Diabetes Flashcards
Alpha-Glucosidase Inhibitors include:
Acarbose (precose), Miglitol (glyset)
Alpha-Glucosidase Inhibitors are used for ___ ___ diabetes, alone or in combination w/a ___.
Type 2, sulfonylurea
The biggest s/e of alpha-glucosidase inhibitors is ___.
flatulence
Thiazolidinediones (aka ____) include:
TZD’s, rosiglitazone (avandia - REMS), pioglitazone (actos)
TZD’s are used as monotherapy or combination w/___, ___, or ___ for ___ ___ diabetes.
metformin, sulfonylurea, insulin, type 2
Biggest s/e of TZD’s is ___ and ___.
weight gain, edema
alpha-glucosidase inhibitors work in the ___ to delay ___ absorption.
gut, glucose
TZD’s work inside ___ to increase ___.
cell, GLUT4
TZD’s have ___ onset and take ___-___ weeks to reach full effect.
slow, 6-8
DPP-IV inhibitors (aka ____) include:
gliptins, saxagliptin (onglyza), sitagliptin (januvia), linagliptin (tradjenta)
Glucagon-like peptide: GLP-1 are ___ and include:
injections, exenatide (byetta), liraglutide (victoza)
MOA for GLP-1 is to: replace ___ phase insulin release, enhance BG-dependent ___ secretion, suppress elevated ___, and slow gastric ___.
first, insulin, glucagon, emptying
A s/e of combination therapy of GLP-1 and sulfonylurea is ___. Not seen in combination w/___.
hypoglycemia, metformin
GLP-1 help pt to feel ___ sooner so they eat ___ and have weight ___.
full, less, loss
Black-box warning for GLP-1 is ___ tumors.
thyroid
Exenatide is associated w/significant weight ___ in Type 2 DM.
loss
GLP-1 receptor analogs added to ___ are associated w/ better ___ control and ___ weight gain.
insulin, glycemic, less
___, ___, and ___ tumors have been observed in pts taking GLP-1’s.
pancreatitis, nausea, thyroid
GLP-1’s have been shows to decrease ___ risk factors, like b/p, cholesterol, triglycerides, and free fatty acids.
CVD
colesevelam HCL (welchol) is the only ___ ___ ___ indicated for the management of Type 2 diabetes (along w/management of lowering ___ levels).
bile acid sequestrant, LDL
As far as dietary therapy for Type 2 diabetes, ___% should be carbs, ___% should be protein, and less than ___% should be fats.
50, 20, 30
Carb budgeting is important. For females, it is ___-___ carb servings per meal. For males, it is ___-___-___ carb servings per meal.
2-3, 3-4-5
Important to do ___ minutes of exercise/day, or at least ___ minutes/week for diabetic pt’s. Wt loss requires ___ minutes of exercise/day.
30, 150, 60
___ is the leading cause of adult blindness, kidney disease, and non-traumatic amputations.
Diabetes
Ethnic groups have a 2-3 time ___ risk than caucasians for developing ___.
higher, diabetes
DM criteria for being dx: 1) a fasting plasma glucose of > ___, 2) a random plasma glucose > ___, 3) an oral glucose tolerance test w/BG > ___, and 4) HbA1c > ___%.
126, 200, 200, 6.5
What are the 3 “poly’s that accompany Type 2 diabetes?
polyphagia, polyuria, polydipsia
Common s/s of Type 2 diabetes include ___, ___ vision, ___ infections.
fatigue, blurry, yeast
Pre-diabetes is impaired glucose tolerance level ___-___ or impaired fasting glucose ___-___.
140-200, 100-126
Secondary diabetes is d/t ___ disease, meds like ___, ___, or ___.
pancreatic, prednisone, hormones, genetics
Gestational DM presents in the ___ or ___ trimester. Dx using criteria of: FBS > ___, at 1hr > ___, at 2hrs > ___.
second, third, 92, 180, 153
Drug therapy for gestational DM includes: ___, ___, ___.
insulin (safest), metformin, glyburide
Targets for glycemic control: A1c = ___%, fasting/premeal = ___-___, postprandial = < ___, bedtime = ___-___.
6.5, 70-110, 140, 100-140
C-Peptide test used to dx both Type 1 and Type 2 and confirms whether a pt is producing ___.
insulin
Fructosamine is a diabetes test that gives ___ ___ over last 7-10 years.
average BS
Urine glucose test is not as ___.
precise
Biguanide Metformin (glucophage) is indicated for ___ ___ diabetes, alone or in combination w/___, ___, or ___.
Type 2, DPP4’s, GLP-1 agonists, sulfonylureas
MOA for Metformin is: ___ hepatic glucose production, ___, and ___. It also ___ intestinal absorption of glucose, ___ insulin sensitivity, and ___ peripheral glucose uptake and utilization.
decreases, glycogenolysis, gluconeogenesis, decreased, improves, increases
Clinical therapy for metformin is to initially start dose at ___mg at ___-time, then eventually increase to ___ for a total of ___mg/day. Clinical therapeutic dose is ___mg/day.
500, supper, bid, 1000, 2000
Avoid using ___ in pt’s w/heart failure or decreased kidney function.
metformin
You should stop Metformin ___ hrs before using ___ ___ and do not restart until ___ hrs after procedure.
24, iodinated contrast, 48
Sulfonylureas (2nd generation) and is used as ___-line treatment only for pt’s w/low income and include:
second, glipizide (glucotrol), glyburide (diabeta), micronized-glyburide (glynase), glimepiride (amaryl)
Use ___ alone. MOA is to increase ___ cell insulin secretion.
sulfonylureas, beta
S/E of sulfonylureas is weight ___.
gain
Meglitinides: D-Phenylalanine include: ___, ___. Cause a ___ of insulin to be released so given immediately ___ meals.
repaglinide (prandin), nateglinide (starlix), bolus, before
Barriers to initiating insulin therapy for patients include: ___ resort, ___ of injection, fear of ___ and weight ___.
last, fear, hypoglycemia, gain
For every 1% drop in A1c = ___ lb weight gain for pts typically.
10
___ cells fail over time.
Beta
Should take Lispro and Glulisine ___-___ mins prior to mealtime.
15-30
Rule for basal insulin = body ___ in lbs x ___%. Example: 210 lbs x 10% = 21 units insulin.
weight, 10
Pt’s tend to have more insulin resistance in the ___, so may need a ___ dose of insulin before ___.
morning, higher, breakfast
___ injections is the GOLD standard insulin regimen. They receive it ___ times/day at mealtime, which would be ___-acting. Then do ___-acting at bedtime.
Multiple, 3, rapid, long
Rapid-acting insulins include: ___, ___, and ___. Long-acting insulins include: ___ and ___.
humalog, novalog, apidra, lantus, levemir
Amylin analog includes: ___. It is given at ___ and is indicated as an adjunct therapy in pt’s who use mealtime insulin therapy already and have ___ to achieve desired glucose control.
pramlintide (symlin), mealtime, failed
pramlintide (symlin) is an ___ given to pt’s w/ Type 1 or Type 2 DM not controlled by ___. Also helps pt’s to feel ___, so weight ___.
injection, insulin, full, loss
pramlintide (symlin) is not appropriate for pt’s w/: poor ___ w/current insulin regimen, A1C > ___%, recurrent ___, dx of ___, ___.
compliance, 9.0, hypoglycemia, gastroparesis, pediatrics
Role of SGLT-2 inhibitors ___ glucose reabsorption in proximal ___ ___.
inhibit, renal tubules
Targets for lipids, b/p, and microalbumin: LDL < ___, HDL ___-___, total cholesterol < ___, triglycerides < ___, b/p < ___/___, microalbumin < ___.
100, 45-55, 200, 150, 130/80, 30
Things to be performed at every visit: ___ and ___ exam.
Every 3-6 months: check ___ level.
Annually: ___ exam, ___ levels, check ___.
b/p, foot
A1C
eye, lipid, microalbumin
___ hormones GLP-1 and GIP are released by the ___ throughout the day that nudge the pancreas to increase insulin secretion in response to a ___.
Incretins, intestine, meal
Glimeperide/Glucatrol XL may provide better ___ hr coverage.
24
Glipizide/Gluburide may be more effective for ___-___ blood glucose.
post-prandial
Glipizide/Glimeperide better to use in pt’s w/impaired ___ function.
renal
___ increase ovlulation, so increases pregnancy. Good for ___ pt’s. Also have higher risk of ___ CA. Do not use in pt’s w/___.
TZD’s, PCOS, bladder, CHF
You know TZD’s are working when they ___ weight.
gain
Black-box warning for GLP-1’s is ___ tumors.
tumors
GI s/e of delayed gastric emptying and n/v is more likely in ___ than in ___.
GLP-1’s, DPP-IV’s
Eat slowly after injections of ___ to prevent the s/e of nausea. It make’s you feel ___ sooner.
GLP-1’s, full
Regular exercise lowers ___, improves plasma ___ levels and ___ activity.
b/p, lipid, fibrinolytic
___ cells decline/fail over time.
Beta
Type 2 diabetes loses ___-___ insulin.
first-phase
___ injections is the Gold standard for insulin. You want to use rapid-acting of ___, ___, or ___ at mealtimes (3 x/day), and long-acting of ___ or ___ at bedtime.
Multiple, humalog, novolog, apidra, lantus, levemir
Pramlintide (Symlin) is started at ___ units for Type 2 and increased to ___. For Type 1, start at ___ units and increase by ___ units every 3 days to max of ___ units.
60, 120, 15, 15, 60
