Diabetes General

Question 1

List 4 Common etiologies of Drug-induced hyperglycemia

Answer 1

1. Atypical antipsychotics
   - increase hunger
   - e.g. olanzapine, aripiprazole
2. Systemic Corticosteroids
   - decrease glucose uptake –> insulin resistance
3. Immunosuppressants
   - e.g. cyclosporine, tacrolimus, sirolimus
4. Niacin
   - insulin resistance, hepatic gluconeogenesis

Question 2

What are the 3 classes of “less common” etiologies causing drug-induced hyperglycemia?

Answer 2

1. Thiazides
2. Statins
3. B-blockers

Question 3

Who should you screen for prediabetes?

Answer 3

Screen pt at risk q 3yrs:

• pt >/= 45yo
• RF: gestational DM, BMI > 25 (>23 in Asian)

Question 4

How do you manage prediabetes?

[A1C 5.7-6.4 or FBG 100-125; on two separate measures]

Answer 4

1. emphasize lifestyle
   - eat real food
   - wt. loss
2. consider METFORMIN if lifestyle is not enough after 3-6mo

Question 5

How often should you monitor blood sugar for patients who are on non-insulin analogues?

Answer 5

• avoid over monitoring STABLE T2DM w/LOW RISK FOR HYPOGLYCEMIA
• • focus daily self-monitoring on:
• newly diagnosed pt
• during acute illness or pregnancy
• after changing meds
• with weight change
• when A1c gets out of desired range

Question 6

What else do you need to be monitoring in diabetic patients in addition to BS/A1C?

Answer 6

• eGFR
• LFTs
• H&H
• Vit B12

Question 7

What are the benefits of lowering A1C?

Answer 7

<7% can further decrease risk of microvascular disease (e.g. retinopathy, neuropathy, nephropathy)

• usually younger pt who does not have CVD or hypoglycemia

Question 8

What should be the pharm focus for decreasing macrovascular events related to diabetes?

Answer 8

Focus on BP, lipids, ASA if needed.

• ACEI/ARB
• ASA
• Statin

Question 9

Why do we not need ALL patients A1C to be < 7%?

Answer 9

Some patients may require less intensive glycemic control based on comorbidities.

Lowering A1C TOO FAST or intensive use of DM drugs may increase mortality in older pt w/long-standing DM2 and high CV risk.

Question 10

When are ACEI/ARB indicated in DM pt?

Answer 10

• HTN –> improves CV and renal outcomes
• pt w/macroalbuminuria* to slow kidney disease
• pt w/microalbuminuria* AND normal BP –> does NOT reduce risk of progression to ESRD

Question 11

When is ASA indicated in DM patient?

Answer 11

1. Secondary* prophylaxis against CV events
2. Primary* prophylaxis against CV events –> DM doesn’t always trump GI bleeding risk

The typical DM pt who would benefit from ASA:
- most men >50y or women >60y WITH at least 1 CV RF

Question 12

When are Statins indicated in a DM patient?

Answer 12

Use statin for most DM pt at diagnosis*