyroid
Decreased T4 in hypothyroid
Look at reference values- lab values vary
QUESTION 5
T3 - ANSWERS-Measures metabolism active form of thyroid hormone
triiodothyronine
Elevated in hyperthyroidism
Indicated when hyperthyroidism is suspected but T4 is normal
Not useful in diagnosis of hypothyroidism
QUESTION 6
Antibody titers - ANSWERS-A lot of thyroid disease is a result of anutoimmune
disorder.
Antithyroidglobulin antibody
Antithyroperoxidase antibody
END OF
PAGE 3
, CMN 572 UNIT 3 2025
Both elevated in Graves' disease
Thyroid stimulating immunoglobulin, tsh receptor antibody: usually positive in
Graves' disease
QUESTION 7
Hypothyroidism - ANSWERS-Common, affecting 1% general population and 5%
population over 60
Affects all major body systems, can be mild (asymptomatic) to very severe.
Due to failure or destruction of he thyroid gland.
Most common cause in us is Hashimoto's thyroiditis
May occur due to severe non thyroid illness (euthyroid sick syndrome)
Affects females 5-8x more than males, esp women over 40
QUESTION 8
Hypothyroidism - clinical manifestations - ANSWERS-May be mild and
asymptomatic or very vague symptoms
Common symptoms: weight gain, lethargy, depression, weakness, dyspnea on
exertion, arthralgias, muscle cramps, menorrhagia, constipation, dry skin,
headache, parasthesias, cold intolerance and Raynauds Syndrome
Common physical findings may include: bradycardia, diastolic hypertension,
brittle nails, coarse, thinning hair, peripheral edema, puffy face and eyelids, skin
pallor and dryness, and hyporeflexive DTRs
END OF
PAGE 4
ANSWER ALL QUESTIONS IN THIS SECTION
QUESTION 1
Premixed insulin preperations - ANSWERS-Premixed insulin provides
convenience for the patient, covering basal and meal requirements:
70/30 insulin: 70% NPH/ 30% regular
50/50 insulin: 50% NPH/ 50% regular
Humalog mix: 50/50: 50% neutral protamine lispro (NPL: very similar to NPH)/
50% insulin lispro (Humalog)
Humalog mix 75/25: 75% neutral protamine lispro (NPL: very similar to NPH)/
25% insulin lispro (Humalog)
Novolog 70/30: 70% neutral protamine aspart (very similar to NPH)/ 30% insulin
aspart (Novolog)
QUESTION 2
Common to all insulin - Facts - ANSWERS-All insulin comes in a concentration of
U100, meaning that they have 100 units/ml. Also available in U200 & U300
Insulin should be refrigerated for long-term storage, but can be left at room
temperature for up to 30 days. Recommend that patients store extra vials in frig,
but can leave the vial/ pen that they are using at room temp
END OF
PAGE 1
, CMN 572 UNIT 3 2025
Titration of insulin dosage is based on self blood glucose monitoring. The more
complex the regime, the most frequent monitoring needs to be done (up to 4-6x
day)
All patients on insulin and their families need to learn the signs, symptoms and
treatment of hypoglycemia.
All patients should get a Rx for Glucogon injection for treatment of severe
hypoglycemia
Patients should be encouraged to wear a Medic-alert bracelet
Usual Total daily dose of insulin can range from 0.2 - >1.5 units/kg depending on
diet, exercise, degree of insulin resistance, oral medications, and beta cell
functioning.
QUESTION 3
Tests of thyroid function - ANSWERS-TSH- ultra sensitive assay. Most sensitive
test to screen for hyper/hypo thyroid. Normal range 0.4-4.0.
TSH >4 with normal free T4=subclinical hypothyroid, usually asymptotic. Monitor
closely for development of hypothyroidism.
Tsh is elevated in hypothyroid and low in hyperthyroidism.
END OF
PAGE 2
, CMN 572 UNIT 3 2025
QUESTION 4
Free T4 - ANSWERS-Measures free (unbound) thyroxine which is he
metabolically active form of T4
Increased in hyperthyroid
Decreased T4 in hypothyroid
Look at reference values- lab values vary
QUESTION 5
T3 - ANSWERS-Measures metabolism active form of thyroid hormone
triiodothyronine
Elevated in hyperthyroidism
Indicated when hyperthyroidism is suspected but T4 is normal
Not useful in diagnosis of hypothyroidism
QUESTION 6
Antibody titers - ANSWERS-A lot of thyroid disease is a result of anutoimmune
disorder.
Antithyroidglobulin antibody
Antithyroperoxidase antibody
END OF
PAGE 3
, CMN 572 UNIT 3 2025
Both elevated in Graves' disease
Thyroid stimulating immunoglobulin, tsh receptor antibody: usually positive in
Graves' disease
QUESTION 7
Hypothyroidism - ANSWERS-Common, affecting 1% general population and 5%
population over 60
Affects all major body systems, can be mild (asymptomatic) to very severe.
Due to failure or destruction of he thyroid gland.
Most common cause in us is Hashimoto's thyroiditis
May occur due to severe non thyroid illness (euthyroid sick syndrome)
Affects females 5-8x more than males, esp women over 40
QUESTION 8
Hypothyroidism - clinical manifestations - ANSWERS-May be mild and
asymptomatic or very vague symptoms
Common symptoms: weight gain, lethargy, depression, weakness, dyspnea on
exertion, arthralgias, muscle cramps, menorrhagia, constipation, dry skin,
headache, parasthesias, cold intolerance and Raynauds Syndrome
Common physical findings may include: bradycardia, diastolic hypertension,
brittle nails, coarse, thinning hair, peripheral edema, puffy face and eyelids, skin
pallor and dryness, and hyporeflexive DTRs
END OF
PAGE 4
