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diabetes Flashcards

1
Q

prediabetes
metformin

A

can be used to help improve BG levels especially if pt w/ a BMI of >=35, <60 years, and women with a history of gestational mellitus

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2
Q

c-peptide test

A

used to determine if the patient is still producing insulin
this is released by the pancreas only when insulin is released
type 1 diabetes is indicated by very low or absent C-peptide level

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3
Q

risk factors

A
  • physical inactivity
  • overweight >25 or >23 in Asian
  • gestational diabetes
  • > A5.7%
  • first-degree relative w/ diabetes
  • HDL <35, TG> 250
  • CVD, hypertension
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4
Q

diagnosis

A
  • hemoglobin A1C: indicates average BG over approximately the past 3 months
  • fasting blood glucose (FPG): gives BG at the moment and is taken after fasting for >=8 hrs
  • OGTT determines how well glucose is tolerated by measuring BG level 2 hrs after drinking liquid that is high in glucose
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5
Q

diabetes diagnosis

A

A1C >= 6.5%
EPG>= 126
OGTT >= 200

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6
Q

prediabetes diagnosis

A

A1C >= 5.7-6.4%
EPG>= 100-125
OGTT >= 140-199

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7
Q

glycemic targets in diabetes
not prego
prego

A

not prego: A1C <7, preprandial 80-130, after meals 2 hours <180

prego: preprandial <=95, after meals 1 hour <=140 and after 2 hours <= 120

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8
Q

testing frequency

A

quarterly if not yet at goal
and biannually every 6 months if at goal

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9
Q

physical activity

A

150 min moderate-intensity per week over at least 3 days
reduce sedentary- stand every 30ming

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10
Q

diabetes complications
microvascular

A

retinopathy, kidney disease, peripheral neuropathy, autonomic neuropathy (gastroparesis, loss of bladder control, and erectile dysfunction)

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11
Q

diabetes complications
macrovascular

A

CAD, CVA, PAD, ASCVD

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12
Q

Natural products

A

cinnamon
alpha lipoic acid
chromium

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13
Q

pt w/ ASCVD, HF or chronic kidney disease

A

regardless of A1C, w/ or w/out metformin
start a GLP-1 or SGLT 2 inhibitors

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14
Q

if baseline A1C is 8.5%-10%

A

start patient on two drugs, metformin + non-insulin drug

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15
Q

insulin can be started if

A

A1C >10% or BG>= 300mg/dL

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16
Q

if injectable medication is preferred

A

GLP1 agonist over insulin is preferred

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17
Q

metformin

A

glucophage, fortamet, glumetza
boxed warning: lactic acidosis- increased renal impairment
contra: GFR <30 and chronic metabolic acidoses don’t start if GFR <45
can cause vitamin b12 deficiency
decrease A1C by 1-2%

  • biguanide
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18
Q

metformin and topiramate

A

increase risk of metabolic acidosis

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19
Q

canagliflozin

A

Inovkana
don’t start if GFR <30 unless albuminuria
increased risk of leg and foot amputations, higher history of PAD, peripheral neuropathy,
risk of fractures and hyper K risk!!
-SGLT2

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20
Q

dapagliflozin

A

farxiga
do not start if GFR < 25, or even 24-45 rang…
-SGLT2

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21
Q

empagliflozin

A

jardiance
do not start if GFR <30
-SGLT2

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22
Q

-SGLT2 general info
safety/SE/monitoring

A

contra in dialysis
warning:
- ketoacidosis can occur so D/C prior to surgery
- genital mycotic infection, urosepsis, pyelonephritis, necrotizing fasciitis
- hypotension and AKI (due to volume depletion)

shown reduction in HF, CKD, and ASCVD

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23
Q

liraglutide

A

victoza
saxenda- for weight loss
daily dosing
- shown ASCVD benefit

  • GLP-1 agonist
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24
Q

dulaglutide

A

trulicity
weekly dosing
- shown ASCVD benefit

  • GLP-1 agonist
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25
Exenatide
Byetta BID dosing (give 60 min of meals) do not start CrCl <30 - GLP-1 agonist
26
Exenatide ER
bydureon weekly dosing do not start eGFR <45 - serious injection-site reactions (abscess, cellulitis, necrosis)! - GLP-1 agonist
27
lixisenatide
adlyxin daily dosing not recommended if eGFR< 15 - GLP-1 agonist
28
semaglutide
ozempic- sc - weekly rybelsus- oral - daily wegovy- for weight loss - increased complications w/ diabetic retinopathy - shown ASCVD benefit - GLP-1 agonist
29
- GLP-1 agonist general info Safety/ SE/ monitoring
- all (except Byetta and Adlyxin): risk of thyroid C-cell carcinomas - warning: pancreatitis, not recommended in pt w/ severe GI disease - SE: weight loss, nausea Notes - DO NOT use w/ DPP-4 inhibitors - byetta and adlyxin within 60 min of meal - pen needles are not provided with byetta, victoza, or adlyxin- provided with all other which are the weekly dose
30
Glipizide
Glucotrol Glucotrol XL- OROS formulation can leave ghost tablets glipizide IR: take 30 min before meals - SU and meglitinides
31
glimepiride
Amaryl not preferred in elderly on beer's criteria - SU and meglitinides
32
glyburide micronized
Glynase not preferred in elderly on beer's criteria - SU and meglitinides
33
- SU Safety/ SE/ monitoring
contra: sulfa allergy warning: hypoglycemia SE: weight gain, nausea decrease A1C by 1-2% pt w/ G6PD deficiency can be increased risk of hemolytic anemia
34
repaglinide
contra w/ gemfibrozil contra: type 1 diabetes, DKA SE: hypo and weight gain, and upper respiratory tract infections - SU and meglitinides
35
nateglinide
contra: type 1 diabetes, DKA SE: hypo and weight gain, and upper respiratory tract infections - SU and meglitinides
36
sitagliptin
Januvia warning: pancreatitis, severe arthralgia (join pain), acute renal failure do not use w/ glp-1 agonsts - DPP4-inhibitor
37
linagliptin
Tradjenta warning: pancreatitis, severe arthralgia (join pain), acute renal failure do not use w/ glp-1 agonsts - DPP4-inhibitor
38
pioglitazone
actos boxed warning: can exacerbate HF, do not use w/ NYHA class III/IV HF warning: edema, risk of fractures hepatic failure, can stimulate ovulation so unpregnant prego SE- weight gain - thiazolidinedione
39
Rosiglitazone
Avandia boxed warning: can exacerbate HF, do not use w/ NYHA class III/IV HF INCREASED RISK OF MI w/ this med!! warning: edema, risk of fractures hepatic failure, can stimulate ovulation so unpregnant prego SE- weight gain - thiazolidinedione
40
- thiazolidinediones - DPP4-Inhibitors - sulfonylureas and meglitinides - GLP1- agonist - SGLT-2 inhibitors - biguanide MOA
- peroxisome proliferator-activated receptor gamma agonists that increase peripheral insulting sensitivity - prevent the enzyme DDP-4 from breaking down incretin hormones - stimulating insulin secretion for pancreatic beta-cells to decrease postprandial BG (meglitinides have faster onset and shorter duration) - analogs of incretin hormone GLP-1, which increase glucose-dependent insulin secretion, decrease glucagon secretion, slows gastric emptying - proximal renal tubules, prevents reabsorption of glucose - decrease hepatic glucose production, increase insulin sensitivity, and decrease intestinal absorption of glucose
40
alpha-glucosidase inhibitors acarbose miglitol
acarbose (precose) miglitol (Glyset) - MOA: inhibit the metabolism of intestinal sucrose, which delays glucose absorption does not cause hypo alone but if it does, sucrose food won't work, use glucose tablets or gel - each dose w/ first bite of meal
41
bile acid binding resin colesevelam
Welchol also indicated for dyslipidemia constipation most common SE
42
dopamine agonist bromocriptine
cycloset contra in pt w/ syncopal migraines should not be used w/ metoclopramide or other dopamine agonists
43
amylin analog pramlintide
Symlin (SC injection) MOA: control post-prandial glucose by slowing gastric emptying admin SC before each big meal contra: in gastroparesis
44
unopen insulin
refrigerate
45
rapid-acting (bolus) insulin injection
aspart (Novolog) lispro (Humalog) lispro U-200 (Humalog U-200) glulisine (Apidra) clear and colorless
46
rapid-acting (bolus) insulin inhaled
afrezza! clear colorless contra in lung disease and smokers replace inhaler ever 15 days requires FEV1 monitoring
47
short-acting (bolus) insulin
regular (Humulin R, Novolin R) prefered for IV infusion concentrated regular (Humulin R U-500) fives times as concentrated- recommend in pt w/ required >200 units per day need to be prescribed U-500 syringes admin SC!!!! not IV, IM or insulin pump!!!
48
intermediate-acting (basal) insulin
NPH (Humulin N, Novolin N) cloudy! given BID generally, if Hypo at night, do 2/3 am and 1/3 pm
49
long-acting (basal) insulin
detemir (Levemir) glargine (Lantus, Toujeo) lantus is 100units/ml toujeo is 300 units/ml semglee is a biosimilar interchanged w/ glargine without separate prescription but biosimilar Rezoglar to glargine can not! NEED NEW prescription
50
ultra-long acting (basal) insulin
degludec (Tresiba) vial is 100units/ml but pen comes 100units/ml and 200units/ml
51
starting basal in type 1 and type 2
0.5 units/kg/day type 1 then divided by 2 to get basal and other is bolus type 2 is 0.1 to 0.2 units/kg/day
52
insulin room temp stability 1-2 weeks
Humalog Mix 50/50 and 75/25 pens Humlin 70/30 pen
53
insulin room temp stability 2 weeks
Humulin N pen Novolog Mix 70/30 pen
54
insulin room temp stability about 4 weeks
Apidra, Humalog, Novolog- vial and pen= 28 days Humalog Mix 50/50 and 75/25 vials = 28 days Novolog Mix 70/30 vials = 28 days Novolin R U-100, N and 70/30 pen = 28days Humulin R U-500 pen= 28 days Lantus, Basaglar, Semglee vials and pen= 28 days Humulin R U-100, N and 70/30 vials= 31 days
55
insulin room temp stability about 6 weeks
Humulin R U-500 vial= 40 days Novolin R U-100, N, and 70/30 vials= 42 days Levemir vial and pen= 42 days
56
insulin room temp stability about 8 weeks
tresiba pen = 56 days toujeo pen = 56 days
57
insulin best absorbed
abdomen! alternative sites: posterior upper arm, superior buttocks, and lateral thigh area
58
drugs that increase BG
beta-blockers (they can lower too) thiazide & loop diuretics tacrolimus cyclosporines PI quinolones (can lower too) antipsych statins steroids cough syrups niacin
59
drugs that lower BG hypoglycemia risk
beta blockers quinolones tramadol
60
DKA
BG >250 Ketones in urine etc. anion gap (arterial pH <7.35, anion gap >12)
61
hyperosmolar hyperglycemic state (HHS)
confusion, delirium BG >600mg/dL extreme dehydration pH > 7.3, bicarb 15 mEq/L
62
DKA and HHS tx
- fluids first for all pts (start NS, and when BG 200mg/dl switch to dex/NS) - regular insulin infusion - prevent hypokalemia - tx acidosis of pH <6.9
63
cancer
avoid GLP-1 agonists
64
GI disorders, gastroparesis
avoid GLP-1 agonists, pramlintide
65
genital infection/UTI
avoid SGLT2
66
HF
avoid TZDs, alogliptin, saxagliptin
67
Hypoglycemia risk
avoid insulin, sulfonylureas, meglitinides and pramlintide
68
hypotension/dehydration
avoid SGLT2
69
ketoacidosis
avoid SGLT2 and remember D/C SGLT2 prior to surgery to avoid ketoacidosis
70
lactic acidosis
avoid metformin w/ renal impairment, alcoholism
71
osteopenia/osteoporosis
avoid canagloflozin, TZDs
72
pancreatitis
avoid DPP-4 inhibitors, GLP-1 agonists
73
peripheral neuropathy, PAD, foot ulcers
avoid canagliflozin
74
sulfa allergy, severe
avoid sulfonylureas
75
renal insufficiency
avoid metformin, SGLT2, exenatide, glyburide
76
weight gain/ obesity
avoid sulfonylureas, meglitinides, TZDs, insulin

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