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Diabetes Flashcards

1
Q

Criteria for Prediabetes

A
  • A1C 5.7-6.4
  • FBG 100-125
  • OGTT 2-hr BG 140-199
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2
Q

Criteria for Diabetes

A
  • A1C >= 6.5
  • FBG >= 126
  • OGTT 2-hr BG >= 200
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3
Q

Non-Preggo Diabetic Targets

A
  • A1C < 7
  • Preprandial BG 80-130
  • 2-hr PPG < 180
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4
Q

Preggo Diabetic Targets

A

-Preprandial BG =<95
-1-hr PPG =< 140
-2-hr PPG =< 120
(A1C inaccurate during pregnancy)

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5
Q

Estimated Average Glucose

A
  • Based on A1C
  • 6% A1C = 126 eAG
  • Each 1% increase ~ 28 increase in eAG
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6
Q

Microvascular Diabetes Complications

A
  • Retinopathy
  • Diabetic Kidney Disease
  • Peripheral neuropathy
  • Autonomic neuropathy (ED, loss of bladder control, etc.)
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7
Q

Macrovascular Diabetes Complications

A

-CAD, including MI
-CVA, including stroke
-PAD
(same as ASCVD)

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8
Q

Best Drug Class for Diabetes + ASCVD

A
  • GLP-1a

- SGLT2i with benefit

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9
Q

Best Drug Class for HF

A

SGLT2i with benefit

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10
Q

Best Drug Class for CKD

A
  • SGLT2i (preferred for albuminuria)

- GLP-1a with benefit

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11
Q

Best Drug Classes for Hypoglycemic Risk

A
  • DPP4i
  • GLP-1a
  • SGLT2i
  • TZD
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12
Q

Best Drug Classes for Weight Loss

A
  • GLP-1a

- SGLT2i

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13
Q

Best Drug Classes for Cost Concerns

A
  • Sulfonylureas

- TZD

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14
Q

Glucophage

A
  • Metfomin (Also Fortamet or Glumetza)
  • Biguanide
  • Start at 500 mg and titrate up weekly to maintenance dose (usually 1000 mg/d)
  • Max dose: 2000-2500 mg/d
  • Give with meal to reduce GI upset
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15
Q

Biguanide Information

A
  • Mechanism: Decreases hepatic glucose production and intestinal glucose absorption, increases insulin sensitivity
  • Warning: Lactic Acidosis; increased risk w/ renal impairment, contrast dye, and excessive alcohol
  • CI: eGFR < 30, metabolic acidosis
  • Warning: Don’t start if eGFR is 30-45, can cause vit. B12 deficiency
  • SE: Diarrhea, nausea
  • Drops A1C 1-2%, weight neutral, no hypoglycemia
  • ER: swallow whole, ghost tablet
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16
Q

Invokana

A
  • Canagliflozin
  • SGLT2i
  • Shown reduction in HF & CKD progression
  • Increases risk of leg/foot amputations, hyperkalemia, and fractures
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17
Q

Farxiga

A
  • Dapagliflozin
  • SGLT2i
  • CI if eGFR < 30
  • Shown reduction in HF & CKD progression
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18
Q

Jardiance

A
  • Empagliflozin
  • SGLT2i
  • CI if eGFR < 30
  • Shown reduction in HF & CKD progression
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19
Q

SGLT2i Information

A
  • Mechanism: Inhibits SGLT2 in proximal tubules to reduce reabsorption of glucose and increase urinary glucose excretion
  • Warning: Ketoacidosis, genital mycotic infections/urosepsis/pyelonephritis/etc., hypotension, AKI (due to volume depletion)
  • SE: Weight loss, increased urination/thirst
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20
Q

Victoza

A
  • Liraglutide
  • GLP-1a
  • Administered daily (must buy pens needles separately)
  • Demonstrated ASCVD benefit
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21
Q

Saxenda

A
  • Liraglutide
  • GLP-1a
  • For weight loss, not diabetes!
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22
Q

Trulicity

A
  • Dulaglutide
  • GLP-1a
  • Administered weekly
  • Demonstrated ASCVD benefit
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23
Q

Byetta

A
  • Exenatide
  • GLP-1a
  • Administered BID (must buy pens needles separately)
  • Not recommended if CrCl < 30
  • Give within 60 mins of meals
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24
Q

Bydureon (+/- BCise)

A
  • Exenatide ER
  • GLP-1a
  • Administered once weekly
  • Not recommended if CrCl < 30
  • Can cause serious injection site rxns with or without nodules
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25
Adlyxin
- Lixisenatide - GLP-1a - Administered QD (must buy pens needles separately) - Give within 60 minutes of meals
26
Ozempic
- Semaglutide - GLP-1a - Administered once weekly - PO formulation (Rybelsus) given daily - Demonstrated ASCVD benefit
27
GLP-1a Information
- Mechanism: analogs of GLP-1 which increases insulin secretion, decreases glucagon, slows gastric emptying, improves satiety, and can cause weight loss - Boxed Warning: risk for thyroid C-cell carcinomas (Byetta and Adlyxin excluded) - Warning: Pancreatitis, not recommended with severe GI disease/gastroparesis - SE: Weight loss, nausea - Don't use with DPP4i (overlapping mechanism, prevent GLP-1a breakdown)
28
Glucotrol
- Glipizide - Sulfonylurea (insulin secretagogues) - IR: take 30 minutes before a meal - XR: OROS formulation, ghost tablet
29
Amaryl
- Glimepiride - Sulfonylurea (insulin secretagogues) - Beer's criteria (hypoglycemic risk)
30
Glynase
- Glyburide - Sulfonylurea (insulin secretagogues) - Beer's criteria (hypoglycemic risk)
31
Sulfonylurea Information
- Mechanism: stimulate insulin secretion for beta-cells to decrease postprandial BG - CI: Sulfa allergy - Warning: hypoglycemia - SE: Weight gain, nausea - Unless otherwise specified, take with breakfast/first meal of day - May hold doses if NPO - Drops A1C 1-2%
32
Meglinides
- Mechanism: stimulate insulin secretion for beta-cells to decrease postprandial BG - Repaglinide or Nateglinide (Starlix) - Repaglinide: take 15-30 minutes before meals - Nateglinide: Take 1-30 minutes before meals - Warning: hypoglycemia - SE: Weight gain
33
1st Generation Sulfonylureas
- Chlorpropamide - Tolazamide - Tolbutamide - DON'T use due to prolonged hypoglycemia
34
Januvia
- Sitagliptin - DPP4i - Risk of HF
35
Tradjenta
- Linagliptin - DPP4i - No renal adjustments necessary
36
DPP4i Information
- Mechanism: Prevents breakdown of incretin hormons like GLP-1 and GIP; increases insulin release and decreases glucagon secretion - Warning: Pancreatitis, arthralgia, renal failure, risk of HF - DON'T use with GLP-1a
37
Actos
- Pioglitazone - TZD - Increased risk of bladder cancer (don't use in patients with bladder cancer hx)
38
Avandia
- Rosiglitazone | - TZD
39
Thiazolidinediones
- Mechanism: PPARy-agonists that increase peripheral insulin sensitivity - Box Warning: Can exacerbate HF; don't use with NYHA III/IV HF - Warning: hepatic failure, edema (macular), risk of fractures - SE: Peripheral edema, weight gain
40
Alpha-Glucosidase Inhibitors
- Acarbose or Miglitol - MUST treat with glucose tablets/gel (not sucrose) if hypoglycemia is occuring - Each dose should be taken with first bite of meal - SE: flatulence, diarrhea, abdominal pain
41
Bile Acid Binding Resins
- Colesevelam (Welchol) | - Constipation is most common SE
42
Amylin Analog
- Pramlintide (Symlin) - SQ injection - MOA: helps PPG control by slowing gastric emptying which decreases glucagon - Administered prior to each meal - CI: gastroparesis - Significant hypoglycemic risk, reduce mealtime insulin by 50% when starting - SE: Nausea, weight loss
43
Actoplus Met
Metformin + Pioglitazone
44
Janumet
Metformin + Sitagliptin
45
Invokanamet
Metformin + Canagliflozin
46
Rapid-Acting Insulin
- Aspart (Novolog) - Lispro (Humalog) - Clear and colorless - Given SQ 5-15 min before meals - Stable 28d room temp
47
Short-Acting Insulin
- Regular (Humulin - normal or concentrated option; 500 u/mL or Novolin R) - Clear and colorless - OTC or Rx - Preferred for IV infusions, non-PVC container - Inject SQ 30 minutes before meals - Stable 28d room temp EXCEPT U-100 Humulin - stable 31d room temp
48
Intermediate-Acting Insulin
- NPH (Humulin - stable 14d room temp or Novolin N - stable 28d room temp) - Cloudy - OTC or Rx - Basal insulin, given BID - More hypoglycemia, more affordable
49
Long-Acting Insulin
- Detemir (Levemir) - stable 42d room temp - Glargine (Lantus or Toujeo, concentrated 300 u/mL) - Lantus: stable 28d room temp - Toujeo: stable 56d room temp - Clear and colorless - Given once daily - Don't mix with other insulins
50
Ultra-Long Acting Insulin
- Degludec (Tresiba) - stable 56d room temp | - 100 or 200 u/mL options
51
Premixed Insulins
- 70/30: 70% NPH and 30% regular; Humulin (stable 10d room temp) or Novolin 70/30 (stable 14d room temp) - Rx or OTC - Also 75/25 and 50/50 mixes made with lispro protamine and lispro (stable 10d room temp) - If contain rapid-acting: give 15 minutes before meal - If contain regular insulin: give 30 minutes before meal
52
Initiating Basal-Bolus Insulin Regimen
1. Calculate TDD (0.5 u/kg/d, using TBW) 2. Divide TDD by 50% - 50% basal and other 50% rapid 3. Divide rapid-bolus units by three for meals (can allocate for larger/smaller meals too)
53
Initiating NPH-Regular Insulin Regimen
- NOT preferred - Lower cost and less injections overall though - Same TDD calculation but 2/3 is NPH and 1/3 is regular
54
ICR for Regular Insulin
- Rule of 450 | - 450/TDD = grams of carbs covered by 1u of regular insulin
55
ICR for Rapid-acting Insulin
- Rule of 500 | - 500/TDD = grams of carbs covered by 1u of rapid-acting insulin
56
CF for Regular Insulin
- 1500 Rule | - 1500/TDD = CF for 1 unit of regular insulin
57
CF for Rapid-Acting Insulin
- 1800 Rule | - 1800/TDD = CF for 1 unit of rapid-acting insulin
58
BID NPH => QD Glargine
- Exception to 1:1 Dosing Conversion | - 80% of NPH TDD => Glargine once daily dose
59
Toujeo => Insulin Glargine or Determir
- Exception to 1:1 Dosing Conversion | - 80% of Toujeo dose for insulin glargine or detemir
60
Drugs that Increase BG
- B-blockers - Thiazide and Loop diuretics - Tacrolimus and cyclosporine - PI - Quinolones - antipsychotics - Statins - Steroids (systemic) - Cough syrups - Niacin
61
Drugs that Decrease BG
- B-blockers - Quinolones - Tramadol
62
If cancer present, avoid...
- Pioglitazone (bladder) | - GLP-1a (thyroid, medullary thyroid carcinoma)
63
If gastroparesis/GI disorders present, avoid...
- GLP-1a | - Pramlintide
64
If genital infections/UTI present, avoid...
-SGLT2i
65
If HF present, avoid...
- TZDs - Alogliptin - Saxagliptin
66
If hepatotoxicity present, avoid...
- TZDs | - Alogliptin
67
If hypoglycemia present, avoid...
- Sulfonylureas - Meglitinides - Insulin - Pramlintide
68
If hypokalemia present, avoid...
-Insulin
69
If Ketoacidosis present, avoid...
- SGLT2i (D/C prior to surgery to reduce risk) | - Increased risk with renal impairment, dehydration, acute illness
70
If lactic acidosis present, avoid...
- Metformin | - Increased risk with renal impairment, alcoholism, hypoxia
71
If osteopenia/osteoporosis present, avoid...
- Canagliflozin (Decreases BMD, fracture risk) | - TZDs (Fracture risk)
72
If pancreatitis present, avoid...
- GLP-1a | - DPP4i
73
If peripheral neuropathy, foot ulcers, or PAD are present, avoid...
-Canagliflozin
74
If severe sulfa allergy is present, avoid...
-Sulfonylureas (or use cautiously)
75
If renal insufficiency (CrCl/eGFR < 30) is present, avoid...
- Metformin - SGLT2i - Exenatide - Glyburide - May need to start insulin at a lower dose
76
If weight gain/obesity is present, avoid...
- Sulfonylureas - TZDs - Meglitinides - Insulin

NAPLEX (59 decks)

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