Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Therapeutics > Diabetes Quiz > Flashcards

Diabetes Quiz Flashcards

1
Q

What does the A1c measure?

A

% of hemoglobin molecule glycosolated with glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How often should A1c be measured?

A

Atleast twice a year; more commonly every 3 mos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does A1c provide us with?

A

The “long term” indication of glycemic control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is eAG?

A

eAG is the value patients get when they check blood sugar at home, can use this to correlate the % of A1c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does 8% A1c correlate to in eAG?

A

183

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The higher the A1c is, what contributes more to it, fasting or prandial levels?

A

Most contribution of fasting glucose dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The lower the A1c, what contributes more to it fasting or prandial levels?

A

More contribution of post prandial dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some factors that can falsely decrease A1c?

A

Any condition that shortens the life cycle of RBC, blood loss (within 3 mos), Hemolytic anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some factors that can falsely increase A1c?

A

Iron deficiency anemia (thats not treated), blood transfusion (within 3 mos)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the target value for HbA1c according to the ADA?

A

<7% (for most)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the target value of pre-prandial/ fasting plasma glucose (FPG) according to the ADA?

A

80-130 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the target value for 1-2 hours post-prandial glucose (PPG) according to the ADA?

A

<180 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Who are these ADA recommendations for?

A

NON-PREGNANT ADULTS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Less stringent ADA goals may be appropriate for individual patients with:

A

Sever hypogylcemia, limited life expectancy, advanced complications/ extensive co-morbid conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ADA recommendation for a healthy older adults A1c?

A

<7.5% (7-7.5%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ADA recommendation for a healthy older adults fasting or pre-prandial glucose?

A

90-130

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

ADA recommendation for a healthy older adults bedtime glucose?

A

90-150

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

ADA recommendation for an older adult with complex/intermediate health A1c?

A

<8% (7.5-8%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

ADA recommendation for an older adult with complex/intermediate health fasting/pre-prandial glucose?

A

90-150

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ADA recommendation for an older adult with complex/intermediate health bedtime glucose?

A

100-180

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

ADA recommendation for an older adult with very complex/poor health A1c?

A

<8.5% (8.0-9.0%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

ADA recommendation for an older adult with very complex/poor health fasting/pre-prandial glucose?

A

100-180

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

ADA recommendation for an older adult with very complex/poor health bedtime glucose?

A

110-200

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

HbA1c for children and adolescents

A

<7.5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Pre-prandial and fasting plasma glucose for children and adolescents

A

90-130

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Bedtime glucose for children and adolescnets

A

90-150

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Why are glycemic goals more relaxed for children and adolescents?

A

To prevent cognitive impairment/worsening of brain development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Pregnancy HbA1c

A

<6-6.5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Pregnancy Fasting plasma glucose

A

<95

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Pregnancy 1 hour post prandial glucose

A

<140

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Pregnancy 2 hour post prandial glucose

A

<120

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Gestational diabetes may present with more what?

A

Postprandial hyperglycemia, due to carbohydrate intolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Postprandial monitoring in pregnancy is associated with what?

A

Less preeclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are some patient factors that contribute to drug selection?

A

Preference, co-morbidities, insurance, duration of diabetes, current weight, hypoglycemia risk, age, aptitude for self-care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Patients are at risk for infection with diabetes, what are some vaccines to keep UTD?

A

Influenza, pneumococcal, hepatitis B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the guidelines for influenza vaccine?

A

All patients > 6mos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the guidelines for pneumococcal vaccine?

A

All patients 2-64 years of age and all patients 65 or older

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the guidelines for hep B vaccine?

A

All unvaccinated patients 19-59; consider administering if > 60 yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are some lifestyle managements for diabetes?

A

Meal planning, weight management, physical activity: 150 mins/week of mod activity, 2-3 days a week of flexibility and interrupt prolonged sitting every 30 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

CVD risk management with diabetes

A

BP goal of <140/90 with HTN, low-dose aspirin therapy, statin therapy for ASCVD and >40yo for increased risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Basal insulin is what?

A

40-50%, constant low level release. It maintains glucose homeostasis in the fasting state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Bolus insulin is what?

A

50-60%, meal stimulated. Covers meal stimulated bursts of glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Who needs insulin?

A

Type 1 diabetics, gestational diabetics, hyperglycemic crisis

44
Q

T2D who need insulin

A

A1c >9%, glucose >300, marked hyperglycemia, A1c above goal despite 3 mo non-insulin antidiabetic agents

45
Q

Basal insulin can be used as what?

A

Second line agent, after metformin

46
Q

What is Afrezza?

A

Inhaled insulin, dry powder of human (recombinant DNA) insulin

47
Q

How is Afrezza formulated?

A

To absorb onto technosphere microparticles for pulmonary administration

48
Q

How is Afrezza absorbed into the circulation?

A

Insulin particles encapsulated into microspheres, particles dissolve in neutral pH of the lung, absorbed and distributed into circulation

49
Q

Adverse effects of Afrezza

A

Cough, throat/mouth irritation, hypoglycemia, acute bronchospasm, hypersensitivity reactions

50
Q

What tests are required when your taking Afrezza or inhaled insulin?

A

Routine pulmonary functions tests @ baseline, 6 mos, and annually.

51
Q

When should Afrezza not be used?

A

C/I if pt has COPD, increased bronchoconstriction in asthma, less efficacy in smokers!

52
Q

What are the unit dosings for inhaled insulin?

A

4 unit: Blue
8 unit: Green
12 unit: Yellow

53
Q

What does long acting basal insulin offer?

A

A flatter, peakless profile with prolonged duration of action

54
Q

What does ultra long acting insulin offer?

A

Has improved pk and longer duration of action to mimic pancreatic secretion

55
Q

What is Insulin Glargine U-300 (Toujeo)

A

Injection. Provides the same number of units as insulin glargine U-100 at a third of the volume

56
Q

How is Insulin glargine U-300 (Toujeo) absorbed?

A

Released more slowly from the subQ tissue to prolong its duration of action (36 hours)

57
Q

What is the bottom line of glargine U-300 (Toujeo)?

A

Has comparable efficacy to insulin glargine U-100, less severe and nocturnal hypoglycemia with U-300, similar risk of weight gain

58
Q

Insulin Degludec efficacy

A

Comparable to insulin glargine U-100, less nocturnal hypoglycemia with degludec, flexible dosing (8-40 hours between doses didnt impact glycemic control)

59
Q

Who needs ultra long acting insulin?

A

Anyone required basal insulin, high risk of hypoglycemia, pts with hypoglycemia on NPH, pts on twice daily insulin glargine U-100 and detemir, pts who need flexible dosing schedules, pts requiring high doses, pts who arent getting 24 hours of coverage, obese/insulin resistant patients

60
Q

Patients requiring __units a day of insulin needs ultra long acting

A

80 units

61
Q

Is Insulin glargine U-100 (Basaglar) bioequivalent to insulin glargine U-100 (Lantus)?

A

No! But it is THERAPEUTICALLY equivalent, cheaper!

62
Q

What is Insulin lispro U-200 (Humalog kwikpen U-200)

A

Contains more insulin per pen, delivers half the volume of lispro U-100

63
Q

Who can Insulin lispro U-200 (Humalog kwikpen U-200) be considered for?

A

Those with high mealtime dosing

64
Q

Humulin R U-500

A

Regular insulin but behaves like NPH

65
Q

When can Humulin R U-500 be used?

A

Dosed 2-3 times per day, consider it for pts on >200 units of insulin per day!

66
Q

What are some advantages of using insulin early?

A

Reduce glucose toxicity, facilitates B-cell “rest” and preserves function, prevents of minimizes diabetes related complications, may protect against endothelial damage, overcomes patient and clinician barriers

67
Q

What are some disadvantages of using insulin early?

A

Most studies that show benefit used MDI or CSII therapy, complex instructions, expensive

68
Q

What patient factors can effect the initiation of early insulin for T2DM?

A

Feelings of failure, - impact on social life, myths/misconceptions about insulin, limited training on use, inadequate provider education on pros/cons, concern over weight gain and hypoglycemia

69
Q

What provider factors can effect the initiation of early insulin for T2DM?

A

Therapeutic/clinical inertia, perceived patient reluctance/resistance, lack of knowledge and training

70
Q

How do you initiate insulin for T1D?

A

Need both basal and bolus coverage; weight based dosing!!

71
Q

What is the typical starting dose for T1D?

A

O.5 units/kg/day
1/2 to 2/3 is the basal requirement
1/3-1/2 is the bolus requirement (divided among meals)

72
Q

How do you initiate basal insulin for a T2D?

A

Usually do it with metformin, start at 10 units/day OR o.1-0.2 units/kg/day

73
Q

If the A1c is not controlled after initiating insulin, what is next?

A

Add 1 rapid acting insulin injection before the largest meal*

74
Q

What is the dosing for the insulin injection before largest meal?

A

4 units, 0.1 unit/kg OR 10% of basal dose

75
Q

What is the other option if A1c is not controlled after initiating insulin?

A

Change to premixed insulin twice daily (before breakfast and dinner)

76
Q

What is the dosing for premixed insulin?

A

Divide the current basal dose into 2/3 AM 1/3 PM or 1/2 AM and 1/2 PM

77
Q

Insulin adjustments

A

Determine which blood sugars arent at goal- FPG or Pre/post prandial dysfunction

78
Q

What to do if the fasting plasma glucose is causing a problem?

A

Adjust the basal insulin

79
Q

What to do if the pre or post-prandial glucose is causing a problem?

A

Adjust the bolus insulin

80
Q

What to do if hyperglycemia all day?

A

“Fix the fasting first”

81
Q

What is the starting dose for insulin naive Degludec?

A

10 Units daily

82
Q

How do you convert from insulin to U-500 insulin if your A1c is >8%?

A

Start on 100% of the U-100 TDD

83
Q

How do you convert from insulin to U-500 if the A1c is <8% or mean glucose is <183?

A

Start on 80% of the U-100 TDD

84
Q

How do you convert U-100 to U-500 if dosing is BID (twice a day)?

A

Give 60% with breakfast and 40% with dinner

85
Q

How do you convert U-100 to U-500 if dosing is TID (three times a day)?

A

Give 40% with breakfast, 30% with lunch and 30% with dinner

86
Q

How do you adjust the basal insulin?

A

Titrate by 10-15% or 2-4 units 1-2 times/week to reach FPG goal

87
Q

How do you adjust the bolus insulin?

A

Titrate by 10-15% or 1-2 units 1-2 times/week to reach PPG goal

88
Q

If the post-breakfast or before lunch is the “dysfunctional glucose” which do you adjust?

A

Pre-breakfast rapid or short acting insulin

89
Q

If the post-lunch of pre-dinner is the “dysfunctional glucose” which do you adjust?

A

Pre-lunch rapid or short acting insulin

90
Q

If the post-dinner or at bedtime is the “dysfunctional glucose” which do you adjust?

A

Pre-dinner rapid or short acting insulin

91
Q

If the early morning is the “dysfunctional glucose” which do you adjust?

A

Basal insulin or PM dose of NPH

92
Q

When switching between insulin preparations, what is the majority conversion?

A

1:1

93
Q

What is the exception to the 1:1 insulin conversion?

A

NPH -> Glargine U-100, U-300, insulin Degludec

94
Q

What is the conversion for NPH -> Glargine U-100, U-300, insulin Degludec?

A

If once daily NPH its a 1:1 conversion

If BID NPH -> 80% of TDD given once daily

95
Q

Hypoglycemia is a serum glucose level of what?

A

<70 mg/dL

96
Q

What is the 15:15 rule?

A

If hypoglycemic, check the glucose, consume 15g of carbs, recheck in 15 minutes and repeat until levels normal

97
Q

What else is important to prescribe with insulin?

A

Glucagon kit: make sure caregivers and family know how to use

98
Q

What is lipohypertrophy?

A

Accumulation of subQ fat deposits

99
Q

How can lipohypertorphy affect insulin?

A

Can reduce the absorption of insulin

100
Q

What can cause lipohypertrophy?

A

Repeated injections at same site OR reuse of needles

101
Q

How many units of insulin can the 1mL syringe hold?

A

Up to 100 units of insulin/syringe

102
Q

What does each line represent in the 1mL syringe?

A

2 units

103
Q

How many units of insulin can the 0.5mL syringe hold?

A

50 units of insulin/syringe

104
Q

What does each line represent in the 0.5mL syringe?

A

Each line represents 2 units

105
Q

How many units of insulin can the 3/10mL syringe hold?

A

Up to 30 units of insulin/syringe

106
Q

What does each line represent in the 3/10mL syringe?

A

Each line represents 1 unit

Clinical Therapeutics (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions