Diabetes Flashcards
What are 4 microvascular complications of DM?
What are macrovascular ones?
Retinopathy
Nephripathy
Neuropathy
Diabetic autonomic neuropathy- gastroparesis
Atherosclerosis - CVA, CAD, PAD
When do you start testing for DM?
At 35 years old and every 3 years
Younger if overweight with physical inactivity, first degree relative with DM, PCOS, HTN, HDL <35 or TG >250, history of CVD
What are fasting, 2H glucose test, and A1c values for non-pregnant individuals for diabetes criteria?
Normal
Pre-diabetes
DM - how many do i need to diagnose?
Fasting <100
2H glucose test - <140
A1C - <5.7%
Fasting 100-125
2H glucose test - 140-199
A1C - 5.7-6.4
You only need ONE of the following to diagnose:
Fasting >126
2H glucose test - >200
A1C - >6.5%
Random >200
What is the goal A1c for diabetics?
<7%
<8% for elderly or frail patients
How to calculate eAG?
What would a 6% a1c eAG be?
What about 10%?
eAG = (28.7 x A1c) - 46.7
6% = 126 eAG
10% = 240 eAG
Which DM patients should be on aspirin?
Secondary prevention
ASCVD >10%
> 50y.o w/1 risk factor
What is the basic treatment for diabetic foot infection?
Mild
If MRSA
Severe
Mild - worries about gram positive like staph and strep - give cephalexin x 1-2 weeks
If MRSA - doxycycline or bactrim
Severe infection - treat 2-3 weeks
What is the basic treatment for T1DM?
Insulin only!!
Diet and exercise
What are the three rapid acting insulins?
Brand names
Storage
What is the onset? DOA?
Lispro - Humalog, ademelog, lyumjev - 28D room temp
Aspart - novolog and fiasp - room temp 28D
Glulisine - Apidra - room temp 28 days
Onset 5-15 minutes, DOA 3-5 hours
Afreeza
How long?
ROA
Administration
Contraindications
Storage
Discard
Rapid acting
Inhaled insulin
At beginning of meal
Lung disease
Refrigerated or room temp x 10days
Discard inhaler after 15 days
What are 2 short acting insulins?
Humulin R
Novolin R
What are 3 intermediate acting insulin?
Appearance?
Storage
NPH - CLOUDY
Humulin N - room temp 31d
Novolin N - room temp 42d
What components make up Ryzodeg 70/30?
What about Xultophy?
Soliqua?
Degludec and aspart
Degludec and liraglutide
Glargine and lixisenatide
What are 3 long acting insulin?
Detemir - Levemir
Glargine - Lantus, semglee, toujeo, basaglar
Degludec - Tresiba
Which insulin can NOT be mixed with any other insulin?
Glargine
How to convert NPH BID to glargine?
Reduce total daily dose by 20% and give glargine QD
How long is glargine good for ?
28 days at room temp
What insulin dosing do you start with T2DM?
What about T1DM?
How do you divide basal and bolus insulin?
0.1-0.2U/kg/day
0.5u/kg/day
50/50
Pramlintide
Brand
Indication
Contraindications
MOA
Dosing
ADE
Mixing
Symlin
T1DM and T2DM as ADJUNCT
A1c>9%, gastroparesis, alpha-glucosidase inhibitors, hypersensitivity to metacresol preservative
Its an analgoue of amylin which is naturally secreted with insulin to help lower BS by delaying gastric emptying, inhibit glucose release, and reduce appetite
T1DM - 15mcg SQ TID before meals
T2DM - 60mcg SQ TID before meals
NAUSEA, anorexia, hypoglycemia
Do NOT mix with any other insulin
What’s the dawn phenomenon?
“growth hormone release”
If the 3AM sugar is HIGH then it’s dawn phenomenon
What’s the somogyi effect?
Rebound hyperglycemia
Blood sugar falls in the night like 3am and causes rebound in the morning hyperglycemia
What meds are:
Biguanides
Sulfonylureas
Meglitinides
Thiozolidinediones
Alpha glucosidase inhibitors
Dopamine agonist
Metformin
Glimepiride, glipizide, glyburide
Nateglinide, Repaglinide
Rosiglitazone, pioglitazone
Acarbose, Miglitol
Bromocriptine
Metformin
Brand names
ADE
Renal dosing
Glucophage, fortamet, glucophage, glutmetza, riomet
Weight LOSS, diarrhea, metallic taste, low B12, lactic acidosis
Avoid in GFR <30
Which GLP’s are given daily?
Litaglutide
Exenatide
Rybelsus
What is the max dose of
Glucophage
Glucophage XR
2550mg/day
2000mg/day
Glimepiride
Brand
Administration
Metabolism
ADE
Amaryl
Take with breakfast
100% in liver
Weight gain and hypoglycemia
Glipizide
Brand
Administration
DOC in…
Glucotrol
30 minutes BEFORE meal
DOC in renal failure
Which is the longest acting sulfonylyurea?
Glyburide
What do you do if you skip a meal while on nateglinide or repaglinide?
Skip the dose also
What are the MOA’s of:
Biguanides
Sulfonylureas
Meglitinides
Thiozolidinediones
Alpha glucosidase inhibitors
Dopamine agonist
Decrease glucose production and absorption
Increase insulin secretion
Increase insulin secretion mostly after postprandial glucose
Insulin sensitizers
Prevent breakdown of complex sugars
Pioglitazone
Max
Warning
45mg QD
May cause bladder cancerT
Thiazolidinediones
Class ADE
Liver failure
Fluid retention
Weight gain
Hyperlipidemia
Decrease bone density
Avoid in CHF
What is the difference between Victoza and Saxenda?
Victoza is for DM and saxenda is for weight loss
Victoza max dose is 1.8mg QD
Saxenda is 3mg QD
Rybelsus
Generic
ROA
Dosing / administration
Semaglutide
PO
3/7/14mg QD on EMPTY stomach
What 3 GLP’s require NO renal adjustment?
Liraglutide (Victoza)
Dulaglutide (trulicity)
Semaglutide (Ozempic)
2 common ADE of DPP4i?
Joint Pain and Pancreatitis
Brand names
Sitagliptipin
Alogliptin
Linagliptin
Saxagliptin
Which one does not need renal adjusment?
Januvia
Nesina
Tradjenta - no renal adjustment
Onglyza
What is Kombiglyze XR?
Sitagliptin and metformin
ADE of SGLT2i
Decrease A1c/weight
increase LDL
Increase K+/Mg/PO
Increase UTI
Renal impairment
Bone fractures
Ketoacidosis
Necrotizing fasciitis
Where do SGLT2i works?
PCT
Which SGLT and GLP1’s have benefit for patients with ASCVD?
SGLT2- Canagliflozin and empagliflozin
GLP1 - Liraglutide, dulaglutide, semaglutide
Which SGLT2 are approved for HF?
Dapagliflozin and empagliflozin
What is the DOC for DM in pregnancy?
Insulin
