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00 Diabetes Flashcards

1
Q

What blood glucose does an A1c of 7 correlate with?

A

154 (+/- ~30 for every 1% increase or decrease)

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2
Q

What are the 3 different blood glucose tests that can confirm a diagnosis of DM?

A

HbA1c 6.5% or higher. FPG 126+ for 2 consecutive visits. 2h OGTT 200+ for 2 consecutive visits

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3
Q

What are the treatment goals like for DM?

A

Should be individualized. 6.5% A1c for younger and healthier patients. 7-8% A1c for older, comorbidities, sensitive, etc.

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4
Q

What are the “Complication Prevention: ABCs” for diabetics?

A

A: A1c < 7%
B: Blood pressure < 140/80 mmHg
C: Cholesterol (TC < 200, TG < 150, LDL < 100, HDL > 40(M)/50(F))

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5
Q

What can you give to an unconscious person d/t hypoglycemia?

A

Glucagon 1mg SQ/IM

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6
Q

What is the definition of hypoglycemia?

A

BG < 70

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7
Q

What is the generic name of Glucophage?

A

Metformin (Biguanide)

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8
Q

What is the efficacy like for Metformin?

A

(Metformin): Decreases A1c by 1.5-2%

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9
Q

What is the MOA of Metformin?

A

(Metformin): Decreases hepatic glucose output. Enhances insulin sensitivity of both hepatic and peripheral (muscle) tissues –> increases uptake of glucose into these insulin-sensitive tissues

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10
Q

What are the advantages with Metformin?

A

(Metformin): No weight gain, no hypoglycemia, decreases TGs/LDL

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11
Q

What is the generic name of Fortamet?

A

Metformin (Biguanide)

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12
Q

What is the generic name of Glumetza?

A

Metformin (Biguanide)

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13
Q

What is the generic name of Janumet?

A

Metformin + Sitagliptin (DPP-4 Inhibitor)

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14
Q

What is the BBW with Metformin?

A

Lactic Acidosis

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15
Q

When is Metformin Contraindicated?

A

With SCr 1.5+ (Males) or 1.4+ (Females) or abnormal CrCl < 60, Metabolic acidosis

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16
Q

When do you need to temporarily d/c Metformin?

A

In patients receiving IV iodinated contrast media. Wait 48 hours after the procedure and restart only once renal function has been confirmed as normal

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17
Q

When should Metformin therapy be stopped?

A

In any case of hypoxia, such as decompensated HF, respiratory failure, acute MI or sepsis. Avoid in patients with hepatic impairment d/t increased risk for lactic acidosis

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18
Q

What is the MOA of Sulfonylureas?

A

Work by stimulating insulin secretion from the pancreatic beta cells

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19
Q

Which medication class should you avoid using with Sulfonylureas d/t similar MOA?

A

Meglitinides

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20
Q

What is the generic name of Diabinese?

A

Chlorpropamide (Sulfonylurea, 1st gen)

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21
Q

What is the generic name of Glucotrol?

A

Glipizide (Sulfonylurea)

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22
Q

What is the generic name of Amaryl?

A

Glimepiride (Sulfonylurea)

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23
Q

What is the generic name of DiaBeta?

A

Glyburide (Sulfonylurea)

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24
Q

What are the disadvantages of Sulfonylureas?

A

Hypoglycemia, Weight gain

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25
Q

What are the precautions/warnings with Sulfonylureas?

A

Sulfa allergy, renal impairment

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26
Q

What are the renal impairment cut-offs for Sulfonylureas?

A

Glyburide: < 50 - Not recommended
Glimepiride: < 22 - Start with 1mg and titrate based on SMBGs
Glipizide: < 10 - Not recommended

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27
Q

Which Sulfonylurea is ideal for geriatric patients since its the only one that doesn’t have active metabolites?

A

Glipizide

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28
Q

All Sulfonylureas are dosed once daily, except which one?

A

Glipizide (BID)

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29
Q

What is the MOA of Meglitinides?

A

Work by stimulating insulin secretion from the pancreatic beta cells

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30
Q

What is the generic name of Prandin?

A

Repaglinide (Meglitinide)

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31
Q

What is the generic name of Starlix?

A

Nateglinide (Meglitinide)

32
Q

What is the MOA of Thiazolidinediones (TZDs)?

A

They are peroxisome proliferator-activated receptor gamma (PPARy) agonists causing increased peripheral insulin sensitivity (increases uptake and utilization of glucose by the peripheral tissues; insulin sensitizers)

33
Q

What is the generic name of Actose?

A

Pioglitazone (TZD)

34
Q

What is the BBW for TZDs?

A

May cause or exacerbate heart failure in some patients; do not initiate therapy in patients with NYHA Class III/IV heart failure

35
Q

What is a warning with TZDs?

A

Do not use pioglitazone in patients with active bladder cancer

36
Q

What are the side effects with TZDs?

A

Peripheral edema, Weight gain, URTIs

37
Q

How do Alpha-Glucosidase Inhibitors work?

A

Cause reversible inhibition of membrane-bound intestinal alpha-glucosidases which hydrolyze oligosaccharides and disaccharides to glucose and other monosaccharides in the brush border of the small intestine. In patients with diabetes, this enzyme inhibition results in delayed glucose absorption and lowering of postprandial hyperglycemia

38
Q

What are the Alpha-Glucosidase Inhibitors used?

A

Acarbose and Miglitol

39
Q

When should Alpha-Glucosidase Inhibitors be taken?

A

With the first bite of each main meal

40
Q

When are Alpha-Glucosidase Inhibitors contraindicated?

A

Inflammatory bowel disease (IBD), colonic ulceration, partial or complete intestinal obstruction

41
Q

What are some common ADRs with Alpha-Glucosidase Inhibitors?

A

GI effects (flatulence, diarrhea, abdominal pain)

42
Q

What is important to counsel about hypoglycemia with Alpha-Glucosidase Inhibitors?

A

They don’t cause low blood sugar by themselves. If you get low blood sugar after taking acarbose or miglitol, you cannot treat with sucrose (present in fruit juice) or with table sugar or candy. You will need to purchase glucose tablets or gel to have on-hand to treat any hypoglycemic episode

43
Q

What is the generic name of Januvia?

A

Sitagliptin (DPP-4 Inhibitor)

44
Q

What is the MOA of DDP-4 Inhibitors?

A

Prolong t1/2 GLP-1 and GIP by blocking DPP-4 enzyme activity for at least 12 hours. This causes a decrease in elevated glucagon postprandially and improves insulin response to high glucose levels

45
Q

What are the advantages with DPP-4 Inhibitors?

A

Very well tolerated, weight neutral, and no GI side effects. Taken once daily w/ or w/o food

46
Q

What are the ADRs with DPP-4 Inhibitors?

A

Nasopharyngitis, upper respiratory tract infections, UTIs

47
Q

What is the MOA of Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors?

A

Inhibit SGLT2 in the proximal renal tubules. Decrease reabsorption of filtered glucose from the tubular lumen and decrease renal threshold for glucose –> increased urinary secretion of glucose and reduced plasma glucose concentration

48
Q

What are the advantages of SGLT2 Inhibitors?

A

Minimal risk of hypoglycemia; weight loss

49
Q

What is the generic name of Invokana?

A

Canagliflozin (SGLT2 Inhibitor)

50
Q

What are the ADRs with SGLT2 Inhibitors?

A

Female genital mycotic infections, UTIs, Hyperkalemia, increased urination

51
Q

What should be done if using a SGLT2 Inhibitor with Insulin or Insulin secretagogue?

A

Consider a lower dose of the insulin or insulin secretagogue when used in combo with canagliflozin to reduce risk of hypoglycemia

52
Q

What is the generic name of Byetta?

A

Exenatide (GLP-1 Agonist)

53
Q

What is the generic name of Bydureon?

A

Exanatide Extended-Release (GLP-1 Agonist)

54
Q

What is the MOA of Glucagon-Like Peptide-1 Agonists?

A

These agents are analogs of GLP-1 which increase insulin secretion and decrease glucagon secretion, slow gastric emptying, improve satiety, and may result in weight loss. These are incretin mimetics

55
Q

What is the BBW for Bydureon?

A

Thyroid C-cell carcinomas seen in rats. Contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) or patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN2)

56
Q

What are the warnings for GLP-1 Agonists?

A

Pancreatitis can occur, most commonly in patients with hx of pancreatitis, gallstones, alcoholism, or high TGs. Avoid in severe impairment (CrCl < 30)

57
Q

What are the most common ADRs with GLP-1 Agonists?

A

Nausea (primary side effect), weight loss

58
Q

What concentration do all insulins come in?

A

All insulins have a concentration of 100 units/mL, except Humulin R U-500 which has a concentration of 500 units/mL

59
Q

What is the generic name of NovoLOG?

A

Insulin Aspart (Rapid-Acting)

60
Q

What is the generic name of Apidra?

A

Insulin Glulisine (Rapid-Acting)

61
Q

What is the generic name of HumaLOG?

A

Insulin Lispro (Rapid-Acting)

62
Q

What is the generic name of HumuLIN R?

A

Regular Insulin (Short-Acting - OTC)

63
Q

What is the generic name of NovoLIN R?

A

Regular Insulin (Short-Acting - OTC)

64
Q

What is the generic name of HumuLIN N?

A

NPH (Intermediate-Acting - OTC)

65
Q

What is the generic name of NovoLIN N?

A

NPH (Intermediate-Acting - OTC)

66
Q

What is the generic name of HumuLIN 70/30 and NovoLIN 70/30?

A

Insulin NPH/Insulin Regular (available OTC)

67
Q

Which insulins are available OTC?

A

Short-acting and Intermediate-acting

68
Q

What is the generic name of Levemir?

A

Insulin Detemir (Long-Acting)

69
Q

What is the generic name of Lantus?

A

Insulin Glargine (Long-Acting)

70
Q

What is a typical starting dose for insulin?

A

0.6 units/kg/day (50% meal and 50% long acting if taking the meal insulins)

71
Q

What is DKA?

A

DKA can occur when there is not enough insulin and the body breaks down fat to make energy. The breakdown of fats causes the concentration of ketones in the blood to increase

72
Q

What are the symptoms of DKA?

A

Hyperglycemia, polyuria, polyphagia, polydipsia, blurred vision, metabolic acidosis (fruity breath), and dehydration

73
Q

What are the lab abnormalities in DKA?

A

Glucose > 300, ketones present, pH < 7.2, Bicarb < 15, WBC 15-40

74
Q

What is the treatment for DKA?

A

Involves giving IV fluids and insulin –> closely monitoring and replacing electrolytes. This typically involves using NS, followed by 1/2 NS, and correcting potassium to bring the level > 3.5 (expected to drop when insulin is given)

75
Q

What are two good counseling points for Bydureon?

A

May cause small, painless nodules at the injection site. It is important to take the medication just prior to meals

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