Diabetes

Question 1

Diabetes diagnosis

Answer 1

fasting BG >125
2 hr post OGTT: >200
A1c >6.5%

Question 2

BG goals

Answer 2

A1c <7%
fasting BG <130
post-prandial BG <180

Question 3

SGLT2 inhibitors

Answer 3

increase glucose excretion
canagliflozin (Invokana)
dapagliflozin (Farxiga)
empagliflozin (Jardiance)
c/i if GFR <30
s/e: yeast/genital infections, AKI, ketoacidosis, risk of amputation

Question 4

DPP-4 inhibitors

Answer 4

decrease glucagon, increase insulin release
sitagliptin (Januvia), saxagliptin (Onglyza), lingliptin (Trajenta)
s/e: pancreatitis, risk of HF w/ saxagliptin

Question 5

GLP-1 agonists

Answer 5

increase insulin secretion, decrease glucagon, slow gastric emptying
liraglutide (Victoza), dulaglutide (Trulicity), albiglutide (Tanzeum)
c/i if CrCl <30
Trulicity, Tanzeum dosed weekly

Question 6

Pramlintide

Answer 6

can use with Type 1 or Type 2 diabetes

inject before meal

Question 7

Initiating Basal/Bolus insulin

Answer 7

Total Daily Dose = 0.6 units/kg/day or 0.6 x weight
divide 50% basal, 50% bolus - divide bolus by 3 for each meal dose
if NPH, 2/3 TDD if NPH, 1/3 is bolus insulin

Question 8

insulin to carbohydrate ratio

Answer 8

rule of 500

500/TDD = grams of carbs covered by 1 unit insulin

Question 9

Correction Factor

Answer 9

Rule of 1800

1800/TDD = BG decrease for each unit insulin

Question 10

Correction Dose

Answer 10

(BG now - BG target) / correction factor

Question 11

Insulin counseling

Answer 11

do not shake, roll vials
if mixing, mix clear before cloudy - NPH is cloudy
inject abdomen, thigh, buttox, upper arm

Question 12

hypoglycemia

Answer 12

BG <70
dizzy, HA, irritable, shaking, sweating, confusion
15 g carbs: 3-4 glucose tabs, 4 oz pop/juice, 1 Tbsp sugar
recheck in 15 min, repeat
glucagon used if unconscious, unable to self treat

Question 13

diabetic ketoacidosis

Answer 13

BG >250, ketones (fruity breath/urine), pH <7.35, anion gap >12

Question 14

drug selection factors

Answer 14

if DM + ASCVD: empagliflozin (Jardiance), liraglutide (Victoza)
if GFR or CrCl <30: avoid metformin, SLT2, exenatide, glyburide
if HF: avoid TZDs, saxagliptin
if peripheral neuropathy, foot ulcers: avoid canagliflozin

Question 15

Major drug risks and side effects

Answer 15

lactic acidosis - metformin
hepatotoxicity - TZDs
UTI/genital infection - SGLT2s
abnormal K - canagliflozin (hyper K), insulin (hypo K)
pancreatitis - DDP-4, GLP-1
ketoacidosis - SGLT2s