2. Endocrine 1 - Diabetes Flashcards
1
Q
poor periop glycemic control risks
A
incr CV
hyper/hypoglycemia
DKA
HHS
2
Q
DKA is more likely in what pts
A
T1D
3
Q
what makes DKA worse
A
sress
4
Q
DKA Glu levels
A
> 250 mg/dL
5
Q
DKA electrolyte abnormaliteis
A
High K+
low Phos
6
Q
HHS is more common in
A
T2D
7
Q
HHS Glu levels
A
Glu > 600 mg/dL
8
Q
HHS diagnostic criteria
A
hyperglycemia
hyperosmolarity
dehydration
9
Q
HHS osmolarity
A
plasma osm > 350 mOsm/L
10
Q
biguanide drug
A
metformin
11
Q
biguanide indication
A
T2D
12
Q
biguanide mechanims
A
activated AMP kinase
13
Q
biguanide SE
A
decr hepatic glu production
incr sk muscle glu metabolism
lactic acidosis
GI symptoms
14
Q
do biganides have hypoglycemia risk
A
NO
15
Q
biguanide DOA
A
8-12 hrs
16
Q
biguanide dosing
A
bid (2x daily)
qd (4x daily)
17
Q
biguanide CI
A
renal insufficiency (Cr > 1.5 mg/dL)
HF
contrast dye
18
Q
sulfonurea drug
A
glyburide
19
Q
sulfonurea mech
A
closes K-ATP channel on beta cell membrane
20
Q
sulfonurea SE
A
incr insulin secretion
hypoglycemia
weight gain
21
Q
do sulfonurea have risk of hypoglycemia
A
yes
22
Q
which drug class has highest risk of hypoglycemia
A
sulfonurea (glyburide)
23
Q
sulfonurea DOA
A
12-24 hrs
24
Q
sulfonurea CI
A
renal insufficiency
25
meglitinides drug
Repaglinide
26
meglitinides mech
closed K-ATP channels on beta cell membrane
27
meglitinide SE
incr insulin secretion
hypoglycemia
28
do meglitinides have risk for hypoglycemia
yes
29
meglitinde DOA
12-14 hrs
30
thizolidinediones drug
pioglitazone
31
thizolidinediones indication
T2D
32
thizolidinediones mech
activate nuclear transcription factor PPAR-gama
33
thizolidinediones SE
incr insulin sensitivity
edema
34
do thizolidinediones have hypoglycemia
NO
35
thizolidinediones DOA
12-24 hrs
36
thizolidinediones CI
systolic HF
37
alpha glucosidase inhibitor
acarbose
38
alpha glucosidase inhibitor mech
inhibits intestinal alpha glucosidase
39
alpha glucosidase SE
no intestinal carb digestion/absorption
40
do alpha glucosidase inhibitors cause hypoglycemia
no
41
DPP4 inhibitor
sitagliptin
42
DPP4 inhibitor mech
inhibits DDP4 activity which increases incretins
43
DPP4 SE
incr insulin secretion
decr glucagon secretion
pancreatitis
44
DPP4 DOA
24 hrs
45
do DPP4 inhibitors cause hypoglycemia?
no
46
GLP1 receptor agonist
semaglutide
47
GLP1 agnoist mech
activates GLP-1 receptors
(incretin mimetic)
48
GLP1 agonist SE
incr insulin secretion
pancreatitis
49
GLP1 agonist risk of hyypoglycemia?
no
50
GLP1 agonist dosing
daily to weekly
51
SGLT2 inhibitors
canaglioflozin
52
SGLT2 inhibitor indication
diabetes / HF
53
SGLT2 mechanism
inhibits sodium glucose transport in proximal tubule
54
SGLT2 SE
blocks glu reabs by kidney
incr glucosuria
UTI
hyponatremia
dehydration
55
SGLT2 DOA
24 hrs
56
do SGLT2 inhibitor cause hypoglycemia
no
57
amylin mimetics
pramlintide
58
amylin mimentics mech
activates amylin receptors
59
amylin mimetic SE
decr glucagon secretion
slow gastric emptying
incr satiety
60
amylin mimemetic hypoglycemia?
no
61
insulin analog mech
activate insulin receptor
- incr glu disposla
- decr hepatic glu production
- suppress ketogenesis
62
rapid insulin analog
lispro
aspart
glulisine
63
short acting insulin analgo
human regular
64
intermed acting insulin analog
human NPH
65
basal insulin analog
glargine
detemir
degludec
66
which insulin can you give IV
regular insulin
67
does insulin cause hypoglycemia
yes
68
risk for hypoglycemia is related to
mechanism of action
69
HOLD/STOP day prior to sx
SGLT2 inhibitors
70
HOLD/STOP day of sx
secreatagogues- sulfonureas
SGLT2 inhibior: gliflozins
GLP1 agonist
71
TAKE day of sx
DPP4 inhibitors
thiazolinediones
metformine (unless dye admin)
72
what meds do T1D need during sx
insulin and glu
73
Insulin DAY before sx
continue
74
insulin NIGHT before sx
basal insulin reduce up to 25%
75
what insulin is held before sx
prandial/short acting
76
Insulin day of sx
80% basal insulin dose
77
BG should be checked every ______ in T2D
2 hrs
78
BG should be checked every _______ in T1D
1 hr
79
goal BG
90-180 mg/dL
80
less tight BG
decr risk of hypoglycemia
81
more tight BG reg
more hypoglycemia w/o benefits
82
BG 100-140 mg/dL insulin dose
0.025 units/kg/hr
83
BG 140-220 mg/dL insulin dose
0.05 units/kg/hr
84
BG 220-270 mg/dL insulin dose
0.075 units/kg/hr
85
BG > 270 mg/dL insulin dose
0.1 units/kg/hr
86
DM1 pts perio-op insulin
1-2 units/hr
(Do Not Stop)
87
DM2 pts perio-op insulin
higher rates due top insulin resistance
88
perio-op hypoglycemia treatment
decr rate to 0.5 units/hr
incr glu infusion rate
89
what should you pair with insulin?
dextrose to prevent hypoglycemia
90
dextrose IV dose
4-6 g /hr
91
dextrose D5W dose
75-125 mL/hr
92
dextrose IV indication
pts on IV insulin
maybe: pts w/preop hypoglycemia
93
restart metform
do not restart if:
- renal insufficient
- hepatic impairement
- CHF
94
restart sulfonurea
after eating
95
thiazolidieodinsae CI
CHF
impaired liver function
96
how long should you continue IV insulin post-op
until resume eating
97
when do you start subq insulin post-op
once tolerating solid foods
GIVE PRIOR TO STOPPING IV INSULIN
98
blood glu goals
avoid hypoglycemia
prevent DKA/HHS
avoid hyperglycemia
fluid/electrolyte balance
decr infection risk
99
hypo0glycemia
< 40 mg/dL
100
when should you start treating low Blood Glu
< 70 mg/dL
101
anesthetics do what
mask hypoglycemia symtpoms
102
treat hypoglycemia
IV dextrose 25 g
glucagon 1 mg IV
15-20 g juice
103
treat hyperglycemia
give insulin
104
DKA diagnosis
AG > 10 mEq/L
105
DKA treatment
1-2 L fluids
IV insulin
K+/Phos replacement
106
DKA IV bolus
0.1 Unit/kg
107
DKA IV infusion
0.1 unit/kg/hr
108
what indicates DKA has resolved
AG < 12 mEq/L
pH > 7.3
bicarb 15 mEq/L
109
HHS treatment
fluid resuscitation 1-1.5L hypotonic saline
insulin
supp electrolytes
110
hypotonic saline
0.45% NaCl
0.225% NaCl
111
HHS diagnosis
plasma osm > 320 mOsm/L
