Diabetes Flashcards
1
Q
What is the central problem related to diabetes?
A
- Blood glucose remian high because of decreased insulin secrestion, decreased insulin sensitivity
2
Q
Where is Insulin produced from and where does it go?
A
- Made from Beta Cells in the pancreas; helps move glucose OUT of the blood & into the body
- Goes to Mucsle cells, liver cells [Glycogen], Fat Cells
3
Q
What is the “opposite” of insulin, where is it made, and what does it do?
A
- Glucagon
- Made from alpha cells in the pancreas; helps move glucose INto the blood & body from glycogen
NO Glycogen = break down of ketones
4
Q
What are the types of diabetes?
A
- Type I
- Type II
- Pre-diabetes
- Diabetes in Pregnancy
5
Q
What is Type I Diabetes and when does it most likely occur?
A
- Autoimmune destruction of the beta-cells = NO insulin to be made (causes ketones to be broken down resulting is DKA)
- Normally found in childhood
6
Q
What is Type II Diabetes?
A
- Due to insulin resistance or insulind deficiency [or both] (Beta cells slowly make less and less insulin as they become damaged)
7
Q
What is Pre-diabetes?
A
- You have increased risk of getting diabetes
- BG is HIGH but not high enough to = diabetes
8
Q
What are the Risk Factors asscioated with Diabetes?
A
- Age
- Physical Inactivity
- Overwieght
- Race [AA, Asian-American, Latino…]
- Gestational Diabetes [Pregnancy]
- A1C > 5.7%
- First degree relative
9
Q
What are the Classic Symptoms see in diabetes?
A
- Polyuria [increased urination]
- Polyphagia [increased hunger]
- Polydipsia [increased thurst]
10
Q
What are the three types of test that are used to diagnosis diabetes?
A
- A1C [gluc over 3 months]
- Blood glucose & Fasting glucose
- OGTT
11
Q
What is the diagnostic criteria for diabetes?
A1c? FPG? Random BG? OGTT?
A
- A1c > 6.5
- FPG > 126
- Random BG > 200
- OGTT > 200
12
Q
What is the diagnostic criteria for pre-diabetes?
A1c? FPG? Random BG? OGTT?
A
- A1c 5.7 - 6.4
- FPG 100 - 125
- Random BG —
- OGTT 140 - 199
13
Q
When should someone get their A1c testing?
A
- x 3 months if not controlled
- x 6 months if controlled
14
Q
What is important to know about individualized Medical Nutrition Therapy when talking about Lifestyle modifications?
A
- Eat natural forms of Carbs [Fruits, Vegs, W. Grains, Dairy]
- Type 1 should count carbs at mealtimes [15g]
15
Q
How much physical activity shoould someone get to help reduce or prevent diabetes?
A
- 150 mins per week & standing every 30 mins
16
Q
What are some natural products that could be used for diabetes?
A
- Cinnamon
- Alpha Lipoic acid
- Chromium
17
Q
Why is it important to have glycemic control?
A
- Prevention any other complications that diabetes could lead too [Micro & Macro events]
18
Q
What is the ADA monitoring, preventing and treating recommendations over Antiplatelet Therapey [Aspirin]?
A
- Aspirin 81 mg for 2nd prevention
- NOTHING for 1st prevention
- Used in pregnancy for decrease preeclampsia
19
Q
What is the ADA monitoring, preventing and treating recommendations over Cholesterol Control?
A
- High intensity statin for those with ASCVD [LDL < 55] or 40 - 75 yo with one risk factor [LDL < 70]
- Moderate intensity statin for 40 - 75 [NO ASCVD] or 20 -36 [w/ ASCVD]
- Add on: Ezetimibe or PSCK-9
20
Q
What is the ADA monitoring, preventing and treating recommendations over Diabetic Retinophaty?
A
- Eye exam AT diagnosis
- if Retinopathy; exams annually
21
Q
What is the ADA monitoring, preventing and treating recommendations over Vaccinations?
A
- GET Hep B, Flu, Pnumoccoal
22
Q
What is the ADA monitoring, preventing and treating recommendations over Diabetic Kidney Disease?
A
- is an eGFR < 60 and/or albuminuria
- Treatment: ACEi, ARB, SGLT-2, Finerenone
23
Q
What is the ADA monitoring, preventing and treating recommendations over Neuropathy?
A
- Annual: 10-g monofilamient test = assess sensation
- Foot Exam annually
- Treatment: Gabapentin, Pregabalin, Duloxtine
24
Q
What is the ADA monitoring, preventing and treating recommendations over Bone Health?
A
- Monitor bone mineral density x 2-3 yearsq
25
What is the **ADA monitoring, preventing and treating** recommendations over **Blood Pressure Control**?
- GOAL BP: **< 130/80**
26
What are the **ADA Guidelines** recommendations for initial treatments based on other comorbidities?
- Start **GLP-1 or SGLT-2** if **ASCVD, HF, or CKD**
- Start **TWO** drugs if **A1c 8.5 - 10%**
- Insuing start for severe Hyperglycemia [A1c > 10 or BG > 300] but **GLP-1/GIP** are best
27
What are the **GLP-1 Agonist & Dual GLP-1/GIP Agoinst** that are used for the treatment of **Type II Diabetes**?
- Liraglutide [Victoza] (Saxenda - Weight Loss)
- Dulaglutide [Trulicity]
- Semaglutide [Ozempic] (Wegovy - Weight Loss)
- Tirzepatide [Mounjaro] (Zepbound - Weight Loss)
## Footnote
LDS = GLP-1
Mounjaro = Dual
28
What is the way that the **GLP-1/GIP** work within the body?
- Increase Insulin secreation
- Decrease glucagon secreation
- Slow gastric emptying = weight loss
29
What are the **Boxed Warnings** for the **GLP-1/GIP agonist** used in diabetes?
-ALL [except Byetta] have a risk of **thyroid C-cell carcinoma**
30
What are some of the warnings for the **GLP-1/GIP agonist** that are used in **diabetes**?
- Pancreatitis
- NOT recommended in those with severe GI disease [Gastroparesis]
31
What are some of the **Side effects** for the **GLP-1/GIP agonst** used in **Diabetes**?
- Weight Loss, **N**/V/D [should decrease dose], Hypoglycemia
32
What are some **additional note** to know about the **GLP-1/GIP agonist** used in **diabetes**?
- Decease A1c by **0.5 - 1.5%**
- DO NOT USE with **DPP-4 inhibitors**
- Liraglutide, Dulaglutide, Semaglutide are best for ASCVD or CKD
33
What is the **MOA** of the **SGLT-2i** that are used in **Diabetes**?
- SGLT-2 in found in the **proximal tubule**; so inhibiting it will **decrease glucose reabsorption**, **increase urinary glucose** = decrease in BG
34
What are the **SGLT-2i** that are used in **diabetes**?
- Canagliflozin [Invokana]
- Dapaglifozin [Farxiga]
- Empaglifozin [Jardiance]
35
What are the **warnings** for the **SGLT-2i** that are used in **Diabetes**?
- Ketaoacidosis [when BG < 250]
- Genital Mycotic infection, Urinary tract infections
- Hypotension, AKI
- Increase risk of leg and foot amputations; increase fractures
36
What are the **Side effects** of the **SGLT-2i** used in **Diabetes**?
- Increased urination
- increase thirst
- Hyperkalemia risk with Canag
37
What are some other **additional note** about the **SGLT-2i** used in **Diabetes**?
- Decrease A1c by **0.7 - 1%**
- Canag, Dapag, Empag are best in patient with **HF, CKD and/or ASCVD**
38
What is the one **Biguanide** that is used in **diabetes**?
- Metformin [Fortamet, Glumetza
39
What is the **dosing** for **Metforin**?
- IR: 500 mg QD or BID
- ER: 500 - 1000 mg QD [with food]
- MAX: 2000 - 2550 mg/day
## Footnote
Titrate doses weekly to maintance of 1000 mg BID
40
What is the **Boxed warning** for **Metformin** used in diabetes?>
- Lactic Acidosis - increased risk with renal issues, dyes, alcohol
41
What are the **contraindicaitons** of **Metformin** used in **diabetes**?
- eGFR < 30 [is dependent on this]
42
What are some of the **warnings** for **Metformin** used in **diabetes**?
- NO start is eGFR is 30 - 45
- Vitamin B12 Deficiency
43
What are the **Side effects** of **Metformin** used in **diabetes**?
- GI: Diarrhea, Nausea, Farting
44
What are some of the **additional notes** to know about **Metformin** used in **diabetes**?
- Decrease A1c by **1 - 2%**
- ER: can leave **Ghost Tablet**
- Decrease dose = decrease GI issues
45
What are the **2 insulin secretagogues** that are used in **diabetes**?
- sulfonylureas [SUs]
- Meglitinides
46
What are the **Sulfonylureas** that are used in **diabetes**?
- Glipizide [Glucotrol XL]
- Glimepiride [Amaryl]
- Glyburide [Glynase]
47
What are the **contraindications** for the **Sulfonylureas** used in **diabetes**?
- Sulfa Allergy
48
What are the **warnings** for the **Sulfonylureas** used in **Diabetes**?
- Hypoglycemia
49
What are some of the **side effects** for the **Sulfonylureas** used in **Diabetes**?
- Weight gain, nausea
50
What are some of the **additional notes** for the **Sulfonylureas** used in **Diabetes**?
- Decrease A1c **1 - 2%**
- Glipizide IR should be taken **30 mins b4 meals**
- Glucotrol XL can leave Ghost Tablet
- Glimepiride, Glyburide = **BEERS CRITERIA** for hypoglycemia
51
What are the **Meglitinides** that are used in **diabetes**?
- Repaglinide 30 mins before meals
- Nateglinide 1-30 mins before meals
52
What are some of the **warnings** for the **Meglitinides** used in **Diabetes**?
- Hypoglycemia
53
What are some of the **Side Effects** for the **Meglitinides** used in **Diabetes**?
- Weight Gain
54
What are some of the **additional notes** for the **Meglitinides** used in **Diabetes**?
- Decrease A1c by **0.5 - 1.5%**
- Skip dose if meal is skipped
55
What is the **MOA** for the **Thiazolidinedione** used in **Diabetes**?
- PPAPy agonist that **increase peripheral insulin** (basicailly increase Insulin sensitivity)
56
What are the **Thiazolidinediones** that are used in **diabetes**?
- Pioglitazone [Actos]
57
What are the **Boxed Warnings** for the **Thiazolidinediones** used in **diabetes**?
- Can cause or exacerbate **HF**
- **DO NOT** use in NYHA III/IV HF
58
What are some of the **warnings** for the **thaizolidinediones** used in **diabetes**?
- Edema
- Increased Fracture risk
- Can stimulate ovulaiton [unintended pregnancy]
59
What are some of the **Side Effects** of the **Thiazolidinediones** used in **Diabetes**?
- Weight Gain
- Peripheral Edema
60
What are some **additional notes** about the **thiazolidinediones** used in **diabetes**?
- Decrease A1c by **0.5 - 1.4%**
61
What are the **Basas Insulins** that are used?
- Glargine
- Detemir
- Degludec [Ultra long]
62
What is important to know about the **Basal Insulins**?
- Typically **"peakless"** with an onset of **3 - 4 hr** and a duration on **> 24 hr**
- Mainly affects **fasting glucose**
63
What are the **intermediate-acting insulins** used?
- Insulin NPH
64
What is important to know about the **intermediate-acting insulins** used?>
- Kinda "basal" with onset of **1 - 2 hr**; peaks at **4 - 12 hr** [risk of hypoglicemia]; and lasts **14 - 24 hr**
## Footnote
"P" = Protamine which helps it extend the time and delay absorption
65
What are the **Rapid Acting Insulins** that are used?
- Aspart, Lispro, Glulisine
- Regular insulin = short acting
66
What is important to know about the **rapid acting insulins** that are used?
- Bolus; just like a pancreas burst
- Onset of **15 mins**; peak within **1 - 2 hr** and lasts about **3 - 5 hr**
67
What is important to know about **short acting insulin**?
- Very similar to Rapid acting
- Slightly slower onset and lasts longer [Onset **30 mins**; peak **2 hr**; duration **6 - 10 hr**
## Footnote
Regular Insulin
68
