Diabetes Flashcards
Diagnosis
Diabetes diagnosis criteria
- Fasting glucose ≥ 126
- HbA1C ≥ 6.5%
- 2 hr glucose test ≥ 200
Goals
Diabetes goal
ADA guideline goal
- pre-prandial 80-130
- post prandial <180
- HbA1C < 7 %
Criteria to start ACEi/ARB
- microalbuminuria > 30
- eGFR < 60
Criteria to start ASA
Secondary prevention
h/o MI or stroke in high risk patients
Criteria to start ASA
Primary prevention
ASCVD > 10%
Criteria to start a STATIN
Age < 40
only if ASCVD/risk factors
Risk factors: LDL ≥ 100, HTN, smoker, family hx, albuminuria
Criteria to start a STATIN
Age 40-75
If ASCVD/risk factors
high intensity statin
Risk factors: LDL ≥ 100, HTN, smoker, family hx, albuminuria
Criteria to start a STATIN
Age 40-75
No risk factors
moderate intensity statin
Criteria to start a STATIN
Age >75; no risk factors
moderate intensity statin
Criteria to start a STATIN
Age >75; ASCVD/Risk factors
moderate-high intensity statin
Risk factors: LDL ≥ 100, HTN, smoker, family hx, albuminuria
Immunizations recommended for diabetic patients
- Influenza
- COVID
- Hep B
- Tdap
- Pneumococcal
- Shringrix
OTC/Herbal
Natural products with benefit in diabetes
- Chromium
- Cinnamon
Rapid Acting Insulin
Generic + Brand
- Lispro- Humalog, Admelog, Lyumjev
- Aspart- Novolog, Fiasp
- Glulisine- Apidra
Insulin
Regular insulin available IV?
Apidra (Glulisine)
Standard insulin concentration & vial size
100U/mL
Available in 10 mL
Standard insulin concentration & pen size
100U/mL
Available in 3 mL
Insulin Brand Names
Novolog, Fiasp
type of insulin
Aspart
Insulin Brand Names
Humalog, Admelog, Lyumjev
type of insulin
Lispro
Rapid Acting
Insulin Brand Names
Apidra
type of insulin
Glulisine
Rapid Acting
Insulin Brand Names
Levemir
type of insulin
Detemir
Long acting
Insulin Brand Names
Lantus, Semglee, Toujeo, Basaglar
type of insulin
Glargine
Long acting
Insulin Brand Names
Tresiba
type of insulin
Degludec
Long Acting
Type of insulin
Short Acting Regular Insulin
Humulin R
Novolin R
Humulin R comes OTC
Type of insulin
Intermediate Acting Insulin
NPH
Humulin N
Novolin N
SE of Insulin (3)
- Hypoglycemia
- Weight Gain
- Hypokalemia
Dosing for Insulin
T1DM
0.5-0.8 U/kg/day
Dosing of Insulin
T2DM
0.1-0.2 U/Kg/day
Insulin conversions
Toujeo to other insulin
TD * 0.8
Insulin conversions
Long acting to NPH
unit to unit given BID
NPH = intermediate
N= cloudy
Insulin conversions
NPH QD to glargine
unit to unit QD
Insulin conversions
NPH BID to glargine
TD * 0.8 QD
NPH to detemir
unit to unit QD or BID
Hypoglycemia
Treatment
Rule of 15
* 5-6 lifesavers
* 2 sugar cubes
* 4 oz of OJ
* 6 jelly beans
* 3-4 glucose tabs
DKA
Treatment
(++) ketones, fruity breath, polydysia, polyuria
- **Hydration 0.9% NS
- Insulin 0.1 U/Kg/hr - k must be ≥ 3.3
- Dextrose if glucose drops to 200-250
- K replacement- 20-40 mEq/hr
- Bicarb if pH < 6**
SE of Metformin
- Diarrhea
- Nausea
- Lactic acidosis
- ↓ B12
- Weight loss ✓
CI of metformin
eGFR of < 30
Glimepiride (Amaryl)
Glipizide (Glucotrol)
Glyburide (Glynase, Diabeta)
Sulfonylureas
- ide
Which SU is good for patient with renal impairment?
Glipizide
CI of SU
Sulfa allergy
Repaglinide (Prandin)
Nateglinide (Starlix)
Meglitinides
-glinide
MOA: stimulates insulin secretion → Take with meals - if you skip a meal, skip the dose
SE of Meglitinides
- Weight gain
- Hypoglycemia
Pioglitizone (Actos)
Thiazolidinediones (TZDs)
Major CI of Actos
HF
SE of Pioglitazone
- edema
- hepatic failure
- ↑ risk of fractures
- bladder cancer
peepee glitizone - bladder cancer
Liraglutide (Victoza)
Exenatide (Byetta)
Dulaglutide (Trulicity)
Semuglutide (Ozempic, Rybelsus)
Glucagon-like peptide (GLP-1) agonist
-tide
SE of GLP1 Agonist
- G- gallbladder dz, GI symptoms (N/V, Diarrhea)
- L- weight loss
- P- pancreatitis
- 1(T)- thyroid tumors
Formulation
PO GLP 1
Rybelsus- Semaglutide
take on empty stomach
keep in OG packaging
Formulation
Weekly GLP-1 Agonist
- Bydureon- Exanatide ER
- Trulicity-Dulaglutide
- Ozempic- Semaglutide
Formulation
Daily GLP-1 Agonist
- Victoza- Liraglutide- SQ
- Rybelsus- Semaglutide - PO
- Byetta- Exanatide- SQ BID
Longest acting SU
Glyburide
Sitagliptin (Januvia)
Alogliptin (Nesina)
Linagliptin (Tradjenta)
Saxagliptin (Onglyza)
DPP4 Inhibitors
-gliptins
all PO QD
SE of DPP4
- Pancreatitis
- Pain in the joints
2 P’s
DPP 4 that does not require renal adjustments
linagliptin (Tradjenta)
DDI
DPP4 CYP3A4 Substrates
- Linagliptin
- Saxagliptin
Liraglutide does for weight loss
Saxenda 3 mg
for Diabetes 1.8
Sitagliptin dose for CrCl 30-49
50 mg
Sitagliptin dose for CrCl <30
25 mg
Alogliptin dose for CrCl 30-60
12.5 mg
Alogliptin dose for CrCl <30
6.25 mg
Canagliflozin (Invokana)
Dapagliflozin (Farxiga)
Empagliflozin (Jardiance)
Ertugliflozin (Steglatro)
SGLT2 Inhibitors
all QD take in the AM
SE of SGLT2 Inhibitors
- G- genital infections (UTI, Pyelo)
- L- ↑LDL, Loss of weight ✓
- ↓BP
- Bone fractures (osteoporosis)
Invokana CI
eGFR < 30
Farxiga CI
eGFR < 45
eGFR < 24 in CKD
Jardiance CI
eGFR < 30
Insulin Calc
Insulin- Carb Ratio for Regular Insulin
Rule of 450
450 / TDD of insulin
Insulin Calc
Insulin- Carb Ratio for Rapid Insulin
Rule of 500
500 / TDD of insulin
Insulin Calc
Correction Factor for Regular Insulin
Rule of 1500
1500 / TDD of insulin
Insulin Calc
Correction Factor for Rapid Insulin
Rule of 1800
1800 / TDD of insulin
What causes hyperglycemia
- Antipsychotics
- Beta Blockers
- B3- Niacin
- Diuretics
- Tacrolimus, Cyclosporine
- Protease Inhibitors
- Statins
- Steroids
Meds that cause hypoglycemia
- Beta blockers
- Quinolones
- Tramadol
- Insulin
- SU
- Meglitinides
MDD of Metformin
Glucophage: 2550 mg/ day
Glucophage XR: 2000 mg/day
Fortamet: 2500 mg/day
