Day 3 Diabetes Flashcards
What is the drug of choice for type 2 diabetes and prediabetes(in special conditions)?
What is metformins MOA?
How do you dose metformin?
Metformin unless CI’d.
Decreases hepatic glucose production by activating AMP kinase, increases insulin sensitivty, GLP-1 activity.
500 mg daily initially–> increase by 500 mg per week–> target dose is 2000 mg or at least 1500 mg.
What are the ADR’s of metformin?
What are the CI’s for metformin?
What are the clinical pearls to know with metformin?
Nausea, Diarrhea,Loss of appetite, metallic taste, lactic acidosis, B12 deficiency.
Renal dysfunciton(<30), Acute MI and other conditions associated with hypoxia(COPD,Sepsis,Surgery,etc.),Unstable or acute heart failure, Chronic liver disease/alcoholism, If contrast dye is given then discontinue and hold for 48 hours or until renal function normalizes.
Fasting>postprandial, weight stabilization, no hypoglycemia, take with food.
What are the Sulfonylureas? What is their MOA?
What are the SU’s ADR’s?
Do the SU’s effect post prandial and fasting glucose equally? Are the meglinitides all similar?
Glipizide, Glimiperide, Glyburide. Increase insulin secretion by closing the Katp channles on beta cell membranes.
Hypoglycemia, Weight gain, CHF risk.
Yes. YES on everything
What are the Thiazolidinediones MOA?
What are the THZD’s ADR’s?
What clinical pearls to know about the THZD’s?
increases insulin sensitivity by activating PPR-gamma.
Weight gain, edema, hepatoxicity, bone fractures.
Fasting>postprandial, take with or without food, can take weeks to start working. CI’d in hepatic dysfunction or class 3 or 4 HF.
What is the DPP-4 inhibitors MOA?
What are the clinical pearls for DPP-4’s?
What are the SGLT-2 inhibitors MOA?
Blocks the breakdown of GLP-1 of inhibiting DPP-4.
Post prandial>fasting, No one DPP-4 is better than another.
inhibits glucose reabsorption in the proximal nephron by inhibiting SGLT-2.
What are the ADR’s of SGLT-2?
What are the clinical pearls of SGLT-2?
What are the GLP-1 receptor agonists MOA?
Mycotic infections, UTI.
Post prandial>fasting, average weight loss 3 kg, reduces BP.
activates GLP-1 receptors, increase insulin secretion, decrease glucagon secretion, slows gastric emptying and increase satiety.
What are the GLP-1 receptor agonists ADR’s?
What are the clinical pearls for the GLP-1’s?
How do you handle insulin in type 2?
Hypoglycemia, Nausea, Vomiting, Dizziness.
Post prandial>fasting, Exenatide not indicated in kidney failure, liraglutide could help albuminuria and HF and CAD.
Start at 10 units and go up, need higher dose of toujeo if you go from lantus to toujeo, U-500 requires NO basal insulin, can decrease pen burden.
What is the rule of 15?
When does Gestational Diabetes happen?
Do women who develop GD have a high chance of developing diabetes later in life?
eat 15 gms of carbs and then recheck in 15 minutes, if still below 70 retreat, if above 70 have a snack.
During the 2nd or 3rd trimester.
YES
What are some Adverse outcomes of GD?
What is the two step process for determining GD?
What are the glycemic targets in pregnancy?
Miscarriages, C-section, hypoglycemia, preclampsia/eclampsia, preterm delivery, birth injury, shoulder blocking, billirubin.
50 gms of glucose if >140 then go to OGTT(some at 130-135). OGTT–> 100 gms glucose–> if fasting >95, 1 h>180, 2h>155, 3h>140 if have any 2 then you have GD.
preprandial–> <95, 1 hour–> <140, 2 hour–> <120
What treatment can you do in GD?
How to treat pre existing diabetes and pregnancy?
How do you treat a healthy older adult?
Life style! Except do NOT do a low carb diet.
insulin is necessary, during 1st trimester it’s low but 2 and 3 it’s high.
A1C<7.5, 90-130 fasting, 90-150 bedtime.
How do you treat a complex/intermediate?
How do you treat a very complex?
What immunizations do you recommend for diabetic patients?
<8.0, 90-150, 100-180.
<8.5, 100-180, 110-200.
Influenza, Pneumovax, Prevnar, Hepatitis B.
