Diabetes

Question 1

What is a rule of thumb of how to calculate fasting blood glucose levels from A1c?

Answer 1

A1c of about 7% is approximately 150, every percent above that is an additional 30 mg/dL
Example A1c of 9% would have average of fasting blood glucose of 150 + 30(9-7)= ~210 mg/dL

Question 2

What’s is the ADA diagnostic level of diabetes?

Answer 2

A1c >=6.5%
8-hr FBG >= 125 mg/dL or
2 hr plasma glucose >= 200 mg/dL or
Random plasma glucose >=200 mg/dL with classic symptoms of hyperglycemia

Question 3

Which CGMs does Medicare cover?

Answer 3

Dexcom and Freestyle libre 2

Question 4

Most diabetes therapies can be combined with the exception of which combos?

Answer 4

GLP-1 RAs and DPP4-i due to similar mechanism of action, not likely to have any added benefit
SUs and insulin, inc risk of hypoglycemia

Question 5

What are some considerations for Metformin?

Answer 5

GI side effects, possible weight loss, and potential for B12 deficiency
*potential for benefit in ASCVD

Question 6

What is the biggest side effect of GLP-1?

Answer 6

Most patients say nausea but it is supposed to be resolved with continuous use

Question 7

T/F: Per ADA patient at A1c goal with established high risk ASCVD risk MUST be treated with either GLP-1 or SGLT2 with proven CVD benefits.

Answer 7

True.

Question 8

What are the GLP-1 RA medications for diabetes? Which have CVD benefits?

Answer 8

Byetta, bydureon (Exenatide): BID, Qweek
Victoza (liraglutide): QD
Trulicity (dulaglutide): Qweek
Adlyxin (Lisixenatide): QD
Ozempic (Semaglutide): Qweek
Rybelsus (Semaglutide): Oral QD

*All have CVD benefits except oral semaglutide, lisixenatide and exenatide

Question 9

Which medications can exacerbate diabetes?

Answer 9

Corticosteroids
Antipsychotics
Thiazides
Cyclosporine, tacrolimus

Question 10

What is a good starting dose of insulin for type 1 Diabetics?

Answer 10

Can vary but 0.5-1 unit/kg in divided doses
Insulin requirements are usually less in type 1 than in type 2

Question 11

What medications do guidelines recommend for DM2?

Answer 11

Moderate to high intensity statin as indicated
Goal of 130/80
ACE/ARB first line for HTN, amlodipine second
ASA 81 mg

Question 12

What is a GIP/GLP-1 agonist?

Answer 12

Mounjaro, tirzepatide

Question 13

What are some GLP-1/ insulin glargine medications?

Answer 13

Lixisenatide/glargine (Soliqua)

Liraglutide/degludec Xytolphy)

Question 14

What happens when someone has a scab and they scratch it off

Answer 14

They can get a scar