Diabetes (Medications, Labs, Side Effects, Insulin) Flashcards
What are the diagnostic criteria for Diabetes Type II?
What is the GOLD standard in a normal person?
What is the GOLD standard in a pregnant patient?
-Fasting glucose: > 126
-2 hour glucose tolerance test: > 200
-Hemoglobin A1c: > 6.5%
-Random plasma glucose: > 200
GOLD: Fasting at least 8 hours on 2 occasions
GOLD in pregnant: 3h GTT
How long does A1c measure back to give you an average?
10-12 weeks prior to measurement
Who should be screened for diabetes?
All adults 45 or older OR any adult with BMI > 25 and 1 risk factor for DM
Initial management for Diabetes is lifestyle modifications including diet and exercise. What are the percentages associated with each food that you should focus on?
-Carbs:
-Protein:
-Unsaturated fats:
-Carbs: 50-60%
-Protein: 15-20%
-Unsaturated fats: 10%
Metformin
-Drug class
-MOA
-Adverse Effects
-Contraindications
-Biguanides
-Decreased hepatic glucose production and increases peripheral uptake of glucose
-GI complaints MC, Vitamin B12 deficiency, lactic acidosis
-C/I: severe renal or hepatic impairment, hold before contrast and results 48 hours after
What drugs are sulfonylureas?
-Names
-MOA
-Adverse
-Glipizide, Glyburide, and Glimepiride
-2nd gen: Chlorpropamide
-Stimulates pancreatic beta cell insulin release (secretagogue)
-Adv: Hypoglycemia (MC), GI upset, dermatitis, weight gain
–Chlorpropamide: hyponatremia, Disulfiram reaction flushing after alcohol ingestion
Repaglinide and Nateglinide are what types of medications?
-MOA
-Adv:
Meglitinides
-Insulin secretagogues
-Adv: Hypoglycemia, weight gain
Thiazolidinediones
-Names
-MOA
-Adv:
-They both are associated with increased incidence of something. Name them.
-Pioglitazone, Rosiglitazone
-Increases insulin sensitivity at peripheral receptor sites (adipose, muscle, liver) which leads to decreased glucose production
-Peripheral edema, fluid retention, CHF, Hepatotoxicity
-Rosglitazone: higher cardio events and atherosclerotic lipid profiles
-Pioglitazone: bladder cancer
SGLT-2 Inhibitors
-Names
-MOA
-Benefit
-Adv
-“-flozin” (Empagliflozin, Canagliflozin, Dapagliflozin)
-Sodium glucose transport inhibition leading to increased urinary glucose excretion
-Benefits: improves cardiovascular outcomes and decreases risk of heart failure. BP and weight reduction.
-Adv: Transient nausea and vomiting, UTI and yeast infections (sugar in the pee)
GLP-1 Receptor Agonists
-Names
-MOA
-Benefits
-Adv
-Liraglutide, Exenatide, Dulaglutide
-MOA: Mimics incretin, increased glucose-dependent insulin secretion, delayed gastric emptying.
-Benefits: weight loss, cardiovascular event decreases
-Adv: GI, pancreatitis, small risk of hypoglycemia
What lab can be drawn to differentiate between Type I and Type II Diabetes?
C-peptide
–LOW is Type I, Normal or High is Type II
What is the somogyi phenomenon?
How can you prevent this?
-Noctural hypoglycemia followed by rebound hyperglycemia
-Prevent the hypoglycemia by
1) decreased nighttime NPH dose
2) move evening NPH dose earlier
3) give a bedtime snack
What is the Dawn phenomenon?
How to prevent this?
-Normal glucose until rise in serum glucose levels between 2-8am due to nightly surge of counterregulatory hormones (during fasting at night)
-Prevent early morning hyperglycemia by
1) bedtime injection of NPH
2) avoiding carb snacks at night
3) insulin pump usage early in morning
Rapid Acting Insulin
-Names
-Onset
-Peak
-Duration
-When do you give it?
-Lispro, Aspart
-Onset: 5-15 minutes
-Peak: 45-75 minutes
-Duration: 2-4 hours
-Give at same time of meal
Short-Acting Insulin
-Name
-Onset
-Peak
-Duration
-When do you give it?
-Regular insulin
-Onset: 30 minutes
-Peak: 2-4 hours
-Duration: 5-8 hours
-Given 30-60 minutes prior to meal
