Diabetes Flashcards
1
Q
Role of insulin?
A
A hormone that moves glucose into muscle and other tissue cells
2
Q
When’s preventing or delaying T2D the focus?
A
Presence of elevated blood glucose
OR
An A1c of 5.7-6.4%
3
Q
How can diabetes be delayed or prevented wrt:
Body weight
Physical activity
A
Target weightloss of 7% of body weight
Increasing physical activity to at least 150min/wk of moderate activity such as walking
4
Q
When may Metformin therapy be considered to prevent/delay diabetes?
A
BMI > 35
Less than 60 yrs of age
Women with a history of GDM
5
Q
Monitoring of Metformin in pre-diabetes?
A
Monitored at least yearly and assisted with methods to reduce CVD risk factors
6
Q
What’s T1D?
A
Caused by a cellular-mediated autoimmune destruction of the beta cells in the pancreas
7
Q
List risk factors for T2D
A
First- degree relative with diabetes
Race/Ethnicity (Native A, Blacks, Asian, Hispanics, Pacific Islanders)
Overweight (BMI >= 25 kg/m2)
Physical inactivity
HTN or taking med for HTN
HDL < 35mg/dL and/or TG > 250mg/dL
Hx of CVD
A1c >= 5.7%, IGT, IFG on previous testing
Women who delivered baby weighing > 9lbs or had GDM
Women with poly cystic ovary syndrome
Other clinical conditions associated with insulin resistance e.g. Severe obesity, Acanthosis nigricans)
8
Q
List drugs that can cause hyperglycemia
A
Corticosteroids Protease inhibitors Atypical antipsychotics e.g. Olanzapine, Clozapine, Quetiapine Niacin Thiazides and loop diuretics Statins Octreotide (in type 2) Fluoroquinolones Beta-agonists Carvedilol and Propranolol and possibly other beta-blockers Cyclosporine, Tacrolimus Interferons Diazoxide (Proglycem-used for low BG due to certain dx) Cough syrups
9
Q
List drugs that cause hypoglycemia
A
Q FLOP
Quinine
Fluoroquinolones
Lorcaserin (Belviq)
Octreotide (T1D)
Propranolol
10
Q
Clinical s/sx of hyperglycemia?
A
Polyuria
Polyphagia
Polydipsia
Blurred vision
Fatigue
11
Q
What clinical s/sx is unique to T1D?
A
Weightloss
12
Q
Name the main types of long-term complications of diabetes
A
Microvascular dx
Macrovascular dx
13
Q
List sx of Microvascular dx (long-term complications)
A
Retinopathy (most common)
Nephropathy (may progress to ESRD)
Peripheral neuropathy (increased risk for foot inf and amputations)
Autonomic neuropathy (erectile dysfunction, gastroparesis, loss of bladder control/UTIs)
14
Q
List sx of Macrovascular dx (long-term complications)
A
Coronary artery dx e.g. HTN, MI, HF
Cerebrovascular dx e.g. TIA/stroke
Peripheral artery dx (PAD)
15
Q
What’s the tx goal of diabetes?
A
ABC
A1c
Blood pressure
Cholesterol
16
Q
What’s ADA tx guidelines?
A1c
Preprandial
Postprandial
A
A1c < 7.0%
Preprandial 70-130mg/dL
Postprandial < 180mg/dL
17
Q
What’s AACE tx guidelines?
A1c
Preprandial
Postprandial
A
A1c < 6.5%
Preprandial < 110 mg/dL
Postprandial < 140 mg/dL
18
Q
When did ADA recommend AACE A1c values (more stringent A1c goal)?
A
Younger adults not experiencing hypoglycemia
Those with long life expectancy
No significant CVD
19
Q
In what circumstances is a less stringent A1c goal (such as < 8%) be appropriate?
A
People with severe hypoglycemia
Limited life expectancy
Extensive comorbid conditions
Advanced complications
Longstanding diabetes where the goal is difficult to attain despite optimal efforts
20
Q
What’s the BP goal of pts with diabetes?
A
< 140/90 mmHg
21
Q
What’s the first-line BP med for diabetes pts?
A
ACE-I or ARBs
22
Q
T/F? One or more of the antihypertensive meds should be given at bedtime to diabetic pts?
A
True
23
Q
What’s the goal of LDL cholesterol in diabetic pts?
A
< 100mg/dL in pts without overt CVD
24
Q
What’s the cholesterol goal in diabetic pts with overt CVD?
A
LDL < 70mg/dL
TG < 150mg/dL
HDL > 40mg/dL (men)
> 50mg/dL (women)
25
When should statin therapy be added to diabetic pts regardless of their baseline lipid levels?
Overt CVD
Or
Without CVD + pt is > 40yrs + has 1/more CVD risk factors (FH of CVD, HTN, smoking, dyslipidemia, or albuminuria)
26
What grp of diabetic pts should be on moderate or high-intensity statin according to ATP IV lipid guidelines?
40-75 yrs + LDL >= 70mg/dL
27
List criteria for diagnosis of diabetes
Classic sx of hyperglycemia crisis (polyuria, polydipsia and unexplained weight loss) or hyperglycemic crisis AND a random plasma glucose >= 200mg/dL
Or
FPG >= 126mg/dL (fasting = no caloric intake for at least 8 hrs)
Or
2-hr plasma glucose of >= 200mg/dL during a 75g oral glucose tolerance test (OGTT)
Or
A1c >= 6.5%
28
List categories of risk for diabetes (pre-diabetes)
FPG 100-125mg/dL
Or
2-hr plasma glucose in the 75g oral glucose tolerance test (OGTT) of 140-199mg/dL
Or
A1c 5.7-6.4%
29
What's the goal of GDM?
Tx should keep BG at levels equal to pregnant women who don't have GDM (this means tighter BG control)
30
What's the BG goal in pregnancy wrt
Preprandial
Postpradial (1 hr post-meal)
Postpradial (2 hr post-meal)
A1c
Preprandial < 6%
31
What's the standard of care in GDM?
Nutritional therapy
32
Howz lifestyle modification used in DM?
In combo with med therapy
33
What's the recommended waist circumference for men and women with DM?
Males < 40 inches
Females < 35 inches
34
What types of diet may overweight or obese DM pts consider? Are these for long-term or short-term?
Low-carbohydrate
Or
Low-fat calorie-restricted
Or
Mediterranean diets
Short-term (up to 2 yrs)
35
What should be monitored in pts using low-CHO diet?
Lipid profiles
Renal fxn
Protein intake
Adjust hypoglycemic therapy as needed
36
Whats the ADA recommendation on saturated fat? Is it the same as obesity guideline recommendations?
Limit saturated fat intake to < 7% of total calories
No! Diff from obesity guidelines
37
What's the exercise recommendation for diabetic pts?
Aerobic exercise of moderate intensity for at least 30 mins x 5 days/wk
(or 150min/wk)
Resistance x 2 days/wk
38
What's the smoking recommendation for DM pts?
All pts should receive smoking cessation + other forms of tx as routine component of diabetes care
39
What's the primary prevention of CVD in DM pts?
Aspirin 81mg
40
List factors that may warrant using aspirin as primary prevention in DM pts
Increased CVD risk (10-yr risk > 10%)
Men > 50yrs
Women > 60 yrs
+
At least 1 additional risk factor e.g.
FH of CVD, HTN, smoking, dyslipidemia or albuminuria
41
Req for nephropathy screening/tx
DM!
Done using Annual urine test. Any protein in urine indicates renal dx
42
Name the types of diabetic nephropathy?
Microalbuminuria - urine protein level of 30-299mg/day
Macroalbuminuria - urine protein level > 300mg/day
43
What's Microalbuminuria (DM nephropathy)?
Urine protein level of 30-299 mg/day
44
What's Macroalbuminuria (DM nephropathy)?
Urine protein level > 300mg/day
45
List DM nephropathy screening timeline in:
T1D
T2D
T1D - Annual testing starting 5 yrs after diagnosis
T2D - Annual testing starting at time of diagnosis
46
What's the tx of DM nephropathy?
Optimize BG and BP control
ACE-I and ARB are 1st line
47
How Often should eyes of DM be screened
T1D - Annually beginning within 5 yrs of diagnosis in pts >= 10yrs
T2D - Annual beginning soon after diagnosis
(Dilated, comprehensive eye exam)
48
Foot care req in DM wrt comprehensive foot exam and pt responsibilities?
Comprehensive foot exam, performed by podiatrist, at least once/yr
Pt responsibility - ALL pts with DM should inspect their feet daily
49
List req vaccinations for ADULTS with DM
Hepatitis B: if 19-59 yrs of age + have never completed series
Influenza: Annually
PPSV23 (Pneumovax): 2-64 yrs + again at 65yrs if >5 yrs since previous vaccination
Tetanus, diphtheria, pertussis (TdaP): Once
Td: Q 10 yrs after TdaP
50
How soon should Metformin (as monotherapy) be started after DM diagnosis?
At or soon after diagnosis,
51
What may be done if target A1c is not achieved after about 3 months of Metformin monotherapy?
You may consider adding a 2nd agent
52
List the grp of meds used as 2nd line agents in DM
Sulfonylurea (2nd gen)
TZD
DPP-4 inhibitor
GLP-1 agonist
Insulin (usually basal)
53
List agents under Sulfonylurea, used as 2nd agents in DM tx
Glipizide (Glucotrol)
Glimepiride (Amaryl)
54
Which Sulfonylurea is NOT preferred?
Glyburide
55
List agents under TZD, used as 2nd agents in DM tx
Pioglitazone (Actos)
Rosiglitazone (Avandia)
56
List agents under DPP-4 inhibitor, used as 2nd agents in DM tx
Sitagliptin (Januvia)
Saxagliptin (Onglyza)
Linagliptin (Tradjenta)
Alogliptin (Nesina)
57
List agents under GLP-1 agonist, used as 2nd agents in DM tx
Exenatide (Byetta)
Exenatide ext-release (Bydureon)
Liraglutide (Victoza)
58
What type of Insulin is typically used as a 2nd agent in DM? Effect on A1c?
Basal insulin
Reduces A1c 1.5%-3.5%
59
How often should u check back with the pt after starting them on med?
Q 3 months
60
If target A1c isn't achieved 3 months after adding the 2nd agent, what course of action can be taken?
Consider adding a 3rd agent (from the Grp used as 2nd agent)
61
What's the next step if a 3 drug combo that includes basal insulin has failed to achieve A1c target after 3-6 months?
Use a more complex insulin strategy (multiple daily doses), usually with 1 or 2 non-insulin agents
62
What grp of DM meds are gen avoided when a pt req more complex insulin regimens?
SU - Glipizide (Glucotrol); Glimepiride (Amaryl)
AND
Meglitinides - Repaglinide (Prandin)
63
When do u consider starting insulin as first line?
In severe hyperglycemia (>= 300 mg/dL or A1c >= 10%)
64
When do u consider Meglitinides?
In pts with irregular meal schedules who develop late postprandial hypoglycemia on SUs
65
When do u consider beginning at the 2 drug stage in DM pts?
Pts with A1c >= 9%
66
List agents under Biguanide. First line therapy?
Metformin
Yes
67
What's the brand name of Metformin (Biguanide; 1st line agent)?
Glucophage
Glucophage XR
Fortamet
Glumetza
68
What's the dose of immediate release (IR) Metformin?
500mg BID
850mg DAILY
1,000mg
69
What's the dose of extended release (XR) Metformin?
500mg
750mg
1,000mg
70
A1c reduction of Metformin?
Reduce by 1-2%
71
Which formation of Metformin, IR or XR, should be taken with dinner?
ER 500-1000mg with dinner
72
What's the black box warning of Metformin?
Lactic acidosis
T4 avoid in pts with hepatic impairment due to increased risk of lactic acidosis
73
CI to Metformin use?
Renal impairment/failure - SCr >= 1.5mg/dL (males)
1.4mg/dL (females)
Abnormal creatinine clearance (CrCl < 60mL/min)
Metabolic acidosis
74
When should Metformin be temporarily discontinued in pts?
Those receiving Intravascular iodinated contrast media
75
In what med condition should Metformin be stopped?
In any case of hypoxia such as
Decompensated HF
Respiratory failure
Acute MI
Sepsis
76
SE of Metformin use?
Diarrhea
Nausea/ Vomiting
Flatulence
Weight neutral
Little to no risk of hypoglycemia (when used as monotherapy$
Vit B12 deficiency (long term)
77
How to use Metformin in pt using contrast dye?
Temporary d/c Metformin
Wait at least 48hrs after procedure and restart only once renal fxn has been confirmed as normal
78
Effect of alcohol on risk of lactic acidosis?
Alcohol increases risk for lactic acidosis, esp with renal impairment and advanced heart dx
79
What vitamin supplement may be considered with Metformin use? Why?
Vitamin B-12 and possibly Folic acid
Bcuz Metformin reduces B-12 absorption -> neuropathy
80
How to alleviate GI sx associated with Metformin use?
Take with meals
81
Whats the unique counseling to give a pt using Glumetza, Fortamet or Glucophae XR?
Pt may see a shell of the med in the stool (medicine is in body and tablet is empty)
82
Whats the brand name of the combo of Metformin + Sitagliptin (DPP-4 inh)?
Janumet
83
MOA of Sulfonylurea?
Stimulate insulin secretion from the pancreatic beta cells
84
Which DM meds can't be used with Sulfonylureas? Why not?
Meglitinides
Due to similar MOA
85
List agents under Sulfonylureas
Chlorpropamide (Diabinese) - no longer used
Glipizide (Glucotrol, Glucotrol XL, Glipizide XL)
Glimepiride (Amaryl)
Glyburide (DiaBeta) - no longer recommended
86
Whats the brand name of Chlorpropamide (Sulfonylureas)?
Diabinese
They are not typically used
87
Whats the brand name of Glipizide (Sulfonylureas)?
Glucotrol
Glucotrol XL
Glipizide XL
88
Whats the brand name of Glimepiride (Sulfonylureas)?
Amaryl
89
Whats the brand name of Glyburide (Sulfonylureas)?
DiaBeta
90
In Which Sulfonylurea should renal fxn be checked b4 use?
Glyburide (DiaBeta)
Avoid in CrCl < 50mL/min. This is why glyburide isn't a recommended agent
91
SE of Sulfonylurea
Glipizide (Glucotrol, Glucotrol XL, Glipizide XL);
Glimepiride (Amaryl);
Hypoglycemia
Weight GAIN
92
List the Sulfonylurea that are still recommended for use
Glipizide (Glucotrol, Glucotrol XL, Glipizide XL)
Glimepiride (Amaryl)
93
Can Sulfonylurea regular tablets be interchanged with Sulfonylurea micro nixed tab formulation?
No
94
At the initiation of what meds should Sulfonylurea and Meglitinides be d/c?
Insulin
95
When should u consider a dose reduction in Sulfonylurea (Glipizide (Glucotrol, Glucotrol XL, Glipizide XL); Glimepiride (Amaryl) AND Meglitinides (Repaglinide (Prandin))?
TZD - Pioglitazone and Rosigliatazone
GLP-1 agonist - Exenatide and Liraglutide
DPP-4 inh - Sitagliptin etc
Canagliflozin
96
How do u use Glipizide XR and Glimepiride (Amaryl)?
With 1st meal of the day
97
How do u use Glipizide?
30mins BEFORE breakfast and dinner
30 mins BEFORE first meal (if dosed onced daily)
98
How do u use Glimepiride?
Once daily with 1st meal
99
MOA of Meglitinides?
Stimulates insulin secretion from the pancreatic beta cells
100
Which Grp of DM meds should not be used with Meglitinides?
Sulfonylureas
101
List agents under Meglitinides
Repaglinide (Prandin)
Nateglinide (Starlix)
102
How do u use Meglitinides (Repaglinide -Prandin; Nateglinide - Starlix)?
At most 30mins b4 meals (1-30mins)
103
SEs of Meglitinides (Repaglinide - Prandin; Nateglinide - Starlix)?
Hypoglycemia
Mild weight gain
UPPER RESPIRATORY TRACT INFECTION
104
Which of the Meglitinides is more effective?
Repaglinide (Prandin) slightly more effective than Nateglinide
105
Effect of Gemfibrozil on Prandin (Repaglinide)? Alternative?
Gemfibrozil increases Prandin conc -> low BG
Fenofibrate is preferred
106
List agent under Thiazolidinediones (TZDs)
Pioglitazone (Actos)
Rosigliatazone (Avandia)
107
What's the brand name of Pioglitazone (TZDs)?
Actos
108
Black box warning of TZDs (Pioglitazone (Actos) and Rosigliatazone (Avandia))?
May cause or exacerbate HF in some pts.
T4 don't use in pts with NYHA class III/IV HF
109
What's the warning associated with TZDs (Pioglitazone (Actos) & Rosiglitazone (Avandia))?
Don't use in pts with ACTIVE BLADDR CANCER
110
SEs of TZDs (Pioglitazone (Actos) & Rosiglitazone (Avandia))?
Peripheral edema
Weight gain
URTIs (similar to Meglitinides)
111
What's the good SE of Pioglitazone (Actos)?
Increases HDL
Reduces TGs and TC
112
List agents under Alpha-Glucosidase inh
Acarbose (Precose)
Miglitol (Glyset)
113
What's the starting dose of both Acarbos and Miglitol and how are they used?
25mg with first bite of each meal
114
CI in alpha-Glucosidase inh (Acarbose; Miglitol)?
Inflammatory bowel dx (IBD)
Colonic ulceration,
Partial or complete intestinal obstruction
115
SEs of alpha-Glucosidase inh (Acarbose; Miglitol)?
GI effects (flatulence, diarrhea, stomach pain) - titrate slowly
Weight neutral
116
Do alpha-Glucosidase inh (Acarbose; Miglitol) by themselves cause low BG?
No
117
How do u treat low BG from alpha-Glucosidase inh (Acarbose; Miglitol)? Same as others?
No! U can't treat with sucrose, table sugar or candy.
Treat with glucose tabs or gel
118
List agents in DPP-4 inhibitors
Sitagliptin (Januvia)
Saxagliptin (Onglyza)
Linagliptin (Tradjenta)
Alogliptin (Nesina)
119
What's the brand name of Sitagliptin (DPP-4 inh)?
Januvia
120
Which DPP-4 inhibitor agent has NO renal dose impairment?
Linagliptin (Tradjenta)
121
SEs of DPP-4 inhibitors (Sitagliptin (Januvia); Saxagliptin; Linagliptin; Alogliptin)?
Nasopharyngitis
URTIs
UTIs
Weight neutral
122
How do u take DPP-4 inhibitor (Sitagliptin etc)?
Once daily in the morning, with or without food
123
What agent is listed under Sodium Glucose Co-Transporter-2 inhibitor?
Canagliflozin (Invokana)
124
SEs of Sodium Glucose Co-Transporter-2 inhibitor agent (Canagliflozin (Invokana))?
Female genital mycotic infections
UTIs
Hyperkalemia
Increased urination
125
How do u reduce risk of hypoglycemia if used Canagliflozin or GLP-1 agonists is used with Insulin or Insulin secretagogue?
Consider using a lower dose of insulin or insulin secretagogue
126
List agents under Glucagon-Like Peptide-1 (GLP-1) Agonist
Exenatide (Byetta)
Liraglutide (Victoza)
127
What's the brand name of Exenatide (GLP-1 Agonists)?
Byetta
128
What's the brand name of Exenatide ext-release (GLP-1 Agonists)?
Bydureon
129
Sites of Byetta/Bydureon inhection? Preferred site?
Abdomen (preferred SC inj site)
Thigh
Upper arm
Count to 5 before withdrawing syringe
130
What's warnings ass with Exenatide (Byetta) and Exenatide ext-release (Bydureon)?
Hx of pancreatitis, gallstones, alcoholism or high TGs
Avoid in severe impairment (CrCl < 30mL/min)
Not for use in severe GI dx
131
SEs of Exenatide (Byetta) and Exenatide ext-release (Bydureon) and Liraglutide (Victoza)?
Nausea (primary SE)
Weightloss
Vomiting
Diarrhea/ constipation
Anti-Exenatide antibodies
132
OCPs and Byetta use?
OCPs levels may be decreased in pts taking Byetta.
Take OCPs at least 1hr b4 Byetta inj
133
Byetta and warfarin?
Byetta may ENHANCE anticoagulant effects of warfarin:monitor INR
134
Pancreatitis or inflammation of pancreas may occur with GLP-1 agonist use. T /F?
True.
Rare, but can happen
135
Storage of GLP-1 agonists?
Refrigerator (stable at room temp for up to 30days)
Never freeze
136
Time to use Byetta (Exenatide)?
Inject 2 times each day, within 60 mins b4 morning and evening meals (or b4 the 2 main meals, but they do need to be 6 hrs or more apart)?
137
Dosing of Bydureon?
Once every 7 days (weekly)
138
Dosing of Victoza?
Once daily
139
Which DM med can be used in both T1D and T2D?
Pramlintide (Symlin)
140
Howz Pramlintide (Symlin) used?
SC in abdomen or thigh prior to each meal
141
SE of Pramlintide?
Hypoglycemia (when starting therapy, reduce meal-time insulins by 50% to reduce risk of hypoglycemia)
Nausea
Anorexia
Weightloss
142
Pramlintide (Symlin) and gastric emptying?
Pramlintide (Symlin) can slow gastric emptying
143
List agents under Bile Acid Binding Resins
Colesevelam (Welchol)
144
Sulfonylureas and Colesevelam (Welchol)?
Give SU (Glimepiride, Glipizide, Glyburide) 4 hrs before Welchol
145
SEs of Colesevelam (Welchol)?
Constipation (give senna, or stool softener Docusate, if appropriate)
Dyspepsia
Nausea
Bloating
Can increase TG
146
MOA of Bromocriptine?
DA agonist but it improves glycemic control by working in the CNS to decrease insulin resistance
147
How should Bromocriptine be dosed?
Take with food, to reduce nausea
148
What's insulin?
Hormone that muscle and adipose tissue require for glucose uptake.
May also have a role in regulating fat storage and inhibits the breakdown of fat for energy
149
What's the usual concentration of ALL insulins? Exception?
All insulins have a concentration of 100 units/mL
Except Humulin R U-500, which has a conc of 500 units/mL
150
List Rapid-acting insulin
LAG
Lispro (Humalog, Humalog KwikPen)
Aspart (Novolog, Novolog FlexPen)
Glulisine (Apidra, Apidra SoloStar)
151
List Regular or short-acting insulin
Humulin R (only 1 with 500units conc)
Novolin R
152
How do u use rapid-acting insulin (Novolog, Apidra, Humalog)?
Up to 15mins b4 eating, or immediately after a meal
153
How do u use Humulin R, Novolog R?
30 mins b4 a meal
154
List Baseline or "Basal" Insulin
NPH or "Intermediate" Insulin: NPH (Humulin N, Novolin N)
155
How do u use Humulin N, Novolin N?
Once or twice a day
Cloudy insulin
156
List Long-acting Insulin agents
Insulin Determir (Levemir, Levemir FlexPen)
Insulin Glargine (Lantus, Lantus SoloStar)
157
How u use Levemir, Lantus?
Once or twice daily
They both last ~24hrs and don't peak
158
What's the advantage of Levemir and Lantus both not peaking?
This is important bcuz when insulin peaks, it can increase the risk of hypoglycemia in some pts
159
Look at insulin charts and tables on pgs 416 and 417
Make sure u look
160
SEs of Insulin
Hypoglycemia
Weight gain
Local skin rxns (to avoid, rotate the inj site)
Lantus (Insulin Glargine) may sting a little when injecting (minor)
161
In mixing insulins urself, how do u remember the right order, that is, the one to draw up first and second
Clear b4 Cloudy (alphabetical)
Rapid- or short-acting insulin drawn B4 NPH (Humulin N, Novolin N)
162
What's the typical starting dose of insulin for T1D?
0.6 units/kg/day
This is the total daily dose (TDD) of insulin
163
If using insulin as basal-bolus for T1D, how do u determine dose for each
TDD = 0.6/kg/day
```
Basal = 50% of TDD
Bolus = 50%/3 (each 1/3 given with each meal)
```
164
If using NPH and Regular insulin for T1D, how do u determine dose for each?
TDD = 0.6/kg/day
```
NPH = 2/3 of TDD
Regular = 1/3 of TDD (gen dosed BID)
```
165
What's the insulin-to-carbohydrate ratio (ICR) for rapid acting insulins for T1D?
Rule of 500
500/TDD = gms of CHO covered by 1 unit of rapid-acting insulin
166
What's the insulin-to-carbohydrate ratio (ICR) for regular insulins for T1D?
Rule of 450
450/TDD = gms of CHO covered by 1 unit of regular insulin
167
What's the correction factor for rapid-acting insulin for T1D?
1,800 Rule
1,800/TDD = correction factor for 1 unit of rapid-acting insulin
168
What's the correction factor for regular insulin for T1D?
1,500 Rule
1,500/TDD = correction factor for 1 unit of regular insulin
169
What's the correction dose formula for T1D?
(BG now) - (target BG)
Divided by. = Correction dose
Correction factor
170
How do u initiate insulin?
Start with bedtime Intermediate-acting insulin
Or
Bedtime or morning long-acting insulin
171
What's the usual starting dose of insulin in T2D?
Can initiate with 10 units
Or
0.2 units per kg
172
How do u titrate up insulin in T2D?
Check BG daily (fingerstick)
Increase dose, typically by 2 units Q 3 days until fasting levels are consistently in target range (70-130mg/dL)
173
What's the target preprandial (fasting) levels in T2D?
70-130 mg/dL
174
When can insulin be titrated in larger increments (4 units, Q 3 days)?
If FBG > 180mg/dL
175
At this point, if hypoglycemia occurs or FBG < 70mg/dL, what should be done?
Reduce bedtime dose by 4 units or 10% - whichever is greater
176
What's the next step if A1c is < 7% after 2-3 months?
Continue regimen
Check A1c Q3months
177
What's the next step if A1c >= 7% after 2-3 months?
If FBG is in target (70-130mg/dL), check BG b4 lunch, dinner & bed.
Can usually begin with ~ 4 units and adjust by 2 units Q3 days until BG is in range
178
What should be done, If pre-lunch BG is out of range?
Add rapid-acting insulin (Novolog, Apidra, Humalog) at breakfast
179
What should be done, If pre-dinner BG is out of range?
Add NPH insulin (Humulin N, Novolin N) at breakfast
Or
Add Rapid acting insulin (Novolog, Apidra, Humalog) at lunch
180
What should be done, If pre-bed BG is out of range?
Add Rapid acting insulin (Novolog, Apidra, Humalog) at dinner
181
Insulin conversion calculations: once daily NPH to Glargine (Lantus)?
1:1 (same dose)
182
Insulin conversion calculations: twice daily NPH to Glargine (Lantus)?
Reduce TDD by 20% and give Lantus once daily
183
Insulin conversion calculations: NPH to Detemir (Levemir)?
1:1 conversion (same dose)
184
Insulin conversion calculations: Glargine (Lantus) to Detemir (Levemir)? And vice versa?
1:1 (same dose)
185
Insulin conversion calculations: Regular or Rapid-acting to another Rapid-acting; or Rapid-acting to regular?
1:1
186
Insulin conversion calculations: Premixed to Premixed e.g. 70% NPH/30% regular to intermediate/rapid-acting 75/25 or vice versa?
1:1 (same dose)
187
Most insulin are 1:1 conversion (same dose, unless adjustment is warranted) except?
Twice daily NPH to Glargine (Lantus)
Reduce TDD by 20%
188
Most insulin are stable to room temp for 28-31 days. What's the exception for LESS time at room temp?
Humulin N and Novolin N (pens) - 14 days
Novolog
Humalog 50/50, 75/25 and Humulin 70/30 - 10 days
189
Most insulin are stable to room temp for 28-31 days. What's the exception for MORE time at room temp?
42 days - Novolin R (U-100 vial)
Novolin N (vial)
Novolin 70/30 (vial)
Levemir (Detemir)
190
Storage of unused insulin?
Refrigerator
191
Check insulin administration procedure on pg 422
Look!
192
What's the BG level of hypoglycemia?
BG < 70mg/dL
193
Whats the #1 drug that causes hypoglycemia?
Insulin
194
List the other classes of DM meds that may cuz hypoglycemia. Why?
Sulfonylurea (Glipizide, Glyburide, Glimepiride)
And
Meglitinides (Repaglinide -Prandin)
Bcuz they make body secrete more insulin (secretagogue)
195
List other DM drugs that may cuz hypoglycemia
Pioglitazone (Actos)
Canagliflozin (Invokana)
Pramlintide
196
List of hypoglycemic sx
Dizziness
Headache
Anxiety
Shakiness
Diaphoresis (sweating)
Excessive hunger
Confusion
Clumsy or jerky movements
Tremor
Palpitations or fast HR
Blurred vision
197
What med can mask hypoglycemia sx? What hypoglycemia sx still exhibits, in spite of this med?
Non-cardio selective agents (Carteolol, Carvedilol, Propranolol, others)
Sweating and hunger won't be masked
198
What's the recommended tx of hypoglycemia in a conscious individual?
15-20g of glucose
Or
Any form of CHO that contains glucose eg 1/2 cup / 4 oz of juice or soda, 1 cup/8oz milk, 1 TSP of sugar or honey
199
How soon should BG be re-tested after hypoglycemia tx?
15 mins
If BG < 70mg/dL, re-treat and re-check in another 15 mins
200
What should be prescribed for ALL pts at significant risk of severe hypoglycemia?
Glucagon
201
When is glucagon used in DM pts?
ONLY if pt is unconscious or not conscious enough to self-treat the hypoglycemia
202
Look at Glucometers on Pg 425
Ok
203
List alternate glucose site testing areas
Upper arm
Thigh
Calf
Fleshy parts of the hand
Fingertips too
204
Whats diabetic ketoacidosis (DKA)?
DKA can occur when there's not insulin and the body breaks down fat to make energy
Breakdown of fats causes the conc of ketones in the blood to increase.
205
Sx of DKA?
Hyperglycemia
Polyuria
Polyphagia
Polydipsia
Blurred vision
Metabolic acidosis (fruity breath, dyspnea)
Dehydration (dry mouth, excessive thirst, poor skin turgor, fatigue)
206
DKA Lab Abnormalities?
Glucose > 300mg/dL
Ketones present in urine and blood
PH < 7.2
Bicarbonate < 15mEq/L
WBC 15-40 cells/mm3
207
DKA tx?
IV fluids and Indulin
Replace electrolytes (starts with NS, followed by 1/2NS and correcting potassium to bring the level > 3.5mEq/L
208
MOA of Metformin?
Decrease hepatic glucose output
209
What size of cartridge goes into insulin pen injection?
3ml cartridge
210
Usual vol of insulin vial?
10ml
211
Usual size of insulin needle used?
25/ 29G (or higher)
212
Usual size of insulin syringe used?
1ml (also 0.3ml and 0.5ml)
213
What does High blood glucose indicate?
Glucose can't get into cell or can't be properly stored
