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Boards > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Type I DM described

A

autoimmune process involving beta cell destruction resulting in insulin deficiency

short hx of symptoms
weight loss
ketonuria
polydipsia
polyphagia
polyuria
child or young adult
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2
Q

Type 2 DM described

A

insulin resistance with insulin def eventually
few if any symptoms
dx during routine screening

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3
Q

What age should testing for DM start if no symptoms

A

45

screen every 3 years

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4
Q

Other criteria to suggest DM testing

A 
BMI >25
physical inactivity
1st degree relative with type 2
women who have had baby > 9lbs or GM
HTN
women with PCOS
HDL < and triglycerides >250
acanthosis nigricans
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5
Q

High risk ethnicity for DM

A 
African American
Latino
Native American
Asian American
Pacific Islander
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6
Q

Tests for dx of DM

A

plasma glucose
glucose tolerance test
A1C

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7
Q

plasma glucose for DM dx

A

Fasting > 126

Random draw >200 with symptoms of polyphagia, polyuria, polydipsia

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8
Q

glucose tolerance test for DM dx

A

2 h glucose of >200 after 75g loading glucose dose

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9
Q

A1C for DM dx

A

> 6.5%

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10
Q

Pre DM according to tests

A

Fasting 100-125
Glucose tolerance test 140-199
A1C 5.7-6.4

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11
Q

Target A1C in those dx with DM

A

<7%

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12
Q

Target fasting BS in those dx with DM

A

70-130

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13
Q

Post prandial BS in those dx with DM

A

<180

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14
Q

Target bedtime BS for those dx with DM

A

90-150

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15
Q

How often to draw A1C in pts with DM

A

2 x a year who are meeting goals and are stable

4 x a year for those how tx is changing or not well controlled

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16
Q

Target A1C for older adults

A

<8%

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17
Q

Sulfonylurea meds for DM tx

A

glipizide
glyburide
glimepride

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18
Q

Sulfonylurea mechanism of action

A

insulin secretague

reduce A1C by 1-2%

19
Q

Facts about sulfonylureas

A

adjust for renal impairment
potosensitizing
less effective with > 5 years use

20
Q

Biguanide meds for DM tx

A

metformin

21
Q

Buguanide mechanism of action

A

reduces hepatic glucose production and intestinal glucose absorption and insulin sensitizer via increased glucose intake
A1C reduction of 1-2%

22
Q

Facts about Buganide

A

monitor creatinine
avoid in heart failure
with contrast or surgery d/c for day before and 2 days following until you know renal fx at baeline
risk of B12 deficiency

23
Q

Thiazolidinedione meds for DM tx

A

Pioglitazone (actos)

24
Q

Thiazolidinedione mechanism of action

A

insulin sensitizer at PPAR receptors of muscle and adipose tissue
A1C reduction 1-2%

25
Q

Facts about Thiazolidinedione

A 
risk of hepatic toxicity: monitor ALT
edema risk
no in heart failure
not to be used with insulin or nitrates
can be associated with risk of bladder cancer
26
Q

Glucagon like peptide 1 agonists meds (GLP-1) for DM tx

A

exenatide (byetta)
Liraglutide (vitoza)
injections

27
Q

Glucagon like peptide 1 agonists mechanism of action

A

stimulates insulin production in response to increase in plasma glucose, inhibits PP glucagon release
slows gastric empyting
A1C reduction 1-2%

28
Q

Facts about Glucagon like peptide 1 agonists

A 
can cause n/v
 no in gastroparesis
no in hx of pancreatic issues
caution in renal impairment: if Cr CL <30 no
can use with insulin
29
Q

Dipeptidly peptidase 4 inhibitor (DPP-4) meds for DM tx

A

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

30
Q

Dipeptidly peptidase 4 inhibitor (DPP-4) mechanism of action

A

increase levels of incretin

increasing synthesis and release of insulin from pancreatic beta cells and decreasing release of glucagon

31
Q

Facts about Dipeptidly peptidase 4 inhibitor (DPP-4)

A

adjust for renal impairment
well tolerated with little hypoglycemic risk
combine with metformin or TZD
monitor for pancreatitis

32
Q

Alpha-glucosidase inhibitor meds for DM tx

A

acarbose

migitol

33
Q

Alpha-glucosidase inhibitor mechanism of action

A

delays intestinal carb absorption by reducing postprandial digestion of startches and disaccharides

34
Q

Facts about Alpha-glucosidase inhibitor

A

taken with 1st bite of meal
helpful for postpradial hyperglycemia
gas producing
avoid with inflammatory bowel disease and impaired renal fx

35
Q

When to use insulin in type 2 DM

A

At time of Dx to achieve control when glucose >250
When acutely ill: try to keep BS 140-180
When 2 oral agents don’t maintain control

36
Q

Lispro insulin (Humalog) onset/peak/duration

A

Onset: 15-30 min, give 15 min of eating
Peak: 30 min - 2.5 hr
Duration: 3-6.5 hr

37
Q

Aspart insulin (Novolog) onset/peak/duration

A

Onset: 10-20 min, give 5-10 min before meals
Peak: 1-3 hr
Duration: 3-5 hr

38
Q

Glulisine insulin (Apidra) onset/peak/duration

A

Onset 10-15 min, give right after meals
Peak: 1-1.5 hr
Duration: 3-5 hours

39
Q

Regular insulin (Humulin R, Novolin R) onset/peak/duration

A

Onset: 30min-1 hour
Peak: 2-3 hr
Duration 4-6 hr

40
Q

Intermediate acting insulin (NPH, Novolin N, Humulin N)

A

Onset: 1-2 hr
Peak: 6-14 hr
Duration 16-24 hr

41
Q

Long acting insulin (Lantus) onset/peak/duration

A

Onset: 1 hr
Peak: None
Duration: >24 hr

42
Q

Long acting insuline detemir solution (Levemir) onset/peak/duration

A

Onset: 1-2 hr
Peak: 6-8 hr
Duration: Albumin bound, 12 hr for .2 units/kg and 24 r for .4 nits/kg

43
Q

Steps for drug therapy in Type 2 DM

A

counsel pt’s regarding lifestyle modifications
add metformin
draw A1C in 3 months and if not in target then add a medication
If A1C not met in with 2 agents then consider a 3rd

44
Q

Additional care considerations for Type 2 DM

A

aspirin 75mg or and ACE or ARB
beta blocker if at risk for MI
check creatinine, GFR and urine microalbumin annually
limit trans and saturated fats
physical activity >150min/wk
eye exam annually
foot exam each visit with 10g monofilamient

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