Diabetes Flashcards by Kristin Blanding

Alpha-Glucosidase Inhibitors include:

Acarbose (precose), Miglitol (glyset)

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Alpha-Glucosidase Inhibitors are used for ___ ___ diabetes, alone or in combination w/a ___.

Type 2, sulfonylurea

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The biggest s/e of alpha-glucosidase inhibitors is ___.

flatulence

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Thiazolidinediones (aka ____) include:

TZD’s, rosiglitazone (avandia - REMS), pioglitazone (actos)

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TZD’s are used as monotherapy or combination w/___, ___, or ___ for ___ ___ diabetes.

metformin, sulfonylurea, insulin, type 2

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Biggest s/e of TZD’s is ___ and ___.

weight gain, edema

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alpha-glucosidase inhibitors work in the ___ to delay ___ absorption.

gut, glucose

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TZD’s work inside ___ to increase ___.

cell, GLUT4

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TZD’s have ___ onset and take ___-___ weeks to reach full effect.

slow, 6-8

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DPP-IV inhibitors (aka ____) include:

gliptins, saxagliptin (onglyza), sitagliptin (januvia), linagliptin (tradjenta)

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Glucagon-like peptide: GLP-1 are ___ and include:

injections, exenatide (byetta), liraglutide (victoza)

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MOA for GLP-1 is to: replace ___ phase insulin release, enhance BG-dependent ___ secretion, suppress elevated ___, and slow gastric ___.

first, insulin, glucagon, emptying

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A s/e of combination therapy of GLP-1 and sulfonylurea is ___. Not seen in combination w/___.

hypoglycemia, metformin

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GLP-1 help pt to feel ___ sooner so they eat ___ and have weight ___.

full, less, loss

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Black-box warning for GLP-1 is ___ tumors.

thyroid

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Exenatide is associated w/significant weight ___ in Type 2 DM.

loss

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GLP-1 receptor analogs added to ___ are associated w/ better ___ control and ___ weight gain.

insulin, glycemic, less

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___, ___, and ___ tumors have been observed in pts taking GLP-1’s.

pancreatitis, nausea, thyroid

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GLP-1’s have been shows to decrease ___ risk factors, like b/p, cholesterol, triglycerides, and free fatty acids.

CVD

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colesevelam HCL (welchol) is the only ___ ___ ___ indicated for the management of Type 2 diabetes (along w/management of lowering ___ levels).

bile acid sequestrant, LDL

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As far as dietary therapy for Type 2 diabetes, ___% should be carbs, ___% should be protein, and less than ___% should be fats.

50, 20, 30

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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

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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

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___ is the leading cause of adult blindness, kidney disease, and non-traumatic amputations.

Diabetes

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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.

___ 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.

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