Diabetes Flashcards
Define DKA
without insulin , glucose cannot enter muscle cells and fat is used as an alternative energy source and fat breakdown produces ketones and the ketones can cause DKA
Fasting BG in pregnancy
< 95
S/S of diabetes
polyuria polyphagia polydipsia blurred vision fatigue
Diagnosis of prediabetes
FPG 100-125
2h PG 140-199
A1C 5.7-6.4%
Diagnosis of diabetes
symptoms and random glucose > 200
FPG > 126
2h PG >200
A1C > 6.5%
prevention of preeclampsia with diabetics in pregnancy
ASA 81
BP goal with DM and ASCVD 10y risk of >15%
<130/80
BP goal with DM and ASCVD 10y risk of <15%
<140/90
how to test for peripheral neuropathy
10-g monofilament
First line treatment for neuropathy
pregabalin
duloxeetine
gabatenpin
treatment for diabetic kidney disease
ACEi or ARB
Diagnosis for diabetic kidney disease
urinary albumin excretion >30mg/24 hours
urine albumin-to-creatinine ratio > 30 mg/g
ADA goal of A1C
<7%
ADA goal of FBG
80-130
ADA goal of PPG
<180
First line treatment for DM with A1C >8.5% and >10%
- 5: dual therapy
10: insulin
If DM and ASCVD treatment
GLP1 agonists -liraglutide -semaglutide -exenatide OR SGLT2 inhibitors -empagliflozin -canagliflozin
If DM and HF or CKD treatment
SGLT2 inhibitors -empagliflozin -canagliflozin IF contraindicated use GLP1 agonists -liraglutide -semaglutide -exenatide
If DM and no ASCVD or CKD treatment
to minimize hypoglycemia -DPP-4i -GLP1-agonist -SGLT2i -TZD to promote weight loss -GLP-1 agonist -SGLT2i consider lower cost -SU -TZD
Which drugs have MOA to increase or replace insulin secretion
insulin
SU
meglitinides
Which drugs have MOA to decrease hepatic glucose output
metformin
Which drugs have MOA to decrease glucagon which decrease glucose production
GLP-1 agonist
DPP-4 inhibitors
Pramlintide
Which drugs have MOA to slow gastric emptying (increasing satiety)
GLP-1 agonists
Pramlintide
Which drugs have MOA to increase glucose excretion
SGLT2 inhibitors
Which drugs increase insulin sensitivity
TZDs
Metformin
Janumet generic name
metformin/sitagliptin
Contraindication to metformin
CrCl < 30
warning for metformin
lactic acidosis
Which clasess of drugs are insulin secretagogues
meglintinides
sulfonylureas
List meglinitides
repalinide
nateglinide
Which classes of drugs cause hypoglycemia
metglinitinides
sulfonylureas
insulin
glipizide brand name
glucotrol
glimepiride brand name
amaryl
glyburide brand name
glynase
Name thiazolidinediones
pioglitazone
rosiglitazone
contraindication for TZD
heart failure-b/c of edema
List SGLT2i
Canagliflozin
dapagliflozin
empagliflozin
canagliflozin brand name
invokana
brand name dapagliflozin
farxiga
brand name empagliflozin
jardiance
Contraindication to all SGLT2i
CrCl < 30
major warning for SGLT2i
ketoacidosis
AKI
hypotension
major warning for canagliflozin
hyperkalemia
MOA DPP4i
prevent the enzyme DPP-4 from breaking down incretin hormones, glucagon-like peptide 1 (GLP1) and glucose-dependent insulinotropic polypeptide (GIP) these hormones help to regulate blood glucose levels by increasing isulin release from the pancreatic beta cells and decreasing glucagon secretion
List DPP4i
Sitagliptin
Saxagliptin
Linagliptin
alogliptin
brand name for sitagliptin
januvia
brand name for linagliptin
tradjenta
Major warning for DPP4i
acute pancreatitis
arthralgia
heart failure
SGLT2i generic name ending
flozin
DPP4i generic name ending
gliptin
List alpha-glucosidase inhibitors
acarbose
miglitol
what dose to start basal insulin at for DM2
10u/d
0.1-0.2 u/kg/d
what dose to start prandial insulin at for DM2
4u/d
10% of basal insulin
GLP1 agonists generic name ending
tide
list GLP1 agonists
exenatide
liraglutide
dulaglutide
semaglutide
GLP1 agonists MOA
analogs of incretin hormone GLP-1 which increase glucose-dependent insulin secretion , decrease glucagon secretion, slows gastric emptying, improves satiety and result in weight loss
Exenatide brand name
Byetta
if ER Bydureon
Liraglutide brand name
Victoza
Dulaglutide brand name
Trulicity
GLP1 agnosts warning
thyroid carcinoma
pancreatits
Pramlintide MOA
analog of amylin which is produced by pancreatic beta cells and helps control postprandial glucose by slowing gastric emptying, suppressing glucagon secretion following a meal
Insulin MOA
signals liver to convert glucose to glycogen
required for glucose uptake by muscle cells
regulates fat storage, converting excess glucose to fat
list rapid acting insulin
aspart
lispro
afrezza
insulin aspart brand name
novolog
insulin lispro brand name
humalog
list short acting insulin
regular insulin
concentrated regular insulin
list intermediate acting insulin
NPH
List long acting insulin
determir
glargine
degludec
brand name for insulin determir
levemir
brand name for insulin glargine
lantus
toujeo
brand name for insulin degludec
tresiba
Key drugs that can lower blood glucose not DM meds
linezolid
beta blockers
quinolones
target BG for hospitalized patients
140-180
3 items to recognize DKA
BG > 250
ketones
anion gap
how to recognize HHS
BG > 600
extreme dehydration
pH > 7.3
which DM drugs cause weight gain
insulin
SU
meglitindies
TZD
which DM drugs cause hepatotoxicity
TZD
alopgliptin
which DM drugs cause UTI
SGLT2i