Diabetes Mellitus Flashcards
A1C
<7.0%
Preprandial capillary plasma glucose
80-130 mg/dL
Peak postprandial capillary plasma glucose
Postprandial glucose measurements should be made 1–2 hours after the beginning of the meal
<180 mg/dL
ABC-KEN-DIPS
Aspirin if indicated Blood pressure control Cholesterol control Kidneys –screen Scr and urine albumin excretion (UAE) / microalbumin:creatinine ratio Eyes- dilated eye exam Nerves-test for loss of sensation, bowel changes, balance issues, erectile dysfunction Dental Immunization Psychological care Smoking cessation
Some pt edu
Food intake
Focus on carbohydrates for glycemic management
Typically stay between 3-4 carbohydrate choices or 45-60 grams of carbohydrate per meal
Eat 3 meals or 5 smaller meals throughout day
If numeracy skills are low, consider plate method
Consider other dx states with medical nutritional therapy
Salt (2300mg/day max)and cholesterol to manage BP
and lipids
Caloric intake for weight management
150 min of moderate-intensity spread over at least 3 days and no more than 2 consecutive days without
If A1c > 9%
Consider dual therapy
If A1c > 10%
Consider combo inj therapy
Metformin
GI adverse events
Minimized with weekly titration
500mg po with largest meal and titrate by one tablet weekly if GI symptoms tolerable to target of 2000mg
Discontinue metformin if the patient’s eGFR later falls below 30 mL/minute/1.73 m2.
Upset stomach, gas, bloating, diarrhea but subsides with time. Take with food.
SU drugs and dosag3
Glipizide: 5mg-20mg* BID
Glimepiride: 1-8mg daily
Glyburide: 2.5-20mg daily
(divide BID if >10mg daily)
Meglinitide drugs and dosing
Nateglinide: 60-120mg TID AC
Repaglinide: 0.5-4mg TID AC
SU and GLN
Weight gain and Hypoglycemia
Esp: Glyburide-not for elderly
Eat 3 meals + snacks –> IMPORTANT because hypo risk
Watch for signs of low blood sugar. Educate on rule of 15.
Rule of 15
If feel weird, nervous, shaky, moody, sweating, chill, irritable, impatient, confused
Test BG
If BG < 70mg/dL: take 15-20g of Carb
_ 3,4 glucose tablet
_ 4 ounces ( or 1/2 a cup) juice or soda
Recheck in 15 mins to make sure BG > 70mg/dL
TZD side effects
Low risk of hypo
Weight gain, edema, HF, fracture
Watch for shortness of breath, lower leg swelling, weight gain. Takes 2-3 months to see full impact.
DPP-4 drugs and dosage
Januvia (sitagliptin): (25-100mg) 30-49 ml/min = 50mg
< 30ml/min = 25mg
Onglyza (saxagliptin): (2.5-5mg) (<50 ml/min = 2.5mg
Tradjenta (linagliptin): (5mg)
DPP-4
Weight neutral
POST-PRANDIAL glucose
NO titration necessary. Start at dose appropriate for renal clearance. EASY!!
AE: rare, joint pain, pancreatitis
Watch for severe nausea, vomiting and call PCP. May cause joint pain.
SGLT-2
Work at kidney: Block sodium reabsorption, block glucose reabsorption
AE: Genital mycotic infections UTIs Hypotension Hypoglycemia w/ insulin or secretagogues Renal impairment DKA Increased fractures Decreased HF and CV benefits*
Watch for vaginal infections or difficulty/painful urination.
Invokana
SGLT-2
Canagliflozin: 100mg to 300mg. CrCl Cutoff <45mL/min. 100mg dose for those 45-60mL/min
Farxiga
SGLT-2
dapagliflozin: 5mg-10mg
CrCl Cutoff <60mL/min
Jardiance
10mg-25mg
Empagliflozin:
CrCl Cutoff <45mL/min
GLP-1 AE
GLP-1 don’t go with DPP-4
Nausea: Injection site rxn Pancreatitis Renal: No dose adjustment Black Box-Thyroid-C cell tumors
Nausea, diarrhea, vomiting may occur but subsides over time. Provide injection education. Injection site may be sore (nodule with Bydureon likely). If difficulty swallowing, call PCP.
Trulicity
GLP-1
Dulaglutide
0.75mg SC, with or without meals, once weekly. Dose can be
increased to 1.5 mg once weekly.
Initiate basal insulin
10 U/day or 0.1-0.2 U/kg/day
10-15% or 2-4 U once or twice weekly
If basal alone does not work
Add GLP-1 RA
OR
Add bolus
Add 1 bolus ins inj before largest meal
Start 4 units, 0.1 u/kg/day, or 10% basal
Dose increases 10-15% once or twice weekly until reach target
