Diabetes Flashcards
Risk Factors and Symptoms
RF: age, overweight (BMI 25+), first-degree relative with diabetes, HTN, CVD, pre diabetes
Sx: polyuria (urination), polyphagia (hunger), polydipsia (thirst)
Diagnostic Criteria
A1C 6.5+
FPG 126+
RBG 200+
OGTT (2 hr BG) 200+
Tx Goals
A1C < 7
Preprandial 80-130
Postprandial < 180
Tx Algorithm: ASCVD, HF, CKD
ASCVD or high risk (55+ w/ 2+ risk factors)
= GLP1 RA or SGLT2i
- then use other, then TZD
HF = SGLT2i
CKD = SGLT2i or GLP1 RA
- then GLP1 RA (other if not started)
Combinations To Avoid
- DPP4i + GLP1 RA (overlapping mechanism)
- SU + insulin (hypoglycemia risk)
GLP1-RAs
Glutides
G: Gastroparesis
L: LOL thyroid cancer
P: Pancreatitis
[AE: GI (NVD - reduced with dose titration), weight loss, injection site reactions]
SGLT2is
Gliflozins
Warnings
-UTI, genital mycotic infections
-Mild diuretics: caution in hypotension
-Euglycemic DKA
(AE: AKI, increased urination/thirst)
Metformin
Lowers A1C 1-2%
Warnings
-Lactic acidosis (increased risk with renal impairment, contrast dye, alcohol)
-CI: eGFR <30 (don’t start <45), metabolic acidosis (DKA)
(AE: vitamin B12 deficiency, GI)
Sulfonylureas
Glipizide, glyburide, glimepiride
CI: sulfa allergy
Warning: hypoglycemia (caution older pts)
AE: weight gain (maybe not in obese pts), nausea
DPP4is
Gliptins
(Januvia/Tradjenta)
Warning:
-Pancreatitis
-Arthralgia (joint pain)
-Acute renal failure
(Saxa/Alo: risk of HF)
(AE: HA, rash, URTIs)
TZDs
Pioglitazone (EF BOHO)
BBW: HF (no with Class 3-4)
-Bladder cancer, osteoporosis
Warning: edema, fractures, stimulate ovulation
(AE: weight gain, myalgia)
Insulin Types
Basal: glargine, detemir, degludec (once daily)
Int: NPH (twice daily)
Rapid: aspart, lispro, glulisine (5-15 min prior)
Short: regular U-100 (30 min prior)
Insulin AE
-Weight gain
-Hypoglycemia
-Hypokalemia
-Lipoatrophy/lipohypertrophy (rotate sites)
Insulin Administration
-Do not shake (gently turn up/down or roll between hands)
-Do not freeze/expose to heat
-Unopened: fridge, opened: RT
-Never share pen devices
-Stable for 28 days mostly (all rapid is)
-REG insulin CLEAR and DRAWN FIRST then NPH which is cloudy and second
Starting Insulin In T2D
10 units SC daily or 0.1-0.2 units/kg/day
-Titrate based on FPG
If FPG not at goal: add prandial insulin
-4 units or 10% of basal dose SC once daily prior to largest meal
-Add on to other meals if needed
Still not at goal
-Basal/bolus reg: basal insulin + mealtime insulin
-Mixed reg: twice daily NPH + short/rapid insulin
Starting Insulin In T1D
0.5 units/kg/day
Use TBW
50% as basal, 50% as bolus (/3)
Adjusting Insulin
High BG readings are indicative of the insulin dose given PRIOR to that reading
-High fasting: adjust basal (or can be low too)
-High postprandial: adjust rapid prior to meal
-High preprandial: adjust rapid prior to meal
Hypoglycemia
BG < 70
Sx: dizzy, anxiety, shaky, hunger, nausea, confusion, sweating, tremors
Rule of 15
-Ingest 15 g of glucose (4 oz juice/soda, 1 tbsp sugar/honey, 3-4 glucose tabs, handful skittles)
-Recheck BG in 15 min
-Repeat if needed
-Once normal, eat small meal/snack
Unconscious: dextrose (if IV), glucagon 1 mg (SC or nasal spray)
DKA and HHS
DKA
-BG > 250, ketones, anion gap acidosis (pH < 7.35 and AG >12), NV, dehydration
-Caused by insulin omission or sub-therapeutic insulin
HHS
-BG > 600, confusion, pH > 7.3, osmolality (>320)
TX:
-Aggressive fluids (NS then D5W1/2NS at BG 200)
-Regular insulin infusion (0.1 u/kg bolus then 0.1 u/kg/hr cont inf)
-Monitor K (prevent hypokalemia)
-Treat acidosis if pH < 6.9 (sodium bicarbonate)
Insulin Sensitivity
1800 / TDD of insulin = ratio
*how much 1 unit of insulin would lower BG
Insulin Peaks/Durations
Rapid: 1-2, 3-5
Reg: 2-4, 4-8
Int: 4-10, 10-18
Long: peakless (det 6-24, glarg 20-26, deg 24)
Goal % In Range
70
