Diabetes Flashcards by Kim Nguyen

Stability of Humalog Mix 50/50 pens

10 days

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Stability of Humulin 70/30 pens

10 days

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Stability of Humulin N pen

14 days

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Stability of Novolog Mix 70/30 pens

14 days

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Stability of Apidra pens/vials

28 days

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Stability of Humalog pens/vials

28 days

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Stability of Novolog pens/vials

28 days

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Stability of Admelog pens/vials

28 days

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Stability of Lyumjev pens/vials

28 days

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Stability of Fiasp pens/vials

28 days

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Stability of Humalog Mix 75/25 vial

28 days

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Stability of Novolog Mix 70/30 vial

28 days

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Stability of Novolin R U-100, N, and 70/30 pens

28 days

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Stability of Humulin R U-500 pens

28 days

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Stability of Lantus, Basaglar, Semglee vials and pens

28 days

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Stability of Humulin R U-100, N, and 70/30 vials

28 days

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Stability of Humulin R U-500 vial

40 days

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Stability of Novolog R U-100, N, and 70/30 vials

42 days

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Stability of Levemir vial and pen

42 days

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Stability of Toujeo pen

56 days

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Stability of Tresiba pen

56 days

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When mixing NPH and regular insulin together in the same syringe, how do you do it?

The regular/rapid-acting insulin is added first, then the NPH insulin

Clear before cloudy!

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Selecting diabetes treatment: what to avoid in a cancer patient

GLP-1 agonists, Mounjaro

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Selecting diabetes treatment: avoid in gastroparesis, GI disorders

GLP-1 agonists, pramlintide, Mounjaro

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Selecting diabetes treatment: avoid in genital infections, UTIs

SGLT2is

Selecting diabetes treatment: avoid in heart failure

TZDs, alogliptin, saxagliptin

Selecting diabetes treatment: avoid in hypoglycemia

insulin, SUs, meglitinides, pramlintide

Selecting diabetes treatment: avoid in hypotension/dehydration

SGLT2is

Selecting diabetes treatment: avoid in hypokalemia

insulin

Selecting diabetes treatment: avoid in ketoacidosis

SGLT2is

Selecting diabetes treatment: avoid in lactic acidosis

metformin

Selecting diabetes treatment: avoid in osteopenia/osteoporosis

canagliflozin, TZDs

Selecting diabetes treatment: avoid in pancreatitis

DPP4is, GLP-1 agonists, Mounjaro

Selecting diabetes treatment: avoid in peripheral neuropathy, PAD, foot ulcers

Invokana

Selecting diabetes treatment: avoid in sulfa allergy

SUs

Selecting diabetes treatment: avoid in renal insufficiency

metformin, exenatide, glyburide; insulin may need to be started at a lower dose

Selecting diabetes treatment: avoid in weight gain/obesity

SUs, meglitinides, TZDs, insulin

Only GLP-1 that's renally cleared

Exenatide (Byetta, Bydureon)

BBW for GLP-1s

risk of thyroid C-cell carcinoma

GLP1s that are recommended in patients with ASCVD risk

liraglutide (Victoza), dulaglutide (Trulicity), SQ semaglutide (Ozempic)

Effects of GLP1s

increase glucose-dependent insulin secretion, decrease glucagon secretion, slows gastric emptying, improves satiety, weight loss

SGLT2is are CI'ed in what?

dialysis

SGLT2is effects

reduce reabsorption of glucose, increase urinary glucose excretion

SGLT2s that are beneficial in HF, CKD, ASCVD

Jardiance, Farxiga, Invokana

eGFR minimum for SGLT2i use

≥20ml

Metformin MoA

decrease hepatic glucose production, increase insulin sensitivity, decreased intestinal absorption of glucose

BBW for metformin

lactic acidosis

MoA of SUs and meglitinides

Stimulate insulin secretion from the pancreatic beta-cells to decrease postprandial BG

DPP4is MoA

prevent DPP4 from breaking down incretin hormones, GLP-1, and GIP

DPP4i effects

increase insulin release from pancreatic beta cells and decreased glucagon secretion

DPP4i warnings

pancreatitis, severe arthralgia, acute renal failure, risk of heart failure

TZD MoA

increase peripheral insulin sensitivity

BBW for TZDs

can cause or exacerbate HF

Warnings for TZDs

edema, risk of fractures, can stimulate ovulation

Acarbose, miglitol MoA

inhibit the metabolism of intestinal sucrose, which delays glucose absorption

Colesevelam side effect

Constipation

Bromocriptine CI

syncopal migraines, breastfeeding

Pramlintide side effect

Significant hypoglycemia risk; reduce mealtime insulin dose by 50% when starting

Drugs that can increase BG

Beta-blockers Thiazide and loops Transplant drugs (tacrolimus, cyclosporine) Protease inhibitors Quinolones APS (olanzapine and quetiapine) Statins systemic steroids cough syrups niacin

Drugs that can decrease BG

beta-blockers, tramadol, quinolones

DKA and HHS treatment: first step

FLUIDS! Start with NS, then change to D5W1/2NS when BG <200

DKA and HHS treatment: second step

Regular insulin infusion

DKA and HHS: what else to monitor

Potassium level

When to treat acidosis in DKA/HHS

If pH <6.9, give sodium bicarb