Diabetes Flashcards
Which medication is FDA approved for the prevention of T1D in those with high-risk?
Teplizumab
Which test is used to determine if a patient is still producing insulin?
C-peptide
C-peptide is released by the pancreas only when insulin is released
What is the preferred treatment of Gestational DM?
Insulin preferred
Diagnostic results for Diabetes
1) A1C: >= 6.5%
2) FBG (>8hr): >= 126 g/dL
3) OGTT (2 hr BG): >= 200 mg/dL
Diagnostic results for Pre-Diabetes
1) A1C: 5.7-6.4%
2) FBG (>8hr): 100-125 g/dL
3) OGTT (2 hr BG): 140-199 mg/dL
What are the GOAL levels in Diabetes?
A1C: <7%
Pre-prandial: 80-130 mg/dL
2-hr postprandial: <200 mg/dL
What is the eAG equivalent of an A1c of 6%?
126 mg/dL
*Each additional 1% increase by ~28 mg/dL
What is the drug of choice for Diabetes + HF or CKD?
SGLT2i
What is the drug of choice for Diabetes + ASCVD or high risk?
SGLT2i or GLP-1
What combinations of medications to avoid for Diabetes?
SU + Insulin [Increases hypoglycemia]
DPP4i + GLP1a [Overlapping mechanisms]
What is the role of the incretin-hormone GLP-1?
1) Increases insulin secretion
2) Decreases glucagon secretion
3) Slows gastric emptying and improves satiety
What are the GLP1 agonist drugs?
1) Semaglutide (Ozempic, Wegovy for weight-loss)
2) Liraglutide (Victoza, Saxenda for weight-loss)
3) Dulaglutide (Trulicity)
4) Exenatide (Byetta)
5) Tirzepatide (Mounjaro)
Which GLP1 is not weekly dosing?
1) Liraglutide subQ (Daily)
2) Exenatide subQ (ER version is once weekly) (BID dosing)
Which GLP1 is available as oral?
Semaglutide (PO daily) - Rybelsus
What is the role of SGLT2 in the body?
1) Found in the proximal renal tubule
2) Allows the reabsorption of glucose
What are the SGLT2i medications?
1) Empagliflozin (Jardiance)
2) Dapagliflozin (Farxiga)
3) Canagliflozin (Invokana)
Once daily medication PO - Take in AM
What is the renal limitations of SGLT2i?
Use only if eGFR >= 20
Contraindicated in dialysis patients
How does Metformin work?
[BIGUANIDE]
1) Lowers hepatic glucose production
2) Increase insulin sensitivity
3) Lowers intestinal absorption of glucose
What are the brand names of Metformin?
Glucophage, Glumetza, Fortamet
Contraindication of Metformin?
-DO NOT USE if eGFR < 30
-Metabolic Acidosis
Metformin drug interactions?
1) Metformin + Contrast media (Lactic Acidosis)
2) Metformin + Alcohol (Lactic Acidosis)
3) Metformin + Topiramate (Metabolic acidosis)
How do sulfonylureas work?
The stimulate insulin secretion
Sulfonylurea Medication?
1) Glyburide (Glynase)
2) Glipizide (Glucotrol)
3) Glimepiride (Amaryl)
Contraindication of Sulfonylureas?
Sulfa allergy
Meglitinides
Drug: Repaglinide
1) Insulin secretagogues along with sulfonylureas
2) Skip med if skipping meal
3) Take 15-30 mins before meal
4) Increased risk for hypoglycemia
What is the role of the enzyme DPP4 in the body?
1) Breaks down the incretin hormones (GLP and GIP)
These hormones help to regulate BG levels by increasing insulin release and decreasing glucagon secretion.
What are the DPP-4i drugs?
1) Sitagliptin (Januvia)
2) Linagliptin (Tradjenta)
3) Saxagliptin (Onglyza)
DPP4-i Warnings
1) Pancreatitis
2) Arthralgia (joint pain)
3) Renal Failure
DPP4-i Side Effects
1) Nasopharyngitis
2) UTI
3) Peripheral edema
How do Thiazolidinediones (TZD) work in the body?
TZD are PPAR-gamma agonists. They increase insulin sensitivity (increase uptake of glucose)
-Pioglitazone is the only TZD available in the USA.
What is the boxed warning for Pioglitazone?
Can cause or exacerbate HF.
What are the rapid acting insulins?
Insulin Aspart (Novolog)
Insulin Lispro (Humalog)
Insulin Glulisine
Onset: 15 mins
Peak: 1-2 hours
Duration: 3-5 hours
What are the intermediate acting insulin?
NPH (Humulin N, Novolin N)
Onset: 1-2 hours
Peak: 4-12 hours
Duration: 14-24 hours
- Used as a basal insulin
- Only insulin that is cloudy, due to protamine
What are the short acting insulin?
Regular Insulin (Novolin, Humulin)
Onset: 30 mins
Peak: 2 hours
Duration: 6-10 hours
*Usually does BID
What are the basal insulin?
Insulin glargine (Lantus, Toujeo)
Insulin detemir (Levemir)
Insulin degludec
Onset: 3-4 hours
Peak: No Peak!
Duration: >= 24 hours
*These impact fasting glucose
How is insulin and potassium related?
Insulin facilitate the entry of potassium into the cell. Therefore, insulin causes hypokalemia.
What is the standard concentration of insulin?
U-100
100 units/mL
What are the brand names of insulins?
Rapid Acting:
- Insulin Aspart (Novolog)
- Insulin Lispro (Humalog)
Short Acting:
- Regular Insulin (Humulin, Novolin)
Intermediate:
- NPH (Humulin N, Novolin N)
Long Acting:
- Insulin glargine (Toujeo, Lantus)
- Insulin detemir (Levemir)
What do the numbers in this formulation mean: Novolin 70/30?
70%NPH, 30%Regular
Premixed Insulin: What does the numbers mean in Novolog Mix 70/30?
70% aspart protamine/ 30% aspart
When to start insulin in T2D?
Usually A1c >10% or BG >300 mg/dL
-It is usually added on to GLP1
What is the starting dose of insulin in T2D?
10 units/day or 0.1-0.2 units/kg/day, then titrate
When to start Prandial (basal) insulin in T2D, and how much?
Start when fasting glucose not at goal.
Start 4 units or 10% of basal dose before largest meal. Add doses before other meals PRN
What is the insulin starting dose in T1D?
0.5 units/kg/day
50% is basal; 50% is prandial
-Long and rapid acting insulins are preferred. NPH can be used if cost is an issue.
What is ICR?
Insulin to Carbohydrate Ratio
It is the grams of Carbs covered by 1 unit of insulin
ICR: Rule of 450
For Regular Insulin
450/TTD of Insulin
ICR: Rule of 500
For Rapid Acting
500/TDD of Insulin
What are the hyperglycemic crises?
1- Diabetic ketoacidosis (DKA)
2- Hyperosmolar hyperglycemic state (HHS)
What are the criteria for DKA?
Usually T1D patients
BG > 250 mg/dL
ketones (Blood or urine)
Anion gap acidosis
What are the criteria for HHS?
Usually T2D
Caused by an illness which leads to less fluid intake and extreme dehydration
BG >600 mg/dL
pH > 7.3
What is the treatment of HHS and DKA?
1) Aggressive fluids (Start with NS until BG ~200 mg/dL, then change to D5W1/2NS
2) Regular insulin (0.1 units/kg bolus, then 0.1 units/kg/hr cont. inf. OR 0.14 units/kg/hr cont. inf.)
3) Prevent hypokalemia
4) Treat acidosis if pH < 6.9 with NaHCO3.
Which T2D medication to avoid with eGFR < 45?
1) Metformin
2) Exenatide ER
3) Glyburide
Which T2D medication should be avoided in HF?
1) Pioglitazone
2) Saxagliptin
Which medication should be avoided in patients with T2D and pancreatitis?
1) GLP-1’s
2) DPP4-i ‘gliptins’
Which T2D medication can cause weight gain?
1) Insulin
2) Sulfonylureas
3) Meglitinides
4) TZD
What is the conversion of regular insulin to rapid acting insulin?
1:1
What is the treatment for gestational diabetes?
1st line: Insulin
2nd line: Metformin or glyburide
What is the conversion of NPH to insulin glargine?
Reduce dose by 20%
