Diabetes

Question 1

Fasting =

Answer 1

No caloric intake for at least 8 hours

Question 2

DM tx in pregnancy

Answer 2

Insulin
Metformin
Glyburide

Question 3

Dx of Pre DM

Answer 3

FBG 100-125
2 hr post 75g OGTT 140-199
A1C 5.7-6.4%

Question 4

Dx of DM

Answer 4

Symptomatic AND random BG of 200 or greater
FBG 126 or greater
2 hr post 75g OGTT of 200 or greater
A1C of 6.5% or greater

Question 5

15g of CHO

Answer 5

1 small piece of fruit
1 slide of bread
1/3 cup of rice/pasta
1/2 cup oatmeal

Question 6

DM Goals for A1C

Answer 6

Less than 7%

Question 7

DM goal preprandial

Answer 7

80-130

Question 8

DM goal postprandial

Answer 8

(2hrs after a meal)

Less than 180

Question 9

Calculation of A1C reading to BG average

Answer 9

(A1C -2) x 30

A1C of 7 = 150

Question 10

Drugs than can increase BG

Answer 10

BBs
Diuretics
Immunosuppressants 
Niacin
2nd gen antipsychotics
Statins
Steroids

Question 11

What A1C reading would you go right to insulin

Answer 11

Over 10%

Question 12

What A1C reading would you start dual therapy

Answer 12

Greater than or equal to 8.5%

Question 13

DM meds that increase/replace insulin secretion

Answer 13

Insulin
SUs
Meglitinides

Question 14

DM meds that decrease hepatic glucose output

Answer 14

Metformin

Question 15

DM meds that decrease glucagon which decreases glucose production

Answer 15

GLP1 agonists
DPP4 inhibitors
Pramlintide

Question 16

DM meds that slow gastric emptying (increasing satiety)

Answer 16

GLP1 agonists

Pramlinitide

Question 17

DM drugs that increase glucose excretion

Answer 17

SGLT2 inhibitors

Question 18

DM meds that increase insulin sensitivity

Answer 18

TZDs

Metformin

Question 19

Max metformin dose

Answer 19

2000-2550 mg/day

Question 20

eGFR and Metformin

Answer 20

<30: CI

30-45: do not start. And if already on, decrease by 50%

Question 21

Meglitinides

Answer 21

Repaglinide (Prandin)

Nateglinide (Starlix)

Question 22

Meglitinides counselling point

Answer 22

Skip a meal, skip a dose

-dosed with meals, 15-30 mins before each one

Question 23

Thiazolidinediones (TZDs)

Answer 23

Pioglitazone (Actos)

Rosiglitazone (Avandia)

Question 24

Boxed warnings with TZDs

Answer 24

Can cause/exacerbate HF

Question 25

SGLT2 inhibitors

Answer 25

Canagliflozin (Invokana) Empagliflozin (Jardiance) Dapagliflozine (Farxiga) Ertugliflozin (Steglatro)

Question 26

Dosing of SGLT2 inhibitors

Answer 26

All dosed based off eGFR - all CI if <30 - not recommended if 30-45

Question 27

SE of SGLT2 inhibitors

Answer 27

Increased urination, weight loss, increased thirst, yeast infections and UTIs

Question 28

DPP4 inhibitors

Answer 28

Sitagliptan (Januvia) Linagliptan (Tradjenta) Saxagliptin (Onglyza)

Question 29

Only DPP4 inhibitor that does NOT need renal dose adjustment

Answer 29

Linagliptan (Tradgenta)

Question 30

SE of DPP4 inhibitors

Answer 30

Risk of HF and acute pancreatitis with all | -URTIs, UTIs, nasopharyngitis, edema, rash

Question 31

GLP1 agonists

Answer 31

``` Exenatide (Byetta) BID Exenatide (Bydureaon) WKLY --both not recommended if CrCl <30 Semaglutide (Ozempic) WKLY Dulaglutide (Trulicity) WKLY Liraglutide (Victoza) (Saxenda) DAILY Lixisenatide (Adlyxin) DAILY ```

Question 32

SE with GLP1 agonists

Answer 32

Nausea | -VD, weight loss, injection site rxns

Question 33

Only GLP1 agonist approved to decrease risk of CV event

Answer 33

Victoza

Question 34

Missed doses with weekly GLP1 agonists

Answer 34

Take dose as soon as you remember as long as it is more than 72 hours before your next dose. If it's less than 72 hours, skip dose

Question 35

Rapid-acting insulins

Answer 35

Aspart (Novolog) Lispro (Humalog) -give up to 15 mins before meals, or immediately after

Question 36

Duration of action of aspart and lispro

Answer 36

Aspart 3-5hrs | Lispro 2-3hrs

Question 37

Short-acting regular insulins

Answer 37

``` Regular insulin (Humalin R, Novolin R) -give 30 mins before a meal ```

Question 38

Duration of action for short-acting insulin

Answer 38

4-12hr

Question 39

Prandial insulins

Answer 39

Rapid-acting: aspart, lispro | Short-acting: regular insulin

Question 40

Basal insulins

Answer 40

Intermediate-acting: NPH insulins | Long-acting: detemir, glargine, degludec

Question 41

Intermediate-acting insulins

Answer 41

NPH insulins (Humulin N, Novolin N) - cloudy insulins - given once or twice daily

Question 42

Mixing insulins

Answer 42

Can mix intermediate (NPH) insulins with prandial insulins, but draw up prandial insulins first -clear before cloudy

Question 43

Duration of action of intermediate-acting insulin

Answer 43

NPH 14-24hr

Question 44

Long-acting insulins

Answer 44

Detemir (Levemir) Glargine (Lantus, Basaglar, Toujeo) Degludec (Tresiba)

Question 45

Duration of action of long-acting insulins

Answer 45

Detemir 6-23hr (dose-dependant) Glargine over 24hrs Degludec over 24hrs

Question 46

Premixed insulins naming

Answer 46

Named as a % of each component with Basal (NPH) first

Question 47

The one insulin you never mix

Answer 47

Long-acting

Question 48

Timing of administration of pre-mixed insulins?

Answer 48

Based before meals is based on whatever prandial insulin is used

Question 49

Usually dose the new insulin at the same dose of the old insulin (1:1 conversion) EXCEPT

Answer 49

Use 80% of NPH or Toujeo dose when switching to Lantus or Basaglar

Question 50

Room stability of injectables of 56 days

Answer 50

Tresiba | Ozempic

Question 51

Room stability of injectables of 42 days

Answer 51

Toujeo | Levemir

Question 52

Room stability of injectables of 30 days

Answer 52

Victoza | Byetta

Question 53

Room stability of injectables of 28 days

Answer 53

Lantus Basaglar Humalog Novolog

Question 54

Room stability of injectables of 14 days

Answer 54

Trulicity

Question 55

Hypoglycemia reading

Answer 55

Less than 70

Question 56

BBs mask sx of hypoglycemia EXCEPT

Answer 56

Hunger and sweating

Question 57

Examples of 15-20g of glucose or simple carbs

Answer 57

4oz juice/soda 1tbsp honey or sugar 8oz milk