Diabetes Flashcards
What is the purpose of fasting blood sugar?
Measure the effectiveness of basal insulin or agents that decrease gluconeogenesis overnight
What is the purpose of premeal blood sugar?
To calculate bolus dose or agents given to improve insulin secretion
What is the purpose of postmeal blood sugar (2hr post prandial)?
Measure the effectiveness of bolus or agents given to increase insulin
Determines needed food changes
What is the purpose of bedtime blood sugar?
To avoid early AM lows from insulin or oral agents
What is a glucose meter? What does it do?
An experimental tool
Determines patterns
Who should receive high vs moderate intensity statin?
Moderate: > 40yo w/ no CV RFs
High: Anyone w/ CV RFs (all ages)
What 2 meds are “high intensity” statins?
Atorvastatin
Rosuvastatin
What are A1c recommendations according to ADA vs AACE/ACE? Which is more stringent?
ADA = < 7.0%
AACE/ACE = ≤ 6.5% (more stringent)
What is the hypoglycemia alert value?
≤ 70
What value is considered clinically significant hypoglycemia?
< 54
If hypoglycemia occurs, what should the pt do?
Consume 15g of simple carbs:
- OJ, milk OR
- 4 glucose tabs OR
- 1 tube glucose gel
Retest BG 15 mins later
If BG < 70, repeat rule of 15
What slows the absorption of sugar?
Fat!
What are sx of hypoglycemia?
Shaking Sweating Fast HR Impaired vision Weakness, fatigue HA, irritable, anxious, dizzy
What are sx of hyperglycemia?
Thirst Frequent urination Dry skin Blurred vision Drowsiness Nausea
What 2 things can cause BG to rise quickly?
Infections
Corticosteroids
What med class decreases glucose absorption?
alpha-glucosidase inhibitors
What 2 meds decrease glucose production?
metformin & insulin
What med class increases glucose secretion?
SGLT2 inhibitors
What 4 med classes increase insulin secretion?
Sulphonylureas
Meglitinides
GLP1 activators
DPP4 inhibitors
What % of A1c should you consider dual therapy?
A1c > 9%
What % of A1c should you consider combination injectable therapy?
A1c > 10%
How often should you monitor A1c?
Every 3-6 mos
What are 5 major concerns when initiating hyperglycemic tx?
Hypoglycemia Wt change CV effects Renal adjustments FDA warnings
What are ADEs of metformin?
GI sx
B12 deficiency
What is the black box warning for SGLT2 inhibitors?
Risk of amputation
What are other risks associated w/ SGLT2 inhibitors?
Bone fx DKA GU infections Volume depletion, hypotension Increased LDL
What is the black box warning for GLP1 activators?
Risk of thyroid c-cell tumors
What are other ADEs of GLP1 activators?
GI sx
Injection site reactions
? Acute pancreatitis
What are ADEs of DPP4 inhibitors?
Acute pancreatitis
Joint pain
Rare: urticaria, facial edema, Steven Johnson syndrome
What is the black box warning for thiazolidinediones?
CHF
What are other ADEs of thiazolidinediones?
Fluid retention Fat accumulation Bone fx Bladder CA Increased LDL
What is the FDA special warning for sulfonylureas?
Increased risk of CV mortality based on studies of tolbutamide
What is an ADE of insulin?
Injection site reactions
What 2 drugs are known to be weight-neutral?
Metformin
DPP4 inhibitors
What 2 drugs cause wt loss?
SGLT2 inhibitors
GPP1 activators
Which sulfonylurea should not be used?
Glyburide
Which GLP1 agonist shows benefit in reducing CV mortality?
Liraglutide
Metformin enhances insulin sensitivity in….
hepatic & peripheral tissues
TZDs enhance insulin sensitivity in….
muscle, liver, & fat
Which TZD can potentially decrease TGs?
Pioglitazone
What drugs have increased risk of hypoglycemia?
Insulin
Sulfonylureas
Metaglinides
What drugs cause wt gain?
Insulin
TZDs
Sulfonylureas
Metaglinides
SGLT2 inhibitors + diuretics can cause….
Orthostatic hypotension
Electrolyte abnormalities
What are 4 ADEs of alpha-glucosidase inhibitors?
Flatulence
Bloating
Abd discomfort
Diarrhea
What drug class can potentially reduce LDL levels by 12-16%?
Bile acid sequestrants
ex. Colesevelam
How should bromocriptine be administered?
Daily w/ food within 2hrs of waking from sleep
*If morning administration is missed, then skip the dose!
How many units of insulin should you start w/?
10U/day OR .1-.2U/kg/day
How should you adjust one’s dose of insulin?
Increase 10-15% or 2-4U once or twice weekly until FBG goal met
Reduction in caloric intake helps w/ _______, whereas exercise helps w/ ______
Wt loss
Wt maintenance
What are ADEs of phentermine (short-term tx for obesity)?
HA Elevated BP & HR Insomnia Dry mouth Constipation Anxiety, palpitations
What are the ADEs of orlistat (lipase inhibitor, long-term tx for obesity) ?
Abd pain/discomfort Oily spotting/stool Fecal urgency Flatulence Malabsorption of fat soluble vitamins & meds
What is the dawn phenomenon?
Surge of hormones produced daily by the body, hours before waking
When is the somogyi effect most likely to occur?
Following an episode of untreated nighttime hypoglycemia –> high blood sugar in AM
How do you correct the somogyi effect?
Check glucose in the middle of the night
Increase food intake or lower insulin in PM
