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diabetes Flashcards

1
Q

glucagon is produced in

A

alpha cells in the pancrease

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2
Q

insulin is produced in

A

Beta cells in pancrease

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3
Q

ketones

A

glucagon signals fat cells to maek ketonees as an alternative energy source

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4
Q

DKA

A

typically in T1 Diabetes
C peptde level is very low or absent T1D is diagnosed

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5
Q

diabetes in pregnancy

A

before pregnancy
during pregnancy- gestational
- in anycase BG goals are more stringent
can cause fetus to be larger
oral glucose test OGTT at 24-28 weeks

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6
Q

symptoms

A

poly uria
polyphagia (hunger)
polydipsia (THIRST)

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7
Q

Diagnosis

A

HG A1C >6.5 A1C
fasting plasma glucose (8hours or more) >126
OGTT(2 hours after drinking glucose) >200

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8
Q

pregnant diagnosis for Diabetes

A

pre prandial>95. (80-130)
1 hr PPG 140. (-)
2 hour >120. (normal 180)

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9
Q

what are some microvascular complications of diabetes

A

retinopathy
diabetic kidney disease
peripheral neuropathy
autonomic neuropathy

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10
Q

what are some macrovascular disease

A

coronary artery disease (CAD) including MI
Cerebrovascular disease (CVA)
peripheral artery disease (PAD)

*kinda like ASCVD

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11
Q

is aspirin recomended for primary prevention

A

NOPE only secondary prevention
CAD/PAD aspirin + lowdose rivaroxaban
used in pregancy to reduce risk of preeclampsia

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12
Q

statin therapy

A

High if diabetes + ASCVD
age 50-75 with multiple ASCVD

moderate if diabetes with no ASCVD
diabetes +ASCVD

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13
Q

what are some natural products used in T2D

A

cinamon
alpha lipoic acid
chromium
magnesium
ginseng

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14
Q

treatment options

A

metformin- 1st line

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15
Q

when to use 2 drugs

A

A1c 8.5-10
when ASCVD risk

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16
Q

when to use insulin

A

A1C >10 or PPG >300

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17
Q

refer to page 616

A

for Treatment pathway

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18
Q

what is metformin

A

GLucophage
Biguanide that decrease hepatic glucose production, absorption of glucose in the intestines
increase insulin sensitivity
can lower 1-2%
can cause GI effects
should not be used in eGFR<30, metabolic acidosis
max 2000-2550

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19
Q

metformin should be stopped before

A

Dye use
topiramate use can increase risk of metabolic acidosis

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20
Q

what are some SGLT2 inhibitros

A

Canagliflozin invokana
dapagliflozin farxiga
empagliflozin jardiance

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21
Q

does SGLT2 cause weight gain

A

no weight losss

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22
Q

does metformin cause weight gain

A

no weight neutral

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23
Q

does SGLT2 cause hypoglycemia

A

YES

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24
Q

does metfomin cause hypoglycemia

A

nope
VITB12 defeciency

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25
which diabetes med can be used in HF
SGLT2 dapagli canagli empagli
26
what are some risks for sglt2
dialysis can cause hypo <30 should not be used urosepsis hypotension aki ketoacidosis
27
how much Ac1 is reduced by SGLT2
0.7-1%
28
SGLT2 MOA
proximal renal tubules inhibits SGLT reducing reabsorption of glucose and increase urinary glucose excretion
29
GLP 1 agonist MOA
increase insulin secretion decrease glucagon secretion slows gastric emptying improves satiety weight loss
30
what are some GLP1
liraglutide or victoza, saxenda dulaglutide or trulicity semaglutide or OZempic or rybelsus is oral
31
how much A1c lowering by GLP
0.5-1.5
32
what can you not use with GLP and why
DPP4 uses same pathway
33
GLP can increase INR
true
34
weight loss is true for GLP
YES
35
GLP can cause hypoglycemia ?
true
36
sulfonylurea MOA
stimulate insulin secretion
37
what are some clinical pearls of sulfonul ureas
can cause weight gain sulfa allergy take 30 mins before meal
38
what are some sulfonulureas
glipizide or glucotrol glimeperide or amaryl glyburide or glynase
39
how much A1c can be reduced by sulfonulureas
1-2%
40
what is the MOA of meglinitides
same as sulfonylurea
41
what are some meglinitides
repaglinide nateglinide
42
is there weight gain or hypoglycemia risk with meglinitide
YES same as sulfonyl urea
43
what is the MOA of DPP4
prevents enzyme DPP4 from breaking down incretin hormones, GLP1 and GIP indirectly these hormones help to regulate GB levels by increasing insulin release and decreasing glucagon secretion
44
what are some DPP4
sitagliptin januvia linagliptin trajenta saxagliptin Onglyza alogliptin nesina
45
which Dpp 4 does not require renal dose adjustment
Trajenta
46
how much A1c can be lowered by DPP4
0.5-0.8%
47
what are the side effects of DPP4
pancreatitis, severe joint pain, AKI ** do not use with GLP
48
moa of thiazolidinediones
PPARy agonist- peroxisome proliferator-activated receptor gamma agonist increases insulin sensitivity
49
what are some thiazolidinediones
pioglitazone (actos) rosiglitazone -avandia
50
what are some side effects of thiazolidinediones
can cause HF Hepatic failure, edema fractures
51
can thizolidine cause weight gain or hypo glycemia
YES, low risk of hypoglycemia
52
what are some drug classess/ drugs used for T2DM
alpha glucosidae inhibitors bile acid binding resins dopamine agonist amylin analog
53
what are alpha glucosidase and what is the MOA
acarbose, miglitol inhibits the metabolism of intestinal sucrose which delays glucose absorption
54
Bile acid binding resins and what is the MOA
Colesevelam, Welchol can bind and decrease absorption of other drugs
55
Dopamine agonist
Bromocriptine (Cycloset)
56
amylin analog and MOA
Pramlintide- Symlin helps control PPG by slowing gastric emptying which suppresses glucagon secretion and increase satiety
57
what are basal insulin with examples
for fasting glucose with 3-4 hours onset and lasts 24 hours- peakless glargine detemir degludec
58
What are NPH with examples
intermediate with 1-2 hours onset peaks 4-12 hours with unpredictable duration of action Humulin novolin N
59
what is the work of protamine
delay absorption and duration of effects
60
what are rapid acting insulins and examples
bolus insulins with fast onset 15 mins ish aand peaks 1-2 hours with a duration of 3-5 hours
61
regular insulins
onset 30 mins with peak 2 hours and lasts 6-10 hours
62
what are the most important warnings for insulin
hypoglycemia and hypokalemia weight gain lipoatrophy
63
what time should rapid acting injected
5-15 mins before meals
64
how long before a meal should short acting be administered
30 mins before meals
65
which insulin can be found in RX and OTC
short acting regular insulin- humulin R and novolin R NPH- Humulin N and Novolin N pre mixed insulin- humulin 70/30 novolin 70/30
66
what is a long acting insulin
basal- detemir (levemir), glargine (lantus, toujeo, basaglar, senglee)
67
what are some ulta long acting basal insulin
degludec - tresiba
68
why should you not combine thiazolidinediones with insulin
Heart failure risk
69
why should insulin with sulfonylurea or meglinitide be avoided
hypoglycemia also monitor with GLP, DPP4 SGLT2
70
how to initiate insulin in T2DM
A1C >10% or PPBG>300 sign of DKA add basal 10 units/ 0.1-0.2 units /kg/ day \ add 4 units or 10% of basal dose
71
how to initaite insulin in T1DM
rapid and long acting are preferred 0.5units/kg/day use TBW 50% basal 50% PPG (this divided by 3 since with meal if NPH then 2/3 NPH and 1/3 regular
72
how to use insulin pumps
continuous dose bolus dose- insulin to carbohydrate ratio
73
what is the insulin to carbohydrate ratio
grams of carbohydrate covered by 1 unit of insulin
74
what rule is used for regular insulin
rule of 450
75
what rule is used for rapid acting insulin
rule of 500
76
what is the ICR formula
grams of carbs covered by 1 unit of insulin =450 or 500/ TDD
77
correction dose
1. calculate correction factor to find out how much BG will be lowered by 1 unit of insulin 2. total insulin needed to return the BG to target. BG now - target BG / Correction factor
78
correction factor for regular
1500/TDD= correction factor for 1 unit of insulin
79
correction factor for Rapid acting
1800/ TDD = correction factor for 1 unit of Rapid acting insulin
80
NPH to basal conversion
use 80% of NPH
81
toujeo to glargine
80% of toujeo
82
which insulins are good for 10 days
humalog 50/50 and 75/25 pens humulin 70/30
83
which insulins are good for 14 days or 2 weeks
humulin N pen novolog mix 70/30 pen
84
which insulin is good for 31 days
Humulin R vials humulin N 70/30 vials
85
which insulin good for 40 days
Humulin R 500 vial
86
which humulin good for 42 days
levemir vial and pen Novolin R and N 70/30 vials
87
which insulin good for 56 days
Tresiba Toujeo
88
the higher the gauge the ___ the needle
thinner
89
thinnest gauge size
32G 28 is thickest
90
which size syringe requires pinching
4mm and 5mm do not require pinching
91
insulin injection counselling
get supplies wash hands NPH or protamine suspensions need to swirled or rolled if pens invert up and down 4-5 times clean injection site use new needle for every application prime the needle 2 units turn the dosing to the required dosing use clear insulin first if mixing NPH in a vial best application site is the abdomen needles more than 5mm gently pinch a 2 inch insert needle straight down at 90 degrees or 45 if thin pt press injection down and count 5-10 seconds rotate injections ite properly dispose needles
92
what is hypoglycemia
<70
93
symptoms of hypo
dizziness, sweating hunger confusion nausia
94
severe hypo symptoms
seizure coma death
95
how to tx hypo
rule of 15 15-20g of glucose recheck after 15 mins repeat 4oz of juice 8oz milk 4oz soda 1 tbsp sugar 3-4 glucose tabs
96
if unconscious how to tx hypo
IV dextrose or glucagon SC nasal glucagon
97
what drugs cause Hypo
insulin sulfonylurea and meglinitide GLP, DPP4 TZD SGLT2 low risk alone BB quinolones can cause both tramadol
98
what drugs can cause Hyperglycemia
BB Quinolones can cause both diuretic tacrolimus, cyclosporine protease inhibitor antipsych statins steroids cough syrups niacin
99
what is diabetic ketoacidosis
DKA- high BG , ketoacidosis and ketonuria BG>250 ketones anion gap acidosis Arterial pH<7.35 anion gap>12
100
hyperosmolar hyperglycemic state HHS
higher mortality rate than DKA primary cause is illness that leads to less fluid intake leads dehydration with altered consciousness confusion, delirium BG>600 high osm >320 extreme dehydration pH>7.3 bicarbonate >15
101
what is the tx for HHS and DKA
fluids first- start with NS, when blood glucose reaches 200mg/dL change to D5W1/2NS regular insulin- 0.1/unit/kg bolus and then 0.1 units/kg/hr or 0.14 units/kg/hr prevent hypokalemia- insulin shifts K into the cells treat acidosis pH <6.9 - give sodium bicarb
102
what is Tx for DKA
fluids start with NS, when blood blucose 200 change to D5W1/2 NS

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