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NAPLEX Studying > Diabetes - Endocrinology > Flashcards

Diabetes - Endocrinology Flashcards

1
Q

What is Type I Diabetes?

A

The patient’s own antibodies attack and destroy the beta cells in the pancreas that make insulin

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2
Q

When is Type I Diabetes commonly diagnosed?

A

In children - but can develop at any age

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3
Q

What happens if there is no insulin in Type I Diabetes?

A

Glucose can’t enter the muscle cells –> body goes into starvation mode –> body starts to metabolize fat into ketones as an alternative energy source

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4
Q

Why is it bad if the body metabolizes fat into ketones in Type I Diabetes?

A

ketones are acidic –> high ketone levels can cause diabetic ketoacidosis –> medical emergency

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5
Q

What protein can be used to see if an adult has Type I Diabetes compared to Type II Diabetes? Why?

A

C-peptide b/c this protein is released by the pancreas only when insulin is released –> Type I diabetes is diagnosed when there is very low C-peptide level

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6
Q

Presentation of Type II Diabetes?

A
  1. low level of physical activity

2. overweight or obese

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7
Q

What happens in Type II Diabetes?

A

pancreas will attempt to overcome insulin resistance by producing more insulin –> beta cells will become dysfunctional –> insulin production decreases –> BG becomes elevated

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8
Q

What is prediabetes a risk for?

A

Type II diabetes

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9
Q

How are 2 ways that diabetes can be present in pregnancy?

A
  1. diabetes was present prior to becoming pregnant

2. diabetes developed during pregnancy

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10
Q

What risks are babies at born to mothers who had hyperglycemia during the pregnancy and how do they present when born

A
  1. at risk for developing obesity and diabetes later in life

2. are larger than normal

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11
Q

When is the oral glucose tolerance test used?

A

during pregnancy - typically between 24-28 weeks

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12
Q

What medications may be needed for pregnant women who develop diabetes during pregnancy?

A
  1. insulin is preferred

2. metformin and glyburide are sometimes used

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13
Q

What microvascular diseases can result from prolonged hyperglycemia?

A
  1. retinopathy - mild to complete vision loss
  2. nephropathy - kidney failure
  3. neuropathy - pain, loss feeling with decrease blood circulation –> resulting in amputation
  4. autonomic neuropathy
    - erectile dysfunction
    - gastroparesis
    - loss of bladder control –> UTIs
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14
Q

What macrovascular diseases can result from prolonged hyperglycemia?

A
  1. atherosclerosis - ASCVD
    - coronary artery disease including MI
    - cerebrovascular disease including stroke
    - peripheral artery disease with pain and high risk of amputation
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15
Q

What are the classic symptoms of high BG?

A

The 3 P’s:

  1. polyuria - excessive urination
  2. polyphagia - excessive hunger or increased appetitie
  3. polydipsia - excessive thirst
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16
Q

What are other uncommon symptoms that can be present in Type II diabetes besides the 3 P’s?

A
  1. fatigue
  2. blurry vision
  3. erectile dysfunction
  4. vaginal fungal infections
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17
Q

Risk factors for developing type II diabetes?

A
  1. physical inactivity
  2. first-degree relative with diabetes
  3. high risk face or ethnicity
    - african-american
    - asian-american
    - latinos/hispanics
    - native americans
    - pacific islanders
  4. baby delivered >9 pounds or diagnosis of gestational diabetes
  5. HDL <35 or TG >250
  6. hypertension (140/90 or taking BP meds)
  7. A1C >5.7%
  8. conditions that cause insulin resistance (PCOS)
  9. cardiovascular disease history
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18
Q

What does an A1C test represent?

A

the average BG over the past approx. 3 months

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19
Q

What does a fasting plasma glucose represent?

A

the BG at the moment after over 8 hours of fasting

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20
Q

What is the oral glucose tolerance test?

A

measures how well a person can tolerate a very surgery drink by measuring the post-prandial glucose level

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21
Q

How can diabetes be diagnosed?

A
  1. A1C >/= 6.5% or FBG >/= 126 twice with the same or different blood sample
  2. different diagnostic test
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22
Q

How often should the A1C test be conducted if the patient is NOT at goal?

A

every 3 months

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23
Q

How often should the A1C test be conducted if the patient is at goal?

A

EVERY 6 MONTHS

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24
Q

What is the goal for A1C?

A

either <6.5% or <7%

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25
Q

What is the diabetes diagnostic criteria for A1C?

A

> /=6.5%

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26
Q

What is the diabetes diagnostic criteria for FBG?

A

> /=126 mg/dL

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27
Q

What is the diabetes diagnostic criteria for 2-hours PPG after OGTT or classic symptoms + random BG?

A

> /=200 mg/dL

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28
Q

What is the prediabetes diagnostic criteria for A1C?

A

5.7-6.4%

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29
Q

What is the prediabetes diagnostic criteria for FBG?

A

100-125 mg/dL

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30
Q

What is the prediabetes diagnostic criteria for 2-hours PPG after OGTT or classic symptoms + random BG?

A

140-199 mg/dL

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31
Q

What is the A1C treatment goal for non-pregnant individuals?

A

<7%

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32
Q

What is the preprandial goal for non-pregnant individuals?

A

80-130 mg/dL

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33
Q

What is the 2-hour PPG goal for non-pregnant individuals?

A

<180 mg/dL

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34
Q

What is the average BG of a A1C 6%? Additional A1C 1%?

A

126 mg/dL

28 mg/dL

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35
Q

How much exercise should a diabetic individual get?

A

at least 150 minutes/week spread over at least 3 days

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36
Q

What antiplatelet therapy should a diabetic patient get for ASCVD secondary prevention?

A

Aspirin 81 mg/day

*CAN BE USED IN PREGNANCY TO DECREASE THE RISK OF PREECLAMPSIA

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37
Q

If a patient has an allergy to aspirin, what is an alternative they can use for ASCVD secondary prevention?

A

Clopidogrel 75 mg/day

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38
Q

How often should diabetic patients get a lipid panel check?

A

annually

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39
Q

What class of drugs should diabetic patients get for cholesterol control and how often should they be reevaluated?

A

statins

every 4-12 weeks after starting a statin or increasing the dose

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40
Q

What kind of statin and what statin should patients with diabetes + ASCVD or 50-75 y/o with multiple ASCVD risk factors get?

A

high intensity statin

atorvastatin 40-80 mg or rosuvastatin 20-40 mg

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41
Q

What kind of statin should patients with diabetes with no ASCVD and older patients (40-75 y/o) get?

A

moderate intensity statin

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42
Q

What kind of statin should patients with diabetes with no ASCVD risk factors and younger people (<40 y/o) get?

A

no statin

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43
Q

What kind of statin should patients with diabetes with ASCVD risk factors and younger people (<40 y/o) get?

A

moderate intensity statin

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44
Q

What drug could be added if the patient is at max tolerated statin and has a ASCVD 10 year risk factor >20%?

A

ezetimibe

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45
Q

What drug should be given for cholesterol control if LDL is controlled but TG 135-499 mg/dL?

A

Vascepa

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46
Q

If you are Type II diabetic, what should you do to prevent diabetic retinopathy?

A

eye exam with dilation

if retinopathy, repeat annually - if not, repeat every 1-2 years

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47
Q

What is the goal BP considered by the ACC/AHA and ADA guidelines?

A

<130/80 mmHg

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48
Q

What goal BP is considered by the ADA guidelines if patient has low ASCVD risk?

A

<140/90 mmHg

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49
Q

What should diabetic patients with hypertension and no albuminuria use?

A

thiazide diuretic, CCB, ACEI or ARB

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50
Q

What should diabetic patients with hypertension and albuminuria use?

A

ACEI or ARB with thiazide or CCB if needed

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51
Q

How often should albumin in the urine be checked if no kidney disease?

A

yearly

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52
Q

How often should albumin in the urine be checked if there is kidney disease?

A

twice yearly

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53
Q

What vaccinations are required for patients with diabetes?

A
  1. hepatitis B virus series
  2. influenza annually
  3. both pneumococcal vaccines - Prevnar 13 and Pneumovax 23
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54
Q

What is the first line drug treatment for Type II diabetes?

A

metformin

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55
Q

what eGFR is contraindicated in metformin?

A

eGFR <30

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56
Q

What class and drugs should patients with ASCVD major issue use as an add on from metformin?

A

SGLT-2 Inhibitors

  • empagliflozin
  • canagliflozin
  • CI in eGFR <30*

GLP-1 agonists

  • dulaglutide
  • liraglutide
  • semaglutide
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57
Q

If patients have HF or CKD as a major issue, and their eGFR >30, what should they use as an add on from metformin?

A

SGLT-2 Inhibitors

  • empagliflozin (Jardiance)
  • canagliflozin (Invokana)
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58
Q

If patients have HF or CKD as a major issue, and their eGFR <30, what should they use as an add on from metformin?

A

GLP-1 agonists

  • dulaglutide
  • liraglutide
  • semaglutide
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59
Q

What drug class/drugs should be an add on from metformin if patient want to lose weight?

A

SGLT-2 inhibitors

GLP-1 agonists

  • semaglutide
  • liraglutide
  • dulaglutide
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60
Q

What drug treatment options for Type II diabetes should not be used together?

A
  1. GLP-1 agonists and DPP-4 inhibitors

2. sulfonylureas and meglitinide

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61
Q

What drug classes should be an add on to metformin if the patient is at high risk of hypoglycemia?

A
  1. DPP-4 inhibitors
  2. GLP-1 agonists
  3. SGLT-2 inhibitors
  4. thiazolidinediones
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62
Q

If patients are on metformin and GLP-1 agonists, ad the A1C is still above target, what should they use?

A

basal insulin or bedtime NPH insulin

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63
Q

What is the typically starting dose for basal insulin or bedtime NPH insulin?

A

10 units/day or 0.1-0.2 units/kg/day

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64
Q

How do you typically titrate basal insulin or bedtime NPH insulin?

A

increase by 2 units every 3 days to reach FBG goal

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65
Q

What happens if you experience hypoglycemia while titrating basal insulin or bedtime NPH insulin?

A

decrease dose by 10-20%

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66
Q

What should be used before starting insulin in most patients?

A

GLP-1 agonist

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67
Q

If adding a basal insulin or bedtime NPH insulin is not adequate to reach A1C goal, what should be done?

A

add prandial (meal-time) insulin - start with one daily dose - before meal with the highest carb intake or highest post-prandial BG

additional prandial doses can be added prior to meals

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68
Q

What do GLP-1 agonists end in?

A

-utide

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69
Q

What do SGLPT-2 inhibitors end in?

A

-gliflozin

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70
Q

What do DPP-4 inhibitors end in?

A

-gliptin

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71
Q

What class is metformin?

A

biguanide

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72
Q

What is the brand name of metformin?

A

glucophage

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73
Q

What are the MOAs of metformin?

A
  1. decreases hepatic glucose output
  2. increases insulin sensitivity
  3. decreases intestinal glucose absorption
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74
Q

How much of a decrease in A1C% is metformin monotherapy?

A

1-1.5%

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75
Q

Does metformin cause hypoglycemia?

A

no

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76
Q

What kind of weight change does metformin cause?

A

no change - neutral

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77
Q

What is the max dosing of metformin that it should be titrated to?

A

2000 mg/day or 2550 mg/day with 850 mg TID

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78
Q

Common side effects of metformin?

A

TYPICALLY WELL-TOLERATED:

  1. diarrhea
  2. nausea
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79
Q

When should metformin be taken?

A

with a meal to decrease nausea

if ER - swallow whole and take with dinner

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80
Q

What is the boxed warning with metformin?

A

lactic acidosis - increased risk with renal disease, alcoholism, or hypoxia

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81
Q

Warnings with metformin?

A
  1. don’t start metformin if eGFR is 30-45
  2. Vitamin B12 deficiency
  3. stop prior to iodinated contrast media
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82
Q

What drugs fall in the class of thiazolidinediones?

A
  1. pioglitazone

2. rosiglitazone

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83
Q

What is the ending of thiazolidinediones?

A

-glitazone

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84
Q

What is the MOA of thiazolidinediones?

A

increases muscle cell-sensitivity to insulin in to increase BG entry into the muscles

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85
Q

How much does thiazolidinediones decrease A1C%?

A

1%

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86
Q

Do thiazolidinediones cause hypoglycemia?

A

not by itself

if used with another drug class, it may - may need to decrease the dose

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87
Q

What weight changes does thiazolidinediones cause?

A

weight increase

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88
Q

Renal impairment rules with thiazolidinediones?

A
  1. no dose adjustment necessary with thiazolidinediones

2. not commonly used in patients with renal impairment due to fluid retention

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89
Q

Common side effects associated with thiazolidinediones?

A
  1. edema
  2. weight gain
  3. bone fractures
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90
Q

Important information on rosiglitazine?

A

drug increases LDL, HDL, total cholesterol, and BP

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91
Q

Boxed warning with thiazolidinediones?

A

should not be used in patients with NYHA Class III/IV heart failure

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92
Q

Warnings associated with thiazolidinediones?

A
  1. hepatic failure
  2. edema
  3. fractures especially in females
  4. can cause or worsen HF
  5. can stimulate ovulation - may need contraception
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93
Q

Warning associated with pioglitazone?

A

do not use in patients with a history of bladder cancer

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94
Q

What drugs are in the class SGLT-2 inhibitors?

A
  1. canagliflozin*
  2. empagliflozin*
  3. dapagliflozin
  4. ertugliflozin
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95
Q

What is the brand name of canagliflozin?

A

Invokana

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96
Q

What is the brand name of empagliflozin?

A

Jardiance

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97
Q

What is the MOA of SGLT-2 inhibitors?

A

to increase the renal excretion of BG

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98
Q

How much do SGLT-2 inhibitors decrease A1C%?

A

0.7-1%

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99
Q

Does SGLT-2 inhibitors cause hypoglycemia?

A

not by itself

if used with other drugs, it can - may need to decrease the dose

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100
Q

What weight change is associated with SGLT-2 inhibitors?

A

weight loss

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101
Q

What benefits are associated with empagliflozin and canagliflozin?

A

heart failure and renal benefit

102
Q

When should you take SGLT-2 inhibitors?

A

every morning

103
Q

Should there be dose adjustments with renal failure if taking SGLT-2 inhibitors?

A

yes - decrease the dose for all drugs

104
Q

Common side effects associated with SGLT-2 inhibitors?

A
  1. UTIs
  2. genital fungal infections
  3. weight loss
  4. increase in urination
  5. increase in thirst
105
Q

What are the boxed warnings associated with canagliflozin?

A
  1. amputation risk - avoid if pt has foot problems/peripheral neuropathy
  2. bone fractures - avoid drug with fracture risk
106
Q

Warnings associated with SGLT-2 inhibitors?

A
  1. increase in LDL
  2. hyperkalemia
  3. fluid loss
  4. hypotension
  5. ketoacidosis
  6. severe UTIs
  7. genital fungal infections
107
Q

What is the eGFR CI with SGLT-2 inhibitors?

A

eGFR <30

108
Q

What drugs are associated with DPP-4 inhibitors?

A
  1. sitagliptin*
  2. linagliptin*
  3. saxagliptin
  4. alogliptin
109
Q

What is the brand name of sitagliptin?

A

Januvia

110
Q

What is the brand name of linagliptin?

A

Tradjenta

111
Q

What is the MOA of DPP-4 inhibitors?

A

increase in incretin –> less glucagon –> lowers BG

112
Q

How much does DPP-4 inhibitors decrease A1C%?

A

<1%

113
Q

Do DPP-4 inhibitors cause hypoglycemia?

A

not by itself - may cause hypoglycemia if used in combination with other drugs - may need to reduce the dose

114
Q

Do DPP-4 inhibitors cause weight change?

A

no

115
Q

What should DPP-4 inhibitors never be used in combination with and why?

A

GLP-1 agonists - similar MOA

116
Q

Are DPP-4 inhibitor dose adjustments necessary with renal impairment?

A

yes - all except linagliptin

117
Q

Common side effects associated with DPP-4 inhibitors?

A

GENERALLY WELL-TOLERATED

  1. nasopharyngitis (common cold)
  2. headache
118
Q

Warnings associated with all DPP-4 inhibitors?

A
  1. pancreatitis
  2. severe arthralgia (joint pain)
  3. acute renal failure
119
Q

Warnings associated with alogliptin?

A
  1. hepatotoxicity

2. do not use with heart failure

120
Q

Warnings associated with saxagliptin?

A
  1. do not use with heart failure

2. more common side effects - edema, UTIs, and hypoglycemia when used with insulin or sulfonylureas

121
Q

What do sulfonylureas end in?

A

-ide

122
Q

What drugs are in the class sulfonylureas?

A
  1. glipizide
  2. glimepiride
  3. glyburide
123
Q

What is the MOA of sulfonylureas?

A

to increase insulin secretion

124
Q

How much do sulfonylureas decrease A1C?

A

0.8%

125
Q

Do sulfonylureas cause hypoglycemia?

A

yes

126
Q

Do sulfonylureas cause weight change?

A

yes - weight gain

127
Q

What should sulfonylureas not be used with?

A
  1. insulin

2. meglitinides

128
Q

Common side effects associated with sulfonylureas?

A

GENERALLY WELL-TOLERATED

  1. hypoglycemia
  2. weight gain
129
Q

Important warnings associated with Glipizide XL

A
  1. made with an OROS formulation - a ghost tablet (empty shell) can present in stool
  2. decrease in efficiency after long-term use since beta-cell function declines
130
Q

Contraindications associated with sulfonylureas?

A

sulfa allergy

131
Q

Warnings associated with sulfonylureas?

A
  1. hypoglycemia

2. beers criteria - do not use in elderly patients due to hypoglycemia - especially if patients are using glyburide

132
Q

What do meglitinides end in?

A

-glinide

133
Q

What drugs are in the class meglitinides?

A
  1. Repaglinide

2. Nateglinide

134
Q

What is the MOA of meglitinides?

A

to increase meal-time insulin section

135
Q

What A1C% do meglitinides decrease?

A

1%

136
Q

Do meglitinides cause hypoglycemia?

A

yes - especially if the meal is skipped and the dose is still taken

137
Q

Do meglitinides cause weight change?

A

yes - weight gain

138
Q

Common side effects associated with meglitinides?

A

GENERALLY, WELL-TOLERATED

  1. hypoglycemia
    - if you skip a meal, skip the dose to avoid hypoglycemia
  2. weight gain
139
Q

What should meglitinides be used in combination with and why?

A

insulin and sulfonynureas - same MOA

140
Q

What kind of injections are GLP-1 agonists and what is the exception?

A

all are SC injections - except for oral semaglutide

141
Q

What drugs are in the class GLP-1 agonists?

A
  1. liraglutide
  2. dulaglutide
  3. exenatide
  4. lixisenatide
  5. semaglutide
142
Q

What are the brand names of liraglutide? What is the difference?

A

Victoza and Saxenda

-Saxenda is used for weight loss

143
Q

What is the brand name of dulaglutide?

A

Trulicity

144
Q

What is the brand name of Exenatide?

A

Byetta

145
Q

What is the brand name of semaglutide?

A

Ozempic-injection

146
Q

What is the MOA of GLP-1 agonists?

A

“incretin mimetic”

increase in incretin –> less glucagon –> lowers BG and slows gastric emptying –> increase in satiety

147
Q

How much of the A1C do GLP-1 agonists decrease?

A

1%

148
Q

Do GLP-1 agonists cause hypoglycemia

A

no - not by itself - maybe if used in combinations with other drugs

149
Q

Do GLP-1 agonists cause weight changes?

A

yes - weight loss

150
Q

Do any GLP-1 agonists have ASCVD benefit and which ones?

A

yes-

  1. liraglutide
  2. dluaglutide
  3. semaglutide SC injection
151
Q

What should you not use GLP-1 agonists with and why?

A

DPP-4 inhibitors - same MOA

152
Q

Should you decrease the dose of GLP-1 agonists with renal impairment?

A

yes

153
Q

What is the CI CrCl of Exenatide?

A

CrCl <30 mL/min

154
Q

What is the CI CrCl of Lixisenatide?

A

CrCl <15 mL/min

155
Q

Common side effects associated with GLP-1 agonists?

A
  1. nausea/vomiting
  2. decrease in appetite/weight loss
  3. dyspepsia (indigestion)
  4. injection site reactions
156
Q

Which GLP-1 agonist injections are dosed weekly?

A
  1. Dulaglutide
  2. Exenatide ER
  3. Semaglutide
157
Q

How often is Exenatide (Byetta) dosed?

A

twice daily

158
Q

Boxed warnings for GLP-1 agonists?

A
  1. all except Exenatide (Byetta) and Lixisenatide (Adlyxin) - do not use if personal /family history of medullary thyroid cancer
  2. do not use if history of multiple endocrine neoplasia
159
Q

Warnings associated with GLP-1 agonists?

A
  1. pancreatitis - monitor for symptoms of severe abdominal pain/nausea
  2. AKI/CKD (kidney damage) due to fluid loss and dehydration
  3. hypersensitivity - anaphylaxis and angioedema
  4. gallbladder disease
  5. GI symptoms - if so, titrate slowly and discontinue if fluid depletion
    - do not use if gastroparesis
160
Q

Warning associated with Exenatide ER?

A

serious injection-site reactions - abscess and skin nodules

161
Q

Warnings associated with Semaglutide?

A

diabetic retinopathy

162
Q

If a patient has cancer, what should they avoid?

A

Pioglitazone

163
Q

If a patient has bladder cancer, what should they avoid?

A

dapagliflozin - SGLT-2 inhibitor

164
Q

If a patient has thyroid issues, including medullatory thyroid cancer, what should they avoid?

A

GLP-1 agonists

165
Q

What should elderly patients avoid and why?

A

sulfonylureas - due to hypoglycemia risk - especially with Glyburide

166
Q

What should patients with GI disorders or gastroparesis avoid?

A

GLP-1 agonists

167
Q

What should patients with genital infections or UTIs avoid?

A

SGLT-2 inhibitors

168
Q

What should patients with heart failure avoid?

A
  1. Thiazolidinediones
  2. alogliptin - DPP-4 inhibitor
  3. saxagliptin - DPP-4 inhibitor
169
Q

What should patients with hepatotoxicity avoid?

A
  1. Thiazolidinediones

2. alogliptin - DPP-4 inhibitor

170
Q

What should patients avoid if they present with hypoglycemia?

A
  1. insulin - more hypoglycemia with NPH and regular insulin

2. drugs that increase insulin such as sulfonyulreas

171
Q

What should patients with hypotension avoid?

A

SGLT-2 inhibitors

172
Q

What should patients with hyperkalemia avoid?

A

Canagliflozin - SGLT-2 inhibitor

173
Q

What should patients with hypokalemia avoid?

A

insulin

174
Q

What should patient who experience hypersensitivity reactions avoid?

A

DPP-4 inhibitors

175
Q

What should patients with ketoacidosis avoid?

A

SGLT-2 inhibitors

176
Q

What should patients with lactic acidosis avoid?

A

metformin

177
Q

What should patients with osteoporosis/osteopenia avoid?

A
  1. canagliflozin - SGLT-2 inhibitor

2. Thiazdolinediones

178
Q

What should patients with pancreatitis avoid?

A
  1. GLP-1 agonists

2. DPP-4 inhibitors

179
Q

What should patients with peripheral neuropathy and foot ulcers avoid?

A

canagliflozin - SGLT-2 inhibitor

180
Q

What should patients with retinopathy avoid?

A

semaglutide SC injection - Ozempic

181
Q

What should patients with sulfa allergy avoid?

A

sulfonylureas

182
Q

What should patients with renal insufficiency (CrCl <30) avoid?

A
  1. metformin
  2. SGLT-2 inhibitors
  3. exenatide - GLP-1 agonist
  4. Glyburide - sulfonylurea
183
Q

What should patients that have weight gain avoid?

A
  1. sulfonylureas
  2. meglitinides
  3. thiazolidinediones
  4. insulin
184
Q

What drugs are regarded as basal insulin?

A
  1. degludec
  2. glargine
  3. detemir
185
Q

What drugs are regarded as rapid-acting insulin?

A
  1. aspart
  2. lispro
  3. glulisine
186
Q

What is NPH insulin?

A

intermediate-acting insulin

187
Q

What does P in NPH stand for?

A

protamine

188
Q

What is the onset time of rapid-acting insulin

A

around 15 minutes

189
Q

When does rapid-acting insulin peak?

A

in 1-2 hours

190
Q

What is the duration of rapid-acting insulin?

A

3-5 hours

191
Q

What is the purpose of rapid-acting insulin?

A

controls meal-time blood glucose

192
Q

What is the purpose of regular-acting insulin?

A

controls meal-time BG

193
Q

What is the onset for regular-acting insulin?

A

30 minutes

194
Q

When does regular-acting insulin peak?

A

2 hours

195
Q

How long does regular-acting insulin last?

A

6-10 hours

196
Q

What is the onset time of detemir?

A

3-4 hours

197
Q

How long does determir last for?

A

one whole day

198
Q

When does detemir peak?

A

never peaks

199
Q

What is the onset of glargine?

A

3-4 hours

200
Q

What is the onset time of Toujeo?

A

6 hours

201
Q

How long does glargine last for?

A

1 day

202
Q

When does glargine peak?

A

no peak

203
Q

When is the onset of degludec?

A

1 hour

204
Q

How long does degludec last for?

A

over 42 hours

205
Q

When does degludec peak?

A

no peak

206
Q

What is the DDI between insulin and rosiglitazone?

A

increase risk of heart failure

207
Q

What is the brand name of Aspart?

A

Novolog

208
Q

What is the brand name of Lispro?

A

Humalog

209
Q

What kind of insulin is Humulin R and Novolin R considered?

A

short-acting insulin; regular

210
Q

What kind of insulin is Humulin N and Novolin N considered?

A

intermediate-acting

211
Q

What is the brand name of insulin detemir?

A

Levemir

212
Q

What are the brand names of insulin glargine?

A

Lantus and Toujeo

213
Q

Can u mix basal/long-acting insulin with other insulin?

A

no - inject separately

214
Q

When is Glargine (Toujeo) used instead of Glargine (Lantus)?

A

when more than 20 units/day is needed

215
Q

When is the maxed effect of Toujeo?

A

on the 5th day

216
Q

What kind of insulin is insulin degludec?

A

ultra-rapid acting insulin

217
Q

When is insulin degludec used instead of levemir or glargine?

A

when patients experience nocturnal hypoglycemia

218
Q

How do you convert NPH that is dosed BID to Lantus or Basaglar that is dosed daily

A

Use 80% of the NPH dose

219
Q

How do you convert Toujeo to Lantus or Basaglar?

A

Use 80% of the Toujeo dose

220
Q

What does ICR stand for and what is the purpose for the calculation?

A

Insulin to carbohydrate ratio

calculates how much grams of carbohydrate is covered by 1 unit of insulin

221
Q

How do you calculate the ICR for regular insulin?

A

Rule of 450

222
Q

How do you calculate the ICR for rapid-acting insulin?

A

Rule of 500

223
Q

What does the correction factor mean?

A

how much BG is needed to lower 1 unit of insulin

224
Q

How do you calculate the correction factor for regular insulin?

A

1,500 Rule

225
Q

How do you calculate the correction factor for rapid-acting insulin

A

1,800 Rule

226
Q

How to calculate the correction dose?

A

(current BG - target BG)/(correction factor)

227
Q

Which insulin is most affected by the fasting BG?

A

the basal insulin

228
Q

Which insulin is most affected by the post-prandial BG?

A

the rapid acting or short acting insulin

229
Q

Should you alternative injection sites and which sites are optimal?

A

yes -

  1. posterior upper arm
  2. superior buttocks
  3. lateral thigh area
230
Q

How long is most insulin stable at room temperature for?

A

28 days

231
Q

Drugs that can increase and decrease BG?

A
  1. beta blockers
  2. quinolones
    3.
232
Q

Drugs that can increase BG?

A
  1. thiazide and loop diuretics
  2. tacrolimus, cyclosporine
  3. protease inhibitors
  4. antipsychotics
  5. statins
  6. systemic steroids
  7. cough syrups
  8. niacin - Vitamin B3
233
Q

Drugs that can decrease BG?

A
  1. Linezolid
  2. Lorcaserin
  3. Pentamidine
  4. Tramadol
234
Q

What is the BG that is defined as hypoglycemia?

A

<70 mg/dL

235
Q

Hypoglycemia symptoms?

A
  1. dizziness
  2. anxiety/irritability
  3. shakiness
  4. headache
  5. diaphoresis (sweating)
  6. hunger
  7. confusion
  8. tremors
  9. palpitations/tachycardia
  10. blurred vision
236
Q

What can severe hypoglycemia cause?

A
  1. seizures
  2. coma
  3. death
237
Q

What are common drugs thatinduced hypoglycemia?

A
  1. insulin
  2. sulfonylureas
  3. meglitinides (considered “insulin secretagogues”

*greater risk if patients are drinking alcohol on an empty stomach with these other drugs

238
Q

Which drugs have the lowest risk of hypoglycemia when used alone?

A
  1. GLP-1 agonists
  2. DPP-4 inhibitors
  3. Thiazolidinediones
  4. SGLT-2 inhibitors
239
Q

How do you treat a patient experiencing hypoglycemia symptoms that is conscious?

A

rule of 15

240
Q

How do you treat a patient experiencing hypoglycemia that is unconscious?

A

dextrose (if patient has IV access) or glucagon

*caregivers should know how to administer a 1mg SC glucagon injection or a 3mg glucagon nasal spray

241
Q

What is the target range for BG?

A

140-180 mg/dL

242
Q

How do you recognize diabetic ketoacidosis?

A
  1. BG >250 mg/dL
  2. ketones - “fruity breath”
  3. N/V
  4. anion gap acidosis - arterial pH <7.35 and anion gap >12
243
Q

What is the emergency state that is common in type 2 diabetes?

A

hyperosmolar hyperglycemic state

244
Q

How do you recognize hyperosmolar hyperglycemic state?

A
  1. confusion/delirium
  2. BG >600 with high serum osmolality >320 mOsm/L
  3. extreme dehydration
  4. pH >7.3 and bicarbonate >15 mEq/L
245
Q

DKA and HSA standard treatment?

A
  1. agressive fluids
    - start with NS
    - when BG reaches 200 mg/dL and change to D5W 1/2NS
  2. insulin to treat the hyperglycemia
  3. monitor for hypokalemia and keep serum level between 4-5
  4. give sodium bicarbonate if pH <6.9
246
Q

Important counseling points with metformin?

A
  1. can cause nausea and diarrhea at first which can go away - taking the medication with food or switching to a long-acting formulation to be taken at dinner will help
  2. do not chew or break long-acting formulation - can cause a ghost tablet in the stool
  3. can cause lactic acidosis
  4. stop medication prior to contrast dye - can restart medication when renal function is normal
  5. take a Vitamin B12 supplement if taking metformin long-term
247
Q

Important counseling points with thiazolidinediones?

A
  1. take once daily in the morning
  2. can cause or worsen heart failure
  3. can cause weight gain
  4. greater risk for bone fractures
  5. don’t use pioglitazone if patient has history of bladder cancer
248
Q

Important counseling points with SGLT-2 inhibitors?

A
  1. take once daily in the morning
  2. can cause an increase in LDL cholesterol
  3. can cause hypotension
  4. can cause ketoacidosis - stop medication prior to surgery to reduce risk
  5. can cause severe UTIs or genital fungal infections
  6. amputation risk, fractures, and hyperkalemia risks associated with canagliflozin
    - avoid if patient has neuropathy or foot problems
  7. dapagliflozin - bladder cancer risk
249
Q

Important counseling points with DPP-4 inhibitors?

A
  1. take once daily in the morning
  2. can cause pancreatitis
  3. can cause renal impairment
  4. can cause severe arthralgia
  5. heart failure risk with saxagliptin and alogliptin
250
Q

Important counseling points with meglitinides/sulfonylureas?

A
  1. take sulfonylureas with breakfast, except with glipizide IR - take 30 min before breakfast
  2. take meglitinides 15-30 min before meals - do not take if skipping meals
  3. can cause hypoglycemia and weight loss
251
Q

Important counseling points with GLP-1 agonists?

A
  1. take Adlyxin and Byetta within 60 minutes of a meal - take the others anytime
  2. if injection has been in the refrigerator - wait at least 15 min at room temperature before using
  3. can cause nausea, diarrhea, decrease in appetite, weight loss
  4. increased risk of pancreatitis and gallbladder disease
  5. increased risk of kidney damage, especially from dehydration if there is severe vomiting or diarrhea
  6. can cause hypersensitivity reaction including anaphylaxis or angioedema
  7. Bydureron can cause severe injection-site reactions such as abscess and nodules
  8. Ozempic has increased risk of diabetic retinopathy
252
Q

Important counseling points for Pramlintide?

A
  1. when starting, reduce the dose of meal-time insulin by 50%
  2. inject before meals
  3. do not mix with insulin
  4. can cause nausea

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