Diabetes therapeutics Flashcards
What is A1c actually measuring
The % of hemoglobin that is glycated, which reflects the average blood glucose over 2-3 months
How often A1c should be checked if not at goal
every 3 months
How often A1c should be checked if at goal
every 6 months
General A1c goal
General FBG goal
80-130 mg/dL
General 2hr post-prandial glucose goal
General BP goal for diabetic pts
Statin therapy if
no statin
Statin therapy if 100, smoking, HTN, obesity)
moderate/high intensity
Statin therapy if
high intensity
Statin therapy if >40 y/o and no risk factors
moderate intensity
Statin therapy if 40-75 y/o with CVD risk factors (LDL>100, smoking, obesity, HTN) or overt CVD
high intensity
Statin therapy if your >75 y/o with CVD risk factors (LDL>100, smoking, obesity, HTN)
moderate or high intensity
Statin therapy if >75 y/o with overt CVD
high intensity
When to recommend aspirin therapy in diabetic patients
primary prevention if 10 year CV risk >10% or if secondary prevention
lab test that can differentiate type I from type II DM
C-peptide
Cloudy insulins
NPH, NPL
Insulin that is acidic and can cause burning when injected
glargine
Initial daily insulin dose for Type I DM
0.5-1 units/kg/day, 50% basal and 50% bolus (split between meals)
How to determine the grams of carbs covered by 1 unit of short acting insulin
500/TDD
How to determine the glucose lowering effect (mg/dL) of 1 unit of rapid acting insulin
1700/TDD
How to determine the glucose lowering (mg/dL) effect of 1 unit of regular insulin
1500/TDD
Conversion from NPH to glargine/detemire
~80% of long acting dose
Conversion from glargine/detemire to NPH
1:1
Class of insulin used in an insulin pump
rapid-acting
Initial dose of pramlintide
15 mcg with meals
Vitamin deficiency that can result from metformin therapy
Vitamin B12
SrCr level under which metfromin is contraindicated
1.5 mg/dL for men or 1.4mg/dL for women
Target dose for metformin
2000 mg/day usually given 1000 mg BID
glucose lowering effect of metformin
dec. FBG 50-60 mg/dL and A1c 1.5-2%
glucose lowering effect of TZDs
Dec. FBG 50-60 mg/dL and A1c 1-2%
4 side effects of TZDs
- fluid retention/weight loss
- cholesterol (rosiglitasone)
- bladder cancer
- loss of bone density with long term use
Glucose lowering effect of sulfonylureas
Dec. FBG 50-60% and A1c 1.5-2%
3 main side effects of sulfonylureas
- hypoglycemia
- weight gain
- hyperinsulinemia (decrease time to beta-cell burn out)
Sulfonyl urea that should not be used in CrCl
glyburide
Glucose lowering effect of meglitinides
Dec. A1c 1.4-1.9%
Limiting side effect of alpha-glucosidase inhibitors
GI (constipation and bloating)
Where incretin is released from
intestinal mucosa cells
4 effects of GLP-1 for DM2 treatment
- glucose-dependant insulin secretion
- inhibits beta-cell apoptosis
- Beta-cell proliferation
- Upregulation of insulin biosynthesis
3 conditions where Incretin mimetics are NOT recommended
- CrCl
Major SE of incretin mimetics
N/V/D
CrCl level that requires dose adjustment for sitagliptin
CrCl level that requires dose adjustment for saxagliptan
CrCl level that requires dose adjustment for alogliptan
DPP4 inhibitor that dose not need dose adjustment based on kidney function
linagliptan
CrCl level that is CI for canagliflozin
CrCl level that is CI for dapagliflozin
CrCl level that is CI for empagliflozin
4 side effects for SGLT2 inhibitors
- weight loss
- hyperkalemia
- UTIs
- hypotension
Initial basal insulin dose for DM2
0.2 units/kg/day or 10 units
dopamine agonist that could be used adjunctively to sulfonylurea
bromocriptine
Recommended % of diet that is carbs
45-55%
Recommended % of diet that is fat
25-25% with
Recommended fiber intake
14g/1000 calories
Recommended cholesterol intake
Recommended salt intake
Talking to a person in a way that encourages them to make lifestyle changes
Motivational interviewing
First line for pre-diabetes
metformin
When to screen for GDM
24-48 weeks using 75g OGTT
Diagnostic criteria for GDM
FBG >92 mg/dL, 1hr PPBG >180 mg/dL, 2hr PPBG >153 mg/dL
Gold standard treatment for GDM
Insulin
Diabetes that has some antibodies present but onset is typically not until >25 y/o
Latent Autoimmue Diabetes in Adults
Non-antibody diabetes that has onset
Mature Onset Diabetes in the Young (MODY)
treatment for hypoglycemia
- check blood sugar if possible
- eat simple sugar (fruit, juice, milk) 15-20 g CHO
- wait 15 min and recheck BG
- eat a small snack (crackers, small sandwich)
Rebound hyperglycemia due to nocturnal hypoglycemia episode
Somogyi effect
Morning hyperglycemia due to morning cortisol release
Down phenomenon
2 treatment options for severe hypoglycemia (BG
- IM glucagon (reconstituted before use)
2. IV dextrose
Leading cause of death in people with DM2
MI
A1c diagnosis for diabetes
> 6.5%
FBG diagnosis for diabetes
> 126 mg/dL
2hr PPBG during 75g OGTT for diabetes diagnosis
> 200 mg/dL
Random BG that is diagnostic for diabetes
> 200 mg/dL
interval to repeat diabetes testing if you get a normal result
3 years
Frequency of A1c testing in controlled patients
at least every 2 years
Frequency of A1c testing in patients whose therapy has changed or who are uncontrolled
every 3 months
A1c diagnosis for pre-diabetes
5.7-6.4%
BMI over which you can consider bariatric surgery
> 35 kg/m2
BP target for pregnant patients with DM
110-129/65-79
How often to measure urine albumin in DM
annually
Urine albumin level that indicates use of ACEI or ARB
> 30 mg/24 hr
Frequency of dilates and comprehensive eye exam
every 1-2 years
How often diabetic patients should have a foot exam
annually
When to screen GDM patients for persistant DM
at 6-12 wks postpartum and every 1-3 years thereafter
targets for women with DM2 during pregnancy
A1c
targets for women with GDM, without prexisting DM
FBG
The preferred method of glycemic control in hospitalized pts
Insulin
BG level when you should initiate insulin in hospitalized patients
> 180 mg/dL
glycemic targets for non-critically ill hospitalized patients
FBG
BG goal for most critically ill patients
140-180 mg/dL
Influenza vaccine recommendation for DM pateints
annually in all pt’s >6 months old
PPSV23 vaccine recommendation for DM pts
all pts >2 y/o
PCV13 recommendation for DM patients
if >65 and previously vaccinated with PPSV23, administer PCV13 followed by PPSV23 6-12 months after PCV13 and at least 5 years since most recent PPSV23 dose
Hep B vaccine recommendations for DM patients
all unvaccinated adults age 15-59, consider if >60
3 ketone bodies produced in ketoacidosis due to FA breakdown
acetone, acetoacetate, beta-hydroxybutyrate
Route of the problem when pH and PaCO2 are both acidic or alkaline
respiratory
Route of the problem when PH an HCO3 are both acidic or both alkaline
metabolic
Calculation of anion gap
Na - (Cl + HCO3)
An elevated anion gap
> 12-15
2 reasons why A1c may be inaccurate
- High RBC turnover (anemia, pregnancy)
2. Recent blood transfusion (dialysis)
