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Board Review > Diabetes > Flashcards

Diabetes Flashcards

1
Q

risk factors for diabetes

A 
family history and ethnicity
overweight BMI > 25kg/m2
prediabetes 
history of gestational diabetes 
poor diet and low physical inactivity
HTN
Hx cardiovascular disease
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2
Q

which two drug classes are most commonly cause hyperglycemia?

A

protease inhibitors and corticosteroids

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3
Q

which atypical antipsychotic is most likley to cause hyperglycemia?

A

olanzapine (zyprexa)

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4
Q

which two anti rejection meds cause hyperglycemia?

A

cyclosporine and tacrolimus

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5
Q

symptoms of hyperglycemia

A 
polyphagia
polyuria
polydypsia
blurred vision 
fatigue
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6
Q

macrovascular complications of diabetes

A

CAD (HTN, MI, HF)
CVD (TIA/stroke)
PAD

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7
Q

microvascular complications of diabetes

A

retinopathy
nephropathy
peripheral neuropathy
autonomic neuropathy

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8
Q

why do patients with diabetes get erectile dysfunction and gastroparesis?

A

they are suffering from autonomic neuropathy,which is damaget to autonomic nerves that control digestion, HR, prespiration, blood pressure

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9
Q

three best ways to lose weight

A

reduce calorie intake
choose nutrient dense foods
exercise

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10
Q

goal of weight loss?

A

lose 10% over 6 months which is about half to 2 pouonds per weeks
waist circumference less than 35 woemn and <40 males

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11
Q

what are some nutrient dense foods to eat?

A 
vegetables 
fruits 
whole grains
fat free or low fat milk
seafood
lean meats 
eggs
beans and legumes
nuts and seeds
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12
Q

what is one serving of carbohydrates?

A

15grams

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13
Q

how many carb servings for diabetics to eat

A

3-4 servings per meal and 1-2 per snack

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14
Q

why should diabetics avoid alcohol?

A

it exacerbates hypoglycemia and can calso cause hyperglycemia depending on the alcohol

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15
Q

max intake for alcohol in diabetics

A

1 drink for women

2 drinks for men (per day for both)

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16
Q

what are the recommended exercise for diabetics?

A

aerobic exercise: 30 minutes x 5 days per week

Resistance : 2 times per week

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17
Q

what does the A1c measure

A

it measures the average blood glucose of the past 2-3 months

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18
Q

how often should the a1c be measured?

A

if they are not controlled: quarterly (every 3 months)

If they are controlled (at a1c goal) then twice per year

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19
Q

what does the ADA says are the goal for A1c for diabetics?

A

7.0%

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20
Q

ADA goal for blood glucose before and after eating

A

before eating 70-130 mg/dl

1-2 hours after the start of the meal <180mg/dL

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21
Q

AACE a1c goals

A

<= to 6.5

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22
Q

AACE blood glucose goal before and after meals

A

before <140mgdl

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23
Q

when should the a1c goal be more stringent ? when should you aim toward the lower end?

A

when the patients are younger adults and not experiencing hypoglycemia

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24
Q

when should your a1c goal be less stringent?

A 
people with severe hypoglycemia
limited life expectancy
extensive comorbid conditions 
advanced complications 
longstanding diabetes hard to reach goal
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25
Q

what is the estimated average glucose for patients? eAG goal?

A

goal is less than 154 mg/dl

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26
Q

correlation of a1c with blood sugars (average)

A 
a1c 6 to 126 
7 to 154
8 to 183
9 to 212
>10 to 200+
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27
Q

first line bp meds for diabetics? why?

A

ACE inhibitors
ARBs
because they decrease progression to diabetic nephropathy

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28
Q

LDL goal for diabetics

A

< 100mg/dL in patient without overt CVD. if patients have overt CVD goal 40 in men goal and >50 in women
TGs should be less than 150

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29
Q

what is the usual ASA dose for dm patients to take daily?

A

75- 162 mg daily (usually ASA 81mg EC) .

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30
Q

what is an alternative to ASA if allergy?

A

clopidogrel 75mg po qd

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31
Q

which diabetes patietns should receive ASA tx?

A

if 10 year risk is >10% which includes men > 50, women > 60 with at least one major risk factor: fan history of CVD, htn, smoking, syslpidemia, or albuminuria

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32
Q

how often should patients receive a urine test for albumin?

A

once every year starting at the time of diagnosis for ppl with dm 2. for ppl with DM1 starting with 5 years after diagnosis

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33
Q

define microalbuminuria?

A

if protein found in urine is 30-299 mg/day

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34
Q

what defines macroalbuniuria?

A

urnie protein level > 300mg/day

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35
Q

how often should a comprehensive eye esame be performed?

A

once a year. Longer intervals of 2-3 years ok if if patin has had normal eye exams and is well contorlled

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36
Q

how often should diabetics get a foot exam?

A

once a year

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37
Q

how often should diabetics inspect their feet?

A

once daily

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38
Q

foot care for diabetics

A

look for any new changes
clean feet and dry, apply lotion sparingly, not between the toes, trim nails carefully
don’t walk barefoot
wear proper fitting comfortable shoes

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39
Q

which vaccines should diabetics receive? and how often

A

influenza every year
pneumococcal: every patient > 2yo one time. Repeat the vaccination if patient is 65 or older and their first vaccination was more than 5 years ago.
hepatitis B in patients 19-59 years of age

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40
Q

for how long do you try each agent in order to try adding another one?

A

3 motnhs.

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41
Q

MOA of metformin

A

decreasing hepatic glucose production primarily

also knone to decrease intestnal absorption of glucose and improve insulin sensitivity

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42
Q

brand metformin

A

Glucophage, fortamet, glumetza

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43
Q

available metformin strengths

A

500, 850, 1000

ER: 500, 750, 1000

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44
Q

max daily dose of metformin allowed?

A

2550mg (850 TID)

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45
Q

Combo brand with met + glyburide?

A

Glucovance

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46
Q

combo brand with sitagliptin?

A

janumet

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47
Q

what dose start for metformin

A

IR : 500mg po daily to BID or 850 mg daily

ER: 500 - 1000mg with dinner

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48
Q

what is the black box warning for metformin?

A

can cause lactic acidosis

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49
Q

what is lactic acidosis? symptoms?

A 
having an acidic ph in the blood with a buildup of lactate
Sx: muscle soreness 
hyperventilation 
abdominal pain 
lethargy 
slow heart rate
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50
Q

when is metformin contraindicated?

A

in males Scr > 1.5mg/dl or >1.4 females
if Clcr < 60ml/min
if metabolic acidosis
stop if patient in a state of hypoxia, such as resp failure, sepsis, decompsated heart failure

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51
Q

metformin side effects

A

NVD
flatulence
long term vit b12 deficiency

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52
Q

advantages of metformin

A

weight neutral

no hypoglycemia!

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53
Q

labs to monitor for metformin

A

A1c
SCR
BUN
FBG

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54
Q

what category for pregnancy for metformin

A

B

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55
Q

what should you do if a patient is going to get IV contrast dye and is on metformin?

A

hold the met prior to dose, and wait 48hrs after procedure to take the next dose

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56
Q

what two agents taken with metformin have drug interacitions?what is the interaction

A

alcohol and iodinated contrast dyes increase the risk of lactic acidosis

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57
Q

patient counseling for metformin

A

take with meals (morning and evening). for once daily take with evening meal
GI sx: N/V/D abd discomfort

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58
Q

MOA of Sulfonylureas?

A

stimulate insulin secretion from beta cells

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59
Q

chlorpropamide brand name

A

diabinese

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60
Q

glipizide brand name

A

glucotrol

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61
Q

glimepiride brand

A

amaryl

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62
Q

glyburide brand

A

DiaBeta

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63
Q

max glipizide per day

A

20 mg

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64
Q

normal dose of glipizide

A

IR 5-10mg bid

XL 2.5-10 po daily

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65
Q

normal dose of glyburide

A

1.25-5mg daily

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66
Q

max glyfuride dose

A

20mg/day

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67
Q

side effects of sulfonylureas

A

hypoglycemia

weight gain

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68
Q

monoitoring for SUs

A

FBG, A1C

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69
Q

what not used the first generation SUs?

A

they cause long-lasting hypoglycemia

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70
Q

what is the pregnancy category for SUs

A

C

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71
Q

how does renal funciton affect glyburide?

A

it has an active metabolite that is renally cleared. IT accumlates if dysfunciton so doent use in pateints with CrCl < 50ml/min

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72
Q

should glyburide be used in the elderly population?

A

no because it has an increased risk of hypoglycemia

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73
Q

what time of the day to take sulfonyl ureas?

A

if once daily: with BF

if twice daily: with

74
Q

which bile acid binding resing can lower blood glucose ?

A

welchol

75
Q

dosing for welchol

A

6 tabs po daily with meal and liquid
3 tabs po bid with meal and liquid
3.75 g packed daily
1.875g bid dissolved in water

76
Q

how much does the welchol lower A1C?

A

0.5%

77
Q

common side effects of welchol?

A

constipation
dyspepsia
nausea
abdominal pain

78
Q

pregnancy category of welchol?

A

B

79
Q

which medications should be taken 4 hours before welchol?

A 
levothyroxine
glyburide
cyclosporine
oral contraceptives 
take welchold 4-6 hours before niaspan
80
Q

what is the MOA of bromocriptine to lower BG?

A

dopamine agaonist and works in the CNS to decrease insulin resistance

81
Q

can a pregnant women use bromocriptine?

A

yes preg category B but contrainidicated if she is nursing

82
Q

which is the only insulin that does not have a concentration of 100Units/ml?

A

Humulin R has U-500 or 500Units/ml

83
Q

name the three rapid acting insulins?

A

Aspart (Novolog)
Lispro (Humalog)
glulisine (Apidra)

84
Q

when should someone inject themselves with rapid acting insulins?

A

inject up to 15 min prior to eating or may inject immediately after a meal

85
Q

what are the names of the regular insulin?

A

humulin R

Novolin R

86
Q

when should you inject the regular insulin?

A

30 minutes before a meal but not after a meal due to risk of hypoglycemia

87
Q

duration of action of reuglar insulin?

A

4-6 hours

88
Q

Name of NPH insulins?

A

Humulin N

Novolin N

89
Q

what is the onset of action of NPH?

A

1-2 hours

90
Q

what is the duration of action of NPH?

A

8-12 hours Up to 24 hours

91
Q

what are the names of hte long-acting or basal insulins?

A 
insulin detemir (Levemir)
insulin glargine (lantus)
92
Q

how often per day to dose NPH?

A

once or twice daily

93
Q

how often to dose long acting insulins?

A

once or twice daily

94
Q

how long is the onset of detemir vs glargine?

A

detemir is 4 hours

glargine is 2 hour

95
Q

duration of rapid acting insulins?

A

3-5 hours

96
Q

what is the starting dose for a patient with type 1 diabetes?

A

0.6 units/ kg/day which is the TDD

97
Q

if using basal-bolus insulin combination ofr type 1 diabetes, how do you divide up the insulin?

A

50% of the TDD is the basal

50% is the bolus insulin (which again is divided TID for each meal)

98
Q

if using NPH-Regular insulin combination ofr type 1 diabetes, how do you divide up the insulin?

A

2/3 of TDD is NPH

1/3 is the regular insulin (which is usually dosed BID

99
Q

what is the rule of 500 and how do you use it?

A

is the rule that allows patients to calculate how many grams of carbs are covered by 1 unit of insulin

Equation– 500/TDD = grams of carbs covered by one unit of insulin

100
Q

correction factor 1800 rule

A

1800/TDD = correction factor

101
Q

Corrrection dose:

A

(Blood glucose now- Target blood glucose) / correction factor = correction dose

102
Q

what is the starting dose of insulin for long acting or NPH insulin for type 2 diabetes?

A

10 units QHS

or 0.2 U /kg

103
Q

what do you if a patient is getting hypoglyecemic episodes wit htheir isnulin or is getting a FPG of < 70?

A

reduce bedtime dose by 4 units or 10% whichever is greater

104
Q

what is the target range for blood glucose for patients?

A

70-130 mg/dl

105
Q

what is the target A1C?

A

< or = to 7%

106
Q

by how much do u increase the insulin when not at BG?

A

can increase by 2 units about ~ 3 days utlnil FPG are at target range.

107
Q

when do you check again if the A1C is at goal?

A

in 2-3 months

108
Q

insulin administration teaching

A
  1. wash hands and lay out supplies
  2. check insulin for any discoloration, crystals or lumps
  3. clean skin site of injection and wipe top of insulin vila with alcohol swab
  4. Inject equal volume of air into vial that is going to be taken out to avoid negative pressure. Avoid bubbles in syringe
  5. Inject in abdomen at least 1 inch away from navel. Rotate injection site.
109
Q

why rotate injection site of insulin administration?

A

avoid inflammation and atrophy

110
Q

what other areas can you inject the insulin?

A

the lateral thighs and the posterior upper arm

111
Q

whats the goal A1C in gestational diabetes?

A

<6%

112
Q

what are the goal BG for gestational dm

A

pre prandial < 140

2 hours after eating <120

113
Q

what constitutes 15 g of rapidly absorbed carbs?

A 
1/2 cup of juice or soda
1 cup of milk
1 tablespoon of sugar or honey 
2 tables spoons of raisns 
4-5 saltine crachkers
3-4 glucose tabs
114
Q

what is the dose for an unconscious patient with hypoglycemia?

A

glucagon 1mg SC, IM or IV

115
Q

symptoms of DKA

A

hyperglycemia, polyuria, polyphagia, polydypsia, blurred vision

metabolic acidosis (fruity breath, dyspnea) and dehydration

116
Q

DKA lab abnormaltiels

A 
Glucose >300
ketones in urine and lbood 
pH, 7.2, 
HCO3 <15meq/l
WBC 15-40 cells /mm3
117
Q

what is the treatment for DKA?

A

IV fluids and insulin and electroltes

Usually given Normal Saline, then 1/2 NS then correcting potassium

118
Q

what does insulin do to potassium levels?

A

drives the potassium into the cell

119
Q

MOA of meglitinites?

A

stimulate insulin secretion

120
Q

side effects of meglitinites?

A

hypoglycemia
weight gain
URTI

121
Q

which is more effective prandin or starlix?

A

prandin is slightly more effective than starlix

122
Q

pregancy category for meglitindes

A

C

123
Q

what medications can be used in pregnant women for BG control?

A

insulin (NPH and regular are FDA approved but others are used too)
Metformin :)
GLyburide (but not in the first trimester)

124
Q

what tow atnibitoic types can cause hypoglycemia?

A

FQs

SMX/TMP

125
Q

how do you take meglintinides

A

15-30 min before meals. If you skip a meal, skip your dose

126
Q

symptoms of hypoglycemia

A 
hunger 
shakinees
irritability 
headache 
sweaty 
confusion 
fast heartbeat
127
Q

MOA of TZDs

A

increase insulin sensitivity

128
Q

by how much does each drug class lower A1C?

A 
metformin 1-2% 
SU- 1-2% 
Meglitinides 0.5-1.5%
TZDs 0.5-1.4% 
Alphaglucosidase 0.5-0.8%
DPP4= 0.5-0.8% 
GLP-1= 0.5-1%
129
Q

pioglitazone strengths

A

15, 30, 45 mg (max ) once daily

130
Q

bbw for actos?

A

Can excacerbate HF NYHA class 3/4

131
Q

SE of pioglitazone

A 
peripheral edema
WT gain 
CHF 
increase fracture risk 
increase risk of bladder cancer if used for longer than 1 year
132
Q

preganancy category pioglitazone?

A

C

133
Q

how long does ti take to lower blood glucose with TZDs

A

several weekas

134
Q

MOA of Alpha glucosidase inhibitors

A

inhibits alpha glucosidase inhibitorswhic leads to delayed absorpiton of glucose

135
Q

how do you take the alpha glucosidase inihbitors (carbose dosing)

A

start at 25mg wti first bite of each meal. Increase by 25 mg every 1-2 months (max 300mg/day ) divided dose

must take with food and wit hfull glass of water

136
Q

side effects of acarbose?

A

flatulence
diearrhea
abdominal pain
contraindicated in IBD , colonic ulceration or complete bowerl obstruction

137
Q

advantages of acarbose?

A

increase HDL, dec TG, dec TC
weight neutral
Pregnancy category B

138
Q

how often do you check LFTs with acarbose?

A

q 3 montht in the first year

139
Q

does flatulence stay with acarbose?

A

goes away with time

140
Q

MOA of DPP 4 inhibitors

A

inhibits dPP4 enzymes which mormall break down increntin hormones. As a result, there are more incretin hormones and this leads to increase insulin secretion, decreases glucagon secretion, decrease hepatic glucose production

141
Q

advantages of sitagliptin

A

pregnancy category B

weight neutral

142
Q

januvia dose

A

100mg po qd if clcr <30ml/min use 25mg po qd

143
Q

Side effects of januvia?

A

p

144
Q

symptoms of pancreatitis

A

severe stomach pain that does not go away +/- vomiting

145
Q

when should you take januvia?

A

in the morning plus or minus food

146
Q

MOA GLP-1 Agonists

A 
analogs of GLP-1
increase insulin secretion 
decrease gluacong secreation 
slow gastric emptying 
increase satiety
can have weight loss!
147
Q

brand name exenatide?

A

byetta or bydureon

148
Q

what is the brand name for liraglutide?

A

victoza

149
Q

where do you inject exenatide?

A

abdomin, SC, count to five

150
Q

how long is exenatide stable at room temperature?

A

30 days

151
Q

which patients are at risk for pancreatitis with exenatide?

A

history of pancreatitis
alcoholism
high triglycerides
gallstones

152
Q

when should you avoid exenatide?

A

clCr<30 ml/min

pancreatitis risk

153
Q

exenatide pregnancy category

A

C

154
Q

SE exenatide?

A

*Nausea
V/D
hypoglycemia
weight loss

155
Q

when to take byetta?

A

twice daily QAM and QPM, 30-60 min before meals

156
Q

stroage of exenatide?

A

room temperature after fisrt use at 25 degrees C but not more
dont freeze and protect from light
remove needles when storing to avoid air bubbles in pen`

157
Q

what to do about the nausea caused by byetta?

A

consume adequate liquids if vomiting

decreases with time

158
Q

MOA of pramlintide?

A

synthetic analog of amylin. Amylin slows gastric emptying prevents glucagon increase after a meal, increases satiety

159
Q

BBW of pramlintide?

A

if co administered with insulin , can lead to severe hypoglycemia

160
Q

when how to take pramlintide?

A

inject in the abdomen prior to meals

161
Q

main SEs of pramlintide?

A

hypoglycemia*
Nausea
anorexia

162
Q

if you are taking pramlintide and insulin, how do you adjust the dose?

A

decrease the insulin dose by 50% of the rapid acting, short acting and mixed insulins

163
Q

what is the ADA definition of PRE diabetes?

A

FPG between 100 but < 126 or A1C from 5.7 to 6.4 %

164
Q

how can pre-diabetics prevent or delay diabetes?

A

> 150minutes exercise per week with healthy eating
if above IBW , goal is to lose 5% weight
adding metformin is optional

165
Q

what does the ADA define as impaired glucsoe tolerance?

A

level of 140-199 mg /dl from 1-2 hours post 75g OGTT

166
Q

if a person has gestational diabetes, when should they be screened for diabetes?

A

6 weeks after delivery and then at least annually after that

167
Q

what screening tests are good for diabetes and prediabetes?

A

FPG after 8 hour fasting

A1C is acceptable as an alternative

168
Q

who should receive aspirin therapy?

A

type 2 diabetics with > 20% 10 year risk for CVD and may prescribe if 10-20% 10 year risk

169
Q

where do you calculate the 10 year risk?

A

2009 ADA guideline criteria

170
Q

how does the ADA define Pre-diabetes?

A

FBG between 100 and 126 or A1c between 5.7 and 6.4%

171
Q

what does the ADA define as Diabetes?

A

FBG > 126 or a1c >= 6.5%

172
Q

which diabetics should receive ASA therapy?

A

if > 20% 10 year risk for CVD
maybe if risk is 10-20%
not if risk <10

173
Q

how do you prevent or delay the onset of diabetes?

A
  1. physical activty > 150minutes / week and healthy eating storgnly recomommended
  2. if you are above your ideal body weight, aim for sutstained body weight loss of 5%
  3. Adding metformin is OPTIONAL
174
Q

how often should a women with gestational diabetes be screened for diabetes?

A

6 weeks after delivery and then annually after that.

175
Q

which population of individuals should be screened annually for diabetes?

A

patients with HLD > 130 LDL
HTN
Pre diabetes
history of gestational diabetes or a baby >9lbs

176
Q

who should be screened every 5 years?

A
  1. if you are 45 years or older
  2. if you are < 45 and BMI > 25 with addional risk factors: physical inactivity, first-degree relative with diabetes, high risk ethnic population, HDK < 35 or tG> 250, PCOS,
177
Q

which diabetics should receive ASA therapy?

A

if > 20% 10 year risk for CVD
maybe if risk is 10-20%
not if risk <10

178
Q

when mixing insulins which goes first?

A

clear before cloudy (alphabetical)

179
Q

whats the typical starting dose for type 1 diabetes patietns

A

0.6 U/kg/day (total daily dose)= TDD

50% basal dose, 50% mealtime (divided each by 3)

180
Q

rule of 500 for Insulin to Carb Ration

A

500/ TDD = grams of carbohydrate covered by 1 Unit of insulin

181
Q

1800 rule to find correction factor

A

1800/tdd = correction factor

182
Q

correction dose w/ 1800 rule

A

(BG now- target BG )/correction factor = correction dose

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