Diabetes

Question 1

If a pt has Type 1 DM, who should they be co-managed with?

Answer 1

Endocrinologist

Question 2

What is pre-diabetes Dx?

Answer 2

FPG: 100-125 mg/dL
HbA1c: 5.7-6.4%

Question 3

What are Tx for Pre-diabetes?

Answer 3

Diet, exercise (150 min/week), dec EtOH, no tobacco, stress reduction, alternative med support, good sleep

Question 4

Dx of DM II?

Answer 4

FPG: 126 or more
Non-fast PG: 200 or more
Uncontrolled hyperglycemia Sx (polyuria, phagia, dipsia) with non-fast PG
A1c 6.5% or more

Question 5

What should be done at every DM visit?

Answer 5

Monofilament, BP, Foot exam, Peripheral blood flow, BMI, waist circumference

Question 6

What should be done quarterly for DM?

Answer 6

A1c, CMP, UA, Lipids (if not in goal range)

Question 7

What should be done semi-annually for DM?

Answer 7

A1c if on target, neuro exam if not on target

Question 8

What should be done annually for DM?

Answer 8

dilated eye exam (refer)
microalbmin
lipids
CMP (on target)

Question 9

What are the targets for BP, A1c, FPG, Post-pran PG, lipids?

Answer 9

BP <130/80
A1c <6.5%
FPG <110
Post Pran PG <140
LDL <100 (<70 in pts with CAD)
HDL >40 m >50 w
TG <150

Question 10

Guidelines recommend drug Tx to be initiated in all pts with Dx of DM why?

Answer 10

pRevent deterioration of glycemic control

Question 11

NUNM guidelines are what for DM tx?

Answer 11

FPG of 126-139, may Tx 3 months with pre-DM therapeutic recommendations with the intent to start Metformin after 3 month trial if #s still within that range

FPG 140+ or A1c >6.5% then pharm Tx with natural therapy indicated

Question 12

When do you need to refer a pt with DM to the ED?

Answer 12

in office BG of >400

Pt in DKA

Question 13

When do you need immediate pharmaceutical action in pts with DM?

Answer 13

TG >1000 (11 mmol)

Tx with goal of dec to <400

Question 14

What do you do for patient’s with hypoglycemia and on insulin or sulfonylurea therapy?

Answer 14

Administer rapidly absorbed carb (if pt able to swallow)
Administer glucagon 1 mg SubQ if pt unresponsive (BG only INC x 45 min)
Consider 50% dextrose 25-50 mL IV for severe hypoglycemia when pt is under medical care and IV access obtainable
Urgent transfer/admission to hospital needed

Question 15

Pt with new Dx of DM, what are the recommended step up Txs?

Answer 15

Metformin and monitor x 2-3 months for goal <6.5%

If >6.5% after 3 months (intensify lifestyle) and adjust medication

Question 16

After 3 months Tx if H1c is <6.5% what do you do?

Answer 16

Stay the course

Question 17

After 3 months Tx if H1c is 6.5-8.5% what do you do?

Answer 17

If on mono therapy - initiate combo therapy with oral agents or basal insulin + oral agent

If on combo therapy - maximize combo oral medication and/or insulin regimen

Question 18

After 3 months Tx if H1c is <8.5% what do you do?

Answer 18

Initiate insulin or intensify insulin therapy using basal and prandial insulin or premixed preps

Question 19

What’s the first med for 6.5-7% and then some additional options?

Answer 19

Metformin

Thiazolidinedione
Acarbose
Sitagliptin

or
Low-dose sulfonylurea, Meglitinide, Prandial insulin (rapid acting or regular)

Question 20

What’s the meds rec for 7-8%?

Answer 20

Combo of 2
Metformin
Thiazolidinedione
Acarbose
Sitagliptin
sulfonylurea
Meglitinide

Prandial, premixed, basal insulin (glargine or detemir)

Question 21

What’s the meds rec for 8.5-9% A1c after 3 months then?

Answer 21

Combo of oral agents (no Acarbose)

AND OR

Prandial insulin
Premixed insulin
Isophane (NPH) insulin
Basal insulin

Question 22

What’s the meds rec for 9-10% A1c after 3 months then?

Answer 22

Combo of oral agents (no Acarbose, Meglitinide, Sitagliptin)

AND OR

Prandial insulin
Premixed insulin
Isophane (NPH) insulin
Basal insulin

Question 23

What’s the meds rec for >10% A1c after 3 months then?

Answer 23

Prandial insulin
Premixed insulin
Isophane (NPH) insulin
Basal insulin