Diabetes Flashcards
DM diagnositc labs? (4)
(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
DM Glycemic Control targets? (3)
FPG (fasting plasma glu) = 70 - 130
2hrs post meal < 180
HbA1c < 7%
Tx stages for DM II? (5)
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
DM tx: Oral Insulin Secretagogues
Stim Insulin secretion:
Sulfonylureas, Meglitinides
DM tx: Oral Insulin Sensitizers
↑ liver/mm sensitivity to insulin,
↓ glucose and insulin levels:
Biguanides
Thiazolidinediones
DM tx: Oral Carb blockers
α-glucosidase Inhibitors
DM tx: Oral DPP-4 Inhibitors
Stop GLP-1 degradation,
↑ action of incretins
DM tx: SQ Incretin Mimetics
GLP-1 Agonists
Oral DOC for DM 2 w/ N liver/kidney fxn?
Metformin
Initiating bedtime insulin?
Interm or long-act at bedtime,
prevents ↑ FBS (fast blood sug) in a.m.
Rapid-acting Insulin:
Onset
Peak
Duration
Onset: < 15min
Peak: 1 hr
Duration: 2-4 hrs
Short-acting (Regular) Insulin:
Onset
Peak
Duration
Onset: < 0.5 - 1 hr
Peak: 2-3 hrs
Duration: 3-6 hrs
Intermediate-acting Insulin:
Onset
Peak
Duration
Onset: 2-4 hrs
Peak: 6-12 hrs
Duration: 10-16 hrs
Long-acting Insulin:
Onset
Peak
Duration
Onset: 1-2 hrs
Peak: none
Duration: 20-24 hrs
Goals of Insulin Tx? (3)
1) normal fasting glu
2) normal postprand glu
3) avoid hypoglycemia
Goals of Intensive Insulin Tx? (4)
1) good glycemic control
2) min hypogly
3) improve lipid profile
4) ↓ risks of complications
Calculate daily insulin dose how?
Obese:
1 - 1.2 u/kg/day
Normal:
0.5 -0.7 u/kg/day
Insulin tx initiates how?
50% of total daily dose
titrate on SMBS and sxs
2/3 pre-breakfast, 1/3 pre-dinner
Physiologic insulin regimen?
mimics normal β-cell secretion, replace basal (long-acting) and prandial (pre-meal) insulin separately
Insulin stacking is?
additive effect of basal/prandial overlap can cause hypogly
Basal/Bolus insulin dosing?
Basal:
↓ glu prdxn b/w meals & overnight
50% of daily need
Bolus:
↓ hypergly post meals
10-20% daily need per meal
Sliding Scale Insulin Schedule?
↑s in short-acting insulin to correct high glu from diet/exercise/illness
Carb Counting Insulin Schedule?
Proactive instead of reactive:
Meal bolus based on current glu level,
carbs planning on eating,
exercise planning on doing
Somogyi Effect?
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
