Diabetes Flashcards
1
Q
Which are the loose guidelines?
A
ADA
2
Q
Which are the strict guidelines?
A
AACE
3
Q
What is ADA A1C goal?
A
<7%
4
Q
What is ADA pre-prandial goal?
A
80-130 mg/dL
5
Q
What is ADA post prandial goal?
A
<180 mg/dL
6
Q
What is AACE A1C goal?
A
<6.5%
7
Q
What is AACE pre-prandial goal?
A
<110 mg/dL
8
Q
What is AACE post-prandial goal?
A
<140 mg/dL
9
Q
When would you use a strict goal?
A
patient <65 and without clinical ASCVD
10
Q
When would you use a loose goal?
A
patient ≥65 OR <65 with clinical ASCVD
11
Q
SGLT2s with ASCVD benefit
A
canagliflozin
empagliflozin
12
Q
SGLT2s with CHF benefit
A
canagliflozin
empagliflozin
dapagliflozin
13
Q
SGLT2s with CKD benefit
A
canagliflozin
empagliflozin
dapagliflozin
14
Q
GLP-1 with ASCVD benefit
A
dulaglutide
liraglutide
semaglutide
15
Q
TZDs with ASCVD benefit
A
pioglitazone
16
Q
68 y/o with T2DM with ASCVD risk of 40% should be started on…
A
Metformin
GLP-1 or SGLT2
17
Q
68 y/o T2DM with HF should be started on…
A
Metformin
SGLT2
18
Q
68 y/o T2DM with CKD should be started on…
A
Metformin
SGLT2 (or GLP-1 if needed)
19
Q
68 y/o T2DM needing to lose weight should be started on…
A
Metformin
GLP-1 or SGLT2
20
Q
68 y/o T2DM needing to minimize hypoglycemia should be started on…
A
Metformin
DPP-4i, GLP-1, SGLT2, TZD
21
Q
68 y/o T2DM worried about cost should be started on…
A
Metformin
SU or TZD
22
Q
68 y/o T2DM starting on insulin should get…
A
Basal insulin
10 units or 0.1-0.2 units/kg/day
23
Q
68 y/o T2DM started on 10 unit basal insulin and should be titrated…
A
2 units every 3 days
24
Q
68 y/o T2DM started on 10 unit basal insulin and is now hypoglycemic, we should…
A
decrease by 10-20% (aka 1-2 units)
25
68 y/o T2DM started on basal insulin of 20 units and now needs prandial insulin, we should give...
4 units or 10% of basal (aka 2 units) with the largest meal
26
68 y/o T2DM started on basal insulin of 20 units and prandial insulin of 4 units and still needs additional blood glucose lowering we should...
stepwise addition of prandial insulin, add one meal on at a time
27
42 y/o T2DM with no clinical ASCVD with an A1C <7.5% should get...
Mono therapy - Metformin
28
42 y/o T2DM with no clinical ASCVD with an A1C ≥7.5-9% should get...
Dual or Triple Therapy
| Metformin, GLP-1, SGLT2
29
42 y/o T2DM with no clinical ASCVD with an A1C >9% with no symptoms should get..
Dual or Triple Therapy
| Metformin, GLP-1, SGLT2
30
42 y/o T2DM with no clinical ASCVD with an A1C >9% with symptoms should get...
Insulin and other agent
31
42 y/o T2DM with no clinical ASCVD with an A1C >8% starting basal insulin should get...
0.2-0.3 units/kg
32
42 y/o T2DM with no clinical ASCVD with an A1C <8% starting basal insulin should get...
0.1-0.2 units/kg
33
42 y/o T2DM with no clinical ASCVD already on 20 units of basal insulin needs to be started on prandial insulin, what could we give him...
10% of basal dose at the largest meal (aka give 2 units at lunch)
34
42 y/o T2DM with no clinical ASCVD needs to be started on basal and prandial insulin, what could we give him...
Begin prandial insulin before each meal
0.3 - 0.5 units/kg
50% basal / 50% prandial
35
Hypoglycemia is a glucose
<70 mg/dL
36
Hypoglycemia treatment
Check BG to confirm
Eat 15g of carb
Wait 15 minutes then re-check
Follow up with substantial snack
37
Severe Hypoglycemia treatment
Glucagon
| AEs N/V
38
Hyperglycemia Signs
BG > 250
| Polyuria, Nocturia, Polyphagia
39
Microvascular Diabetic Complications
Retinopathy, Nephropathy, Neuropathy
40
Macrovascular Diabetic Complication
Cerebrovascular Disease, Heart Disease, Peripheral Vascular Disease
41
ADA blood pressure treatment
no preference unless albuminuria is present (then ACE/ARB)
42
AAC blood pressure treatment
drug of choice ACE/ARB
43
ADA ASA primary prevention
for patients with high CVD risk
44
AACE ASA primary prevention
when ASCVD risk score >10%
45
ADA ASA secondary prevention
everyone gets it
46
AACE ASA secondary prevention
everyone gets it
47
AACE guidelines say you are a candidate for obesity meds at BMI of...
≥27
48
AACE guidelines say you are a candidate for bariatric surgery at BMI of...
≥35
49
Immunizations diabetics should receive
Influenza
Pneumococcus
Hepatitis B
50
DCCT Trial said...
T1DM tight glucose control = less micro and macro
51
UKPDS Trial said...
T2DM tight glucose control = less micro and macro
52
Advance Trial said...
micro and macro will be decreased in T2DM with intensive therapy
53
Accord Trial said..
intense glucose control with ASCVD patients already isn't great
54
Hospital Diabetic A1C
>6.5%
55
Hospital hypoglycemia
<70
56
Hospital hyperglycemia
>140
57
Hospital severe hypoglycemia
<40
58
Fasting blood glucose goal in hospital
<140
59
Random blood glucose goal in hospital
<180
60
Modify therapy in hospital when blood glucose is...
<100
61
T1DM insulin dosing inpatient
0.2-0.4 units/kg/day
50% as basal
50% as nutritional (divided into 3)
Use correctional for values above goal
62
T2DM insulin dosing inpatient
Insulin naive - 0.3-0.5 units/kg
50% as basal
50% as nutritional (divided into 3)
Use correctional for values above goal
If take insulin at home decrease by 20-25% when inpatient
63
DKA onset
hours to days
64
DKA glucose
> 250
65
DKA acidosis
< 7.3
66
DKA anion gap
> 12
67
DKA ketones
positive
68
DKA serum osmolality
<320
69
HHS onset
several days to weeks
70
HHS glucose
> 600
71
HHS acidosis
normal
72
HHS anion gap
variable
73
HHS ketones
negative
74
HHS serum osmolality
> 320
75
Main therapies in treatment of DKA and HHS
Fluids
Insulin
Potassium
Sodium Bicarbonate
76
Sulfonylureas MOA
Stimulate insulin release from Beta cells
77
Sulfonylurea drugs
Glyburide
Glipizide
Glimepiride
78
Glyburide dose
1.25-20mg PO
Glynase or glynase prestab
Can't use CrCl<50
79
Glipizide dose
IR: 2.5-20 PO QD-BID
XL: 5-10 PO QD
80
Glimepiride dose
1-4 PO
81
Beer's List Sulfonylureas
Glyburide and Glimepiride
82
Sulfonylurea AEs
N/V, weight gain
83
Sulfonylurea counseling points
Take first thing in the morning
Take with food
Avoid alcohol
Ask about hypo and weight gain
84
Sulfonylurea CV effects?
None
85
Sulfonylurea HF effects?
None
86
Meglitinides MOA
Stimulate insulin release from beta cells, short acting
87
Meglitinide drugs
Repaglinide (Prandin)
| Natglinide (Starlix)
88
Repaglinide brand name
Prandin
89
Nateglinide brand name
Starlix
90
Nateglinide dose
60-120 mg PO before meals
91
Repaglinide dose
0.5-2 mg PO before meals
92
Repaglinide drug interactions
NPH insulin - can cause MI
Gemfibrozil
Mifepristone
93
Nateglinide drug interactions
Mifepristone
| Pazopanib
94
Meglitinides precautions in
renal or impaired liver
95
Meglitinides counseling points
Skip meal, skip the dose
Avoid alcohol
ask about hypo and weight gain
96
Meglitinides ASCVD benefit?
none
97
Meglitinides HF benefit?
none
98
Meglitinides CKD benefit?
none
99
Biguanides MOA
Primary: decrease glucose output from the liver (hepatic glucose production)
Secondary: increase peripheral muscle glucose sensitivity (glucose uptake and utilization)
100
Target Metformin dose
2,000 mg QD
101
Metformin renal considerations
d/c with eGFR≤30
102
Metformin AEs
N/V/d
103
Metformin ASCVD benefit?
maybe
104
Metformin HF benefit?
none
105
Metformin CKD benefit?
none
106
Metformin monitoring
renal function
107
Thiazolidinediones (TZDs) MOA
Primary: increase peripheral muscle glucose sensitivity (glucose uptake and utilization)
Secondary: decrease glucose output from the liver (hepatic glucose output)
108
TZD drugs
Rosiglitazone (Avandia)
| Pioglitazone (Actos)
109
Rosiglitazone brand name
Avandia
110
Pioglitazone brand name
Actos
111
Rosiglitazone dose
4-8mg PO
112
Pioglitazone dose
15-30mg PO
113
TZD AEs
Edema (worsen CHF), weight gain
114
Pioglitazone drug interactions
oral contraceptives
115
Rosiglitazone drug interactions
insulin, nitrates
116
TZD Black box warning
can exacerbate CHF, MI (rosiglitazone)
117
TZD counseling
Take once a day at the same time each day
118
TZD ASCVD benefit?
maybe (pio)
119
TZD HF benefit?
increased RISK
120
TZD CKD benefit?
none
121
Alpha Glucosidase Inhibitors (AGI) MOA
decrease breakdown of sucrose and complex carbs in brush border of the small intenstine
122
AGI drugs
Acarbose (Precose)
| Miglitol (Glyset)
123
Acarbose brand name
Precose
124
Miglitol brand name
Glyset
125
Acarbose dosing
25mg PO TID
126
Miglitol dosing
25mg PO TID
127
AGI Contraindications
bowel stuff (IBS, crohn's, colonic ulceration)
128
AGI counseling points
Take with the first bite of each meal
| Skip meal skip dose
129
AGI ASCVD benefit?
none
130
AGI HF benefit?
none
131
AGI CKD benefit?
none
132
Gliptins/DPP4-i MOA
potentiate the effects of incretin hormones (which are involved inn physiologic regulation of glucose homeostasis)
suppresses glucagon secrertion, slow gastric emptying , reduces food intake, promotes beta cell proliferation
133
DPP4-i drugs
Januvia (Sitagliptin)
Tradjenta (Linagliptin)
Onglyza (Saxagliptin)
Nesin (Alogliptin)
134
Sitagliptin dose
100mg QD
| use less with worsening renal function
135
Saxagliptin dose
5mg QD
| use less with worsening renal function
136
Alogliptin dose
25mg Qd
| use less with worsening renal function
137
Linagliptin dose
5mg QD
| no renal adjustment
138
Gliptins AEs
nasopharyngitis, URI
139
Gliptins precautionns
impaired renal. hx of pancreatitis, heart failure, use with GLP-1
140
Gliptins ASCVD benefit?
none
141
Gliptins HF benefit?
potential RISK (sax & alo)
142
Gliptins CKD benefit?
nonne
143
SGLT-2i MOA
inhibit SGLT2, reabsorption of filtered glucose is reduced and the renal threshold for glucose is lowered --> increase sugar in pee
144
SGLT2-i drugs
Invokana (canagliflozin)
Farxiga (dapagliflozin)
Jardiance (emagliflozin)
Steglatro (ertugliflozinn)
145
SGLT2-i renal consideration
contraindicated in eGFR<30
146
Canagliflozin dose
100-300 QD
147
Dapagliflozin dose
5-10 QD
148
Empagliflozin dose
10-25 QD
149
Ertugliflozin dose
5-15 QD
150
SGLT2-i AEs
UTIs, mycotic infections
151
SGLT2-i counseling points
take in the morning
| wipe good
152
SGLT2i ASCVD benefit?
yes
153
SGLT2i HF benefit?
yes
154
SGLT2i CKD benefit?
yes
155
bone fractures seen in
TZD and SGLT2i
156
GLP-1 MOA
slows gastric emptying, promotes beta cell proliferation
157
GLP-1 Contraindications
Thyroid C-cell tumor
Severe GI disease
Pancreatitis
CrCl < 30
158
GLP-1 counseling points
avoid large meals
store in fridge
timing of doses (30 mins before first meal)
take with little water
159
GLP-1 drugs
```
liraglutide
semaglutide
dulaglutide
exenatide
lixisenatide
```
160
GLP-1 ASCCVD benefit?
yes
161
GLP-1 HF benefit?
none
162
GLP-1 CKD benefit?
yes (lira, dula)
163
Ultra rapid acting insulins
```
insulin aspart (Fiasp)
insulin lispro-aabc (Lyumjev)
```
164
rapid acting insulins
insulin lispro, aspart, glulisine (humalog, novolog, apidra)
165
short acting insulins
regular insulin (humulin, novolin)
166
intermediate acting insulin
nph (humulin-nph, novolin-nph)
167
long acting insulins
insulin glargine, detemir, degludec (Lantus, Toujeo, Basaglar, Levemir, Tresiba)
168
Ultra rapid insulin info
can be used in SQ pumps
do not give IV
can be mixed with NPH
169
rapid acting insulin info
can be used in SQ pumps
do not give IV
can be mixed with NPH
eat within 15 min of injection
170
regular insulin info
can be given in SQ pumps
can be given IV
171
NPH insulin info
frosting = loss of potency
| can mix with regular, aspart, lispro, glulisine
172
Long acting insulin info
do not dilute
| do not mix
173
Fast insulin absorption when you are
hot and hydrated
