Diabetes Flashcards

1
Q

DM diagnositc labs? (4)

A

(Confirms DM if these criteria)

HbA1c ≥ 6.5% or

Fasting glu ≥ 126 or

2hr glu post tolerance test ≥ 200 or

Random glu in pt w/ hyperglycemia sxs ≥ 200

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2
Q

DM Glycemic Control targets? (3)

A

FPG (fasting plasma glu) = 70 - 130

2hrs post meal < 180

HbA1c < 7%

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3
Q

Tx stages for DM II? (5)

A

1) lifestyle ∆
2) LS∆ + oral
3) LS∆ + oral (a.m.) + NPH or glargine insulin (p.m.)
4) LS∆ + insulin BID (rapid and interm)
5) LS∆ + rapid insulin pre-meals + long insulin x 1

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4
Q

DM tx: Oral Insulin Secretagogues

A

Stim Insulin secretion:

Sulfonylureas, Meglitinides

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5
Q

DM tx: Oral Insulin Sensitizers

A

↑ liver/mm sensitivity to insulin,
↓ glucose and insulin levels:

Biguanides
Thiazolidinediones

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6
Q

DM tx: Oral Carb blockers

A

α-glucosidase Inhibitors

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7
Q

DM tx: Oral DPP-4 Inhibitors

A

Stop GLP-1 degradation,

↑ action of incretins

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8
Q

DM tx: SQ Incretin Mimetics

A

GLP-1 Agonists

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9
Q

Oral DOC for DM 2 w/ N liver/kidney fxn?

A

Metformin

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10
Q

Initiating bedtime insulin?

A

Interm or long-act at bedtime,

prevents ↑ FBS (fast blood sug) in a.m.

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11
Q

Rapid-acting Insulin:

Onset

Peak

Duration

A

Onset: < 15min

Peak: 1 hr

Duration: 2-4 hrs

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12
Q

Short-acting (Regular) Insulin:

Onset

Peak

Duration

A

Onset: < 0.5 - 1 hr

Peak: 2-3 hrs

Duration: 3-6 hrs

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13
Q

Intermediate-acting Insulin:

Onset

Peak

Duration

A

Onset: 2-4 hrs

Peak: 6-12 hrs

Duration: 10-16 hrs

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14
Q

Long-acting Insulin:

Onset

Peak

Duration

A

Onset: 1-2 hrs

Peak: none

Duration: 20-24 hrs

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15
Q

Goals of Insulin Tx? (3)

A

1) normal fasting glu
2) normal postprand glu
3) avoid hypoglycemia

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16
Q

Goals of Intensive Insulin Tx? (4)

A

1) good glycemic control
2) min hypogly
3) improve lipid profile
4) ↓ risks of complications

17
Q

Calculate daily insulin dose how?

A

Obese:
1 - 1.2 u/kg/day

Normal:
0.5 -0.7 u/kg/day

18
Q

Insulin tx initiates how?

A

50% of total daily dose
titrate on SMBS and sxs

2/3 pre-breakfast, 1/3 pre-dinner

19
Q

Physiologic insulin regimen?

A
mimics normal β-cell secretion,
replace basal (long-acting) and prandial (pre-meal) insulin separately
20
Q

Insulin stacking is?

A

additive effect of basal/prandial overlap can cause hypogly

21
Q

Basal/Bolus insulin dosing?

A

Basal:
↓ glu prdxn b/w meals & overnight
50% of daily need

Bolus:
↓ hypergly post meals
10-20% daily need per meal

22
Q

Sliding Scale Insulin Schedule?

A

↑s in short-acting insulin to correct high glu from diet/exercise/illness

23
Q

Carb Counting Insulin Schedule?

A

Proactive instead of reactive:
Meal bolus based on current glu level,
carbs planning on eating,
exercise planning on doing

24
Q

Somogyi Effect?

A

Rebound hyperglycemia in a.m. in response from too much insulin at bedtime

Release of cortisol, glucagon and GH during sleep to combat hypogly

Lower p.m. insulin or eat snack

25
Q

Waning of Insulin?

A

Hypergly in a.m. due to prior evening insulin wearing off

↑ dose or timing

26
Q

Dawn Phenomenon?

A

Hypergly in a.m. due to ↑ GH from 3-7 a.m.

↑ dose or timing

27
Q

TID Insulin dosing?

A

2/3 in a.m.: 75% N (interm), 25% H (rapid)

1/3 divided b/w pre-supper and bedtime:
25% H pre-supper
75% N bedtime

28
Q

Best control for HgbA1c >9%?

A

insulin

29
Q

What levels of A1c, FBG and RBG are good and require no pharm intervention?

A

A1c ≤ 7.5%
FBG < 200
RBG < 250

30
Q

What levels of A1c, FBG and RBG are fair and do require pharm intervention?

A

A1c 7.6 - 9%
FBG 200 - 250
RBG 250 - 300

Oral agents, Incretins

31
Q

What levels of A1c, FBG and RBG are poor and do require pharm intervention?

A

A1c > 9%
FBG > 250
RBG > 300

Insulin