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CDM 1 Exam 2 > Diabetes: Lecture 2 > Flashcards

Diabetes: Lecture 2 Flashcards

1
Q

Goal of Diabetes Management?

A

Reduce morbidity and mortality
Prevent or slow progression of late complications
Keep BG lvl as close to normal as possible
Keep pt free of symptoms of hyper/hypo glycemia
Maximize pt contribution to their health

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2
Q

Trialnet.org

A

ppl with Type 1 diabetes enter this study or have relatives

intent to find how insulin production can be preserved

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3
Q

Prediabetes A1c?

A

Between 5.7% and 6.4%

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4
Q

Patients with A1c between 5.5% and 6%…..

A

increased risk of DM in 5 years between 9-25%

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5
Q

Patients with A1c between 6.0% and 6.4%….

A

Increased risk of DM in 5 years between 25-50%

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6
Q

Those with prediabetes should be informed about increased risk for….

A

DM, CVD and how to reduce risk

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7
Q

Treatments for Prediabetes?

A

Metformin = 31% reduction in risk after 3 years
Diet and Exercise change = 57% reduction risk after 3 years

Method for that group was weight loss of 7% and 30min/day exercise. Low fat/high fiber diet

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8
Q

Good points Metformin Pre-DM?

A

strong evidence

Demonstrated long-term safety

as effective as lifestyle with DMI > 35

Women with History of GDM, metformin + lifestyle reduced risk to 50%

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9
Q

Bad points Metformin Pre-DM?

A

less effective than lifestyle changes

not better than placebo of those 60+

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10
Q

Big diabetes study?

A

DPP

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11
Q

Overall, only med considered for pre-DM?

A

Metformin, shown to be best for variety of reasons

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12
Q

ADA pre-DM recommendations

A

Screen yearly
Treat other CVD risk factors
DPP = lifestyle modification…Weight loss/Physical activity

Metformin considered those at high risk

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13
Q

ADA risk factors to be considered high risk?

A

A1c of pre-DM
DMI >35
60yr old +
Women w/ H/o GDM

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14
Q

Foods that don’t raise blood glucose?

A

Fats and proteins

Carbs = raise BG

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15
Q

Lifestyle changes with Type 1?

A

Carb count to determine insulin dose, meal planning with insulin timing

eat at consistent times, synchronized with insulin

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16
Q

Lifestyle changes in Type 2?

A 
Moderate weight loss = 7%
Moderate caloric restriction
Pay attention to carbs
Increase fiber
Reduce salt
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17
Q

Carb info

A

1 serving = 15 grams

Limit to 3(W)-4(M) servings of Carb per meal or 1-2 serving per snack

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18
Q

Perfect plate method

A 
1/2 = Veggies
1/4 = carbs
1/4 = protein

If still hungry, go back for veggies/protein

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19
Q

Quick Nutrition counseling diabetes?

A 
No sugar sweetened beverages
No juice 
Severly limit deserts
Cheat less often
Plan meals
20
Q

Physical Activity Recommendation

A

Children w/DM or Pre-DM = 60min/day
Adults = 150min/week

  • all adults, esp those with DM, decrease sedentary behavior*
21
Q

Drug Therapy Type 1

A

Insulin = mandatory

Oral agents and GLP-1 RA injectables no indicated

22
Q

Pramlintide (Symlin) info

A

indicated for Type 1

Not often used, injected at every meal but not very effective in glucose lowering.
V expensive ~$2500 month

23
Q

Biguanide

A

Metformin

24
Q

SGLT2 inhibitors

A

Canagliflozin (Invokana)
Dapagliflozin (Farxiga)
Empagliflozin (Jardiance)

25
Q

GLP-1RA

A 
Exenatide* (Byetta and Bydureon)
Liraglutide*(Victoza)
Dulaglutide* (Trulicity)
Lixisenatide (Adlyxin)
Semaglutide* (Ozempic (SC) and Rybelsus (PO))
26
Q

Sulfonylureas

insulin secretagogues

A

Glyburide* (Diabeta, Glynase)

Glipizide* (Glucotrol)

27
Q

Non-SU Secretagogues

A

Repaglinide* (Prandin)

28
Q

DPP4 inhibitors

A

Sitagliptin* (Januvia)
Saxagliptan* (Onglyza)
Linagliptin* (Tradjenta)

29
Q

TZDs *Thiazolidinediones

A

Pioglitazone (Actos)

30
Q

General 1st line therapy for Type 2 DM?

A

generally includes metformin and comprehensive lifestyle modifications

Depends on comorbidities, pt centered treatment factors

31
Q

Type 2 DM w/ ASCVD

A

GLP and/or SGLT2i

32
Q

Type 2 DM w/ HF

A

SGLT2i

33
Q

Type 2 DM w/ CKD

A

Elevated UACR = SGLT2i preferred or GLP

No elevated UACR = GLP and/or SGLT2i

34
Q

Metformin MOA

A

Inhibits Hepatic Glucose Production

Major efect îs decrease hepatic glucose output, lowering fasting BG levels

Also increases insulin sensitive and better uptake in the muscle

35
Q

Miscellaneous Metformin info

A 
Multiple generic
Comes in combo w/ a bunch of stuff
Pills are big
IR and ER formulations
*Generally add agents too, not replace with BG uncontrolled*
36
Q

Metformin Efficacy

A

Reduce A1c ~1%, - 1.5%
reduced risk of micro/macrovascular complications
Decrease weight
Dose not cause hypoglycemia as monotherapy

37
Q

UKPDS

A

landmark trial used to establish goals

38
Q

Metformin Adverse Effect

A

GI = diarrhea,cramping,bloating (start low dose taper up, take w/ food, switch to ER)

B12 deficiency
Lactic acidosis = V rare

39
Q

When to not use Metformin?

A

Known Hypersensitivity

Alcohol Abuse = LFTs 3x ULN

Liver Dysfunction = LFTs 3x ULN

Stop for acute serious medical situations that req restrictions, start 2 day after

Sig renal disease

When undergoing iodinated contrast media

40
Q

Dose adjustment recommendations Metformin

A

eGFR > 60 = OK
eGFR = 45-59 = continue using, reduce dose
eGFR = 30-44 = Don’t start, can continue reduce 50%
eGFR < 30 = Should DC

41
Q

Metformin IR Dosing

A

BID = due to side effects

Usually 1000mg BID

Max dose IR = 2550mg/day, stop ~ 2000mg

If GI sx not tolerated, go to ER

42
Q

Metformin ER Dosing

A

can be dosed once daily

max dose is 1500mg/day of the 750mg

43
Q

Metformin Monitoring

A

Compliance
A1c, renal function, B12 check
SMBG readings
Low blood sugar not expected with monotherapy
Don’t take on empty stomach, w/ meals
GI SE can decrease or go away after few weeks.

44
Q

GLP-1 RA with proven cv benefit

A

Liraglutide (Victoza)
Semaglutide (Ozempic)
Dulaglutide (Trulicity)

45
Q

SGLT2i with proven Cv benefit

A

Empagliflozin (Jardiance)

Canagliflozin (Invokana)

CDM 1 Exam 2 (16 decks)

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