Diabetes Flashcards
Which lab tells you if you have T1DM
C-peptide low or absent
examples of microvascular complications from hyperglycemia
retinopathy, nephropathy, neuropathy
examples of macrovascular complications from hyperglycemia
atheroschlerosis –> ASCVD
at what age should people be screened regardless of risk factors
45 years old
A1c to bg equivilence
6% = 126 mg/dL and each 1% increases by 28 mg/dL
diabetes vaccines
hep b, prevnar 13 and pneumococcal
Which diabetes drugs have best evidence for weight loss
SGLT2, GLP1 (semaglutide, liraglutide, dulaglutide)
which diabetes drugs do not cause hypoglycemia
DPP4, GLP-1, SGLT2, Thiazolidenediones
which class drugs do you use if ASCVD is major issue
GLP 1 (semaglutide, liraglutide, dulaglutide) or SGLT2 (empaglifozin, canaglifozen) if GFR < 30
which class to use 1st if CKD or HF is major issue
SGLT2
what is the a1c and BG cutoff for severe hyperglycemia
> 300 or aic >10
what dose to start bedtime insulin
0.1-0.2 units/kg/day (TBW)
Actoplus Met
Metformin/pioglitazone (tzd)
Janumet
Metformin/Stigaliptin (DPP4)
Invokamet
Metformin/canaglifozin (SGLT2)
fortamet, glucophage, glumteza
metformin names
metformin moa
decrease hepatic glucose output
metformin warnings
may cause B12 deficiency, do not start with GFR less than 30, stop prior to iodated contrast media
actos
pioglitazone
avandia
rosiglitazone
moa of thiaglitazones
increase muscle sensitivity to insulin to increase BG entry
pioglitazone and rosalitazone are what drug class
thiazolidinediones
glycemia/weight effects of thiazolidinediones
not known for hypoglycemia by itself but may enhance effect of insulin. May cause weight gain
thiazolidinedione side effects, warnings, and boxed warning
S/E: edema, bone fractures
Warnings: Hepatic failure, can simulate ovulation, bladder cancer
Boxed warning: Do not use in HF
Canaglifozen, empaglifozen
SGLT2 inhibitors
Invokana
Canaglifozen
Jardiance
Empaglifozen
Sitagliptin, Linagliptin
DPP-4 inhibitors
MOA of SGLT2
increase BG renal excretion (pee out glucose)
MOA of DPP4
increase incretin
Januvia
Sitagliptin
Tradjenta
Linagliptin
Glucotrol
Glipizide
Amaryl
Glimepiride
Glynase
Glyburide
MOA of Sulfonylureas
increase insulin secretion
Hypoglycemia/weight loss of SGLT2
Hypoglycemia in combo with insulin and may cause weight loss
warnings, and side effects of SGLT2
Warning: UTI, genital fungal infection
Warning: Increase LDL, hyperkalemia, fluid loss, hypotension, ketoacidosis
boxed warning canaglifozn
amputations
hypoglycemia and weight loss of DPP4
No hypoglycemia by itself but maybe with insulin, no weight change
which two classes should not be used together (x2)
DPP4 and GLP 1 because both insulin increetin
Meglinitides and sulfonylureas because both insulin secretaloges
dpp4 warnings
pancreatitis, arthralgia, renal failure, saxagliptin/alogliptin do not use with HF, alogliptin hepatotoxicity
sulfonylurea hypoglycemia and weight effects
may cause hypoglycemia, may cause weight gain
contraindacations sulfonylureas
sulfa allergy, BEERS elderly
meglinitide hypoglycemia and weight effects
may cause hypoglycemia and weight gain
GLP 1 receptor agonist moa
increase incretin
warning GLP-1
pancreatitis
hypoglycemia and weight effects of GLP1
no hypoglycemia, weight loss
what is the effect of pramilitide and what is it
a synthetic analog of amylin and can cause gastroparesis, n/w/anorexia, headache and severe hypoglycemia
colveselam effects and moa
welchol, a bile acid binding resin, may decrease the absorption of fat soluble vitamins, may cause constipation and increase TG and should not be used in pancreatitis
Which diabtetes drug classes can cause weight loss
GLP-1, SGLT-2
which diabetes drug classes can cause weight gain
thiazolidinediones, sulfonulureas, meglinitides
which diabetes drugs are weight neutral
DPP-4, metformin
which diabetes drugs can cause hypoglycemia by themselves
sulfonylureas, meglinitides, pramlinitide
A1c, FPG and PPG goal in diabetes
Aic less than 6.5, ppg less than 126, ppg less than 200
rapid acting insulins
aspart (novolog), lispro (humalog)
short acting insulin
regular (humulin R, novolin R)
intermediate acting
NPH (humulin N, Novalin N) *cloudy
long acting basal insulin
insulin detemir (levemir) insulin glargine (lantus, toujeo)
insulin mix ratios
70/30 (humulin and novolon), 75/25, 50/50
dka cutoff
BG > 250
how to calculate TDD for insulin
0.5 units/kg/day and then seperate into 50% basal and 50% bolus
Exceptions to insulin 1:1 conversion
1) NPH (2x) to glargine (1x) - Use 80% of TDD NPH
2) Toujeo (glargine, 1x) to lantus (detemir) or basaglar (glargine, 1x) - Use 80% of TDD
* basically from glargine to glargine……
ratio Rule for rapid acting insulin, correction factor for rapid acting
ICR 500
Correction: 1800
ratio rule for regular insulin
ICR: 450
Correction: 1500
Correction dose equation
(blood glucose now - target)/correction dose
Calculating ICR is for what type of insulin
Mealtime so Regular and rapid acting
hum = eli lili insulin = how long stability
usually 1 month except for the concentrated insulin (humulin U500 - 40) and the pens
nov = novo norodisk insulin = how long stability
rapid acting (novolog) - 28 days
short acting/others (i.e. detemir, novolin R/N) - usually 42 days
ultra long acting (tresiba) - 56 days
sanofi rapid actng (aspidra, lispro) or basal (lantus, toijeo)
usually 28 or double that 56 (for toujeo)
drugs that can raise BG
BB, diuretics, tacrolimus, cyclospirine, PI, Quinolones, antipsycphotics, statins, steroids, cough syrups, niacin
drugs that can lower BG
linezolid, lorcaserin, pentamidine, beta blockers, quioolones, tramadol
tx for dka and hhs
fluids (NS) for dehydration, regular insulin IV, prevent hypokalemia so give K+, treat acedosis if pH <6.9
