Diabetes

Question 1

DM diagnositc labs? (4)

Answer 1

(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

Question 2

DM Glycemic Control targets? (3)

Answer 2

FPG (fasting plasma glu) = 70 - 130

2hrs post meal < 180

HbA1c < 7%

Question 3

Tx stages for DM II? (5)

Answer 3

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

Question 4

DM tx: Oral Insulin Secretagogues

Answer 4

Stim Insulin secretion:

Sulfonylureas, Meglitinides

Question 5

DM tx: Oral Insulin Sensitizers

Answer 5

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

Biguanides
Thiazolidinediones

Question 6

DM tx: Oral Carb blockers

Answer 6

α-glucosidase Inhibitors

Question 7

DM tx: Oral DPP-4 Inhibitors

Answer 7

Stop GLP-1 degradation,

↑ action of incretins

Question 8

DM tx: SQ Incretin Mimetics

Answer 8

GLP-1 Agonists

Question 9

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

Answer 9

Metformin

Question 10

Initiating bedtime insulin?

Answer 10

Interm or long-act at bedtime,

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

Question 11

Rapid-acting Insulin:

Onset

Peak

Duration

Answer 11

Onset: < 15min

Peak: 1 hr

Duration: 2-4 hrs

Question 12

Short-acting (Regular) Insulin:

Onset

Peak

Duration

Answer 12

Onset: < 0.5 - 1 hr

Peak: 2-3 hrs

Duration: 3-6 hrs

Question 13

Intermediate-acting Insulin:

Onset

Peak

Duration

Answer 13

Onset: 2-4 hrs

Peak: 6-12 hrs

Duration: 10-16 hrs

Question 14

Long-acting Insulin:

Onset

Peak

Duration

Answer 14

Onset: 1-2 hrs

Peak: none

Duration: 20-24 hrs

Question 15

Goals of Insulin Tx? (3)

Answer 15

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

Question 16

Goals of Intensive Insulin Tx? (4)

Answer 16

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

Question 17

Calculate daily insulin dose how?

Answer 17

Obese:
1 - 1.2 u/kg/day

Normal:
0.5 -0.7 u/kg/day

Question 18

Insulin tx initiates how?

Answer 18

50% of total daily dose
titrate on SMBS and sxs

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

Question 19

Physiologic insulin regimen?

Answer 19

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

Question 20

Insulin stacking is?

Answer 20

additive effect of basal/prandial overlap can cause hypogly

Question 21

Basal/Bolus insulin dosing?

Answer 21

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

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

Question 22

Sliding Scale Insulin Schedule?

Answer 22

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

Question 23

Carb Counting Insulin Schedule?

Answer 23

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

Question 24

Somogyi Effect?

Answer 24

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

Question 25

Waning of Insulin?

Answer 25

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

↑ dose or timing

Question 26

Dawn Phenomenon?

Answer 26

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

↑ dose or timing

Question 27

TID Insulin dosing?

Answer 27

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

Question 28

Best control for HgbA1c >9%?

Answer 28

insulin

Question 29

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

Answer 29

A1c ≤ 7.5%
FBG < 200
RBG < 250

Question 30

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

Answer 30

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

Oral agents, Incretins

Question 31

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

Answer 31

A1c > 9%
FBG > 250
RBG > 300

Insulin