Ch 39: Diabetes Flashcards
Glucovance
metformin + glyburide
Janumet
metformin + sitagliptin
Invokamet
metformin + canagliflozin
Synjardy
metformin + empagliflozin
Glyxambi
linagliptin + empagliflozin
Qtern
saxagliptin + dapagliflozin
Xultophy
liraglutide + insulin degludec
Soliqua
lixisenatide + insulin glargine
humalog vs novolog
humalog is lispro. novolog is aspart.
afrezza
PO inhaled insulin. replace inhaler every 15 days. contraindication for asthma, copd. BBW: acute bronchospasm with chronic lung disease. otherwise similar to rapid insulin.
concentrated insulin products
humalog kwikpen (200 u/ml), humulin r u-500, tresiba flextouch (200 u/ml), toujeo solostar (300 u/ml)
mixing insulin in same syringe
clear insulin into syringe first, before cloudy (NPH). (inject air into cloudy, then clear, take in clear, then cloudy.
hypoglycemia
<70. normal fasting is 70-99.
15 g of simple carbs
3-4 glucose tabs, 1 serving of gel tube, 2 tbsp raisins, 4 oz juice or reg soda, 1 tbsp sugar/honey/corn syrup, 8 oz milk.
hospitalized bg goal
140-180. avoid SSI. instead basal, bolus, and correction.. basal and correction only if poor intake.
DKA
bg >250 mg/dl, ketones +/- fruity breath, ag metab acidosis (arterial pH <7.35, ag >12). T1DM or noncompliance.
HHS
hyperglycemia, hyperosmolar state. T1DM d/t severe stress. serum ketones negligible or absent. much higher bg >600, high serum osmolality >320 mosm/L, extremem dehydration, AMS, pH >7.3, bicarbonate >15 mEq/L.
DM agents with biggest decrease in a1c (>1%)
insulin, metformin, sulfonylureas, TZDs, GLP1As
DM agents with greatest hypoglycemia risk
insulin, sulfonylureas, meglitinides, TZDs, pramlintide (with insulin)
DM agents with wt gain
insulin, sulfonylureas, meglitinides, TZDs
DM agents with wt loss
SGLT1Is, GLP1As, pramlintide
DM agents with cardiac benefits
empagliflozin (Jardiance), liraglutide (victoza), canagliflozin (invokana)
do not use ___ if eGFR/CrCl <30
metformin, SGLT2Is, exenatide, glyburide
do not use ___ if HF
TZDs, alogliptin, saxagliptin
do not use ___ if PAD, diabetic foot ulcers, peripheral neuropathy
canagliflozin (invokana)
do not use ___ if gastroparesis or other GI disorder
GLP11As, pramlintide
do not use ___ if G6PD deficiency
sulfonylureas