Diabetes Treatment

Question 1

Biguanides

Answer 1

Metformin
dose related transient (except diarrhea) GI s/e
titrate slowly and take w food
alcohol increases risk of hypo
DDI radio contrast media
renal dose adjust

Question 2

Sulfonylureas

Answer 2

Gliclazide, Glyburide, Glimepiride
AE: weight gain and hypoglycemia: don’t skip meals
renal dose adjust

Question 3

Meglitinide

Answer 3

Repaglinide
AE: hypoglycemia
Take 0-30min before food

Question 4

Thiazolidinediones

Answer 4

Rosiglitazone, Pioglitazone
CI: HF (edema)
AE: wt gain, increased risk of: fractures (both), MI (R), bladder cancer (P)

Question 5

Alpha-glucosidase Inhibitors

Answer 5

Acarbose
AE: diarrhea, flatulence, cramps
Avoid in GI obstruction, ulceration, hernia
Hypoglycemia must be treated with dextrose NOT sucrose
Take w 1st bite of each meal

Question 6

DPP4 Inhibitors

Answer 6

Sitaglitpin, Linagliptin, Saxagliptin, Alogliptin
AE: headaches, UTI, URTI, gas, bloating
rare: pancreatitis, severe joint pain

Question 7

GLP1 Agonists

Answer 7

Subcut
Delaglutide, Exenatide, Liraglutide, Semaglutide, Lixisenatide
AE: n/v/d initially, allergic rxn (E), retinopathy (S)
CI: medullary thyroid cancer, MEN2 family hx
Caution or CI below eGFR 15-30

Question 8

SGLT2 Inhibitors

Answer 8

Canagliflozin, Dapagliflozin, Empagliflozin, Ertugliflozin
AE: wt loss, lowers SBP, UTI, genital yeast infections, volume depletion, hyperkalemia, increased SCr, fracture risk
Renal: ineffective below 60 eGFR
Dose before breakfast

Question 9

SADDMANS

Answer 9

Sulfonylureas
ACEI
Diuretics
Direct Renin Inhibitors
Metformin
ARBs
NSAIDs
SGLT2 inhibitors

Question 10

Goal is to reach target A1C within

Answer 10

3-6 months

Question 11

Symptoms of hypoglycemia

Answer 11

Confusion, drowsiness, dizziness, weakness, headache, vision changes, insomnia, nausea, hunger, trembling, palpitations, anxiety, sweating

Question 12

Treatment of hypoglycemia

Answer 12

15g of carbs q15min until BG>4
eg. 3 tsp sugar, 1 tbsp honey, 4 Dex4 tabs

Question 13

Statins indicated in diabetes when

Answer 13

age 40+, clinical CVD, microvascular complications, diabetes for over 15y and age >30, other risk factors eg ACR>2

Question 14

ACEi/ARB indicated in diabetes when

Answer 14

age >55 w CV risk factors or end organ damage, clinical CVD, microvascular complications

Question 15

Antihyperglycemic drugs w CV benefit

Answer 15

old: Empa, Cana, Lira
new: Dapa, Dela, Sema

Question 16

Antihyperglycemic drugs w renal benefit

Answer 16

Empa, Cana, Dapa

Question 17

Cloudy insulins

Answer 17

NPH and protamine mixes are cloudy

Question 18

Somogyi effect

Answer 18

nocturnal hypoglycemia causes surge of counterregulatory hormones leading to nightmares, hunger, sweating and high AM FBG - treat by lowering evening dose of postponing dinner NPH

Question 19

Dawn phenomenon

Answer 19

mildly elevated AM FBG due to decrease in tissue sensitivity to insulin at 5-8am caused by counterregulatory hormones - treat by increasing evening dose or NPH and bedtime

Question 20

DKA signs and symptoms

Answer 20

Diabetic Ketoacidosis
signs: BG>14
sx: headache, n/v/dry mouth, abdominal pain, fruity acetone breath, deep laboured breathing, decreased LOC

Question 21

DKA causes

Answer 21

alcohol, extensive exercise, infection, less food or insulin, drugs (clozapine, olanzapine, cocaine, lithium, terbutaline)

Question 22

DKA treatment

Answer 22

fluid, electrolytes, insulin

Question 23

DKA when to go to the ER

Answer 23

unable to take fluids or keep BG>4, taking extra insulin but BG stilll elevated, diarrhea/vomitting>4h, ketones>3

Question 24

Urine vs blood ketone testing

Answer 24

urine is delayed, blood is quicker more accurate
go to ER if ketones >3

Question 25

Aspart, Lispro, Glulisine onset, duration

Answer 25

rapid acting 10-15m onset 3-5h duration

Question 26

Regular insulin onset, duration

Answer 26

short acting 30m onset 6.5h duration (17-24h with U500 Entuzity)

Question 27

NPH insulin onset, duration

Answer 27

intermediate acting 1-3h onset 12-18h duration

Question 28

Glargine, Detemir onset, duration

Answer 28

long acting 1.5h onset, 24h duration (36h toujeo)

Question 29

Degludec onset, duration

Answer 29

ultra-long acting 1h onset, 42h duration

Question 30

What does 30 mean in Novomix 30?

Answer 30

30% short acting (aspart) 70% intermediate (NPH)

Question 31

what does 25 or 50 mean in Humalog mix 25 or 50?

Answer 31

25 or 50% short acting (lispro) the rest is NPH

Question 32

which antihyperglycemics cause weight gain? loss?

Answer 32

gain: sulfonylureas, thiazolidinediones loss: GLP1 and SGLT2

Question 33

which antihyperglycemics cause hypoglycemia?

Answer 33

sulfonylureas, repaglinide

Question 34

Ozempic key points

Answer 34

2mg pen usually for 0.25mgx4weeks then 0.5mgx2 weeks total 6 wks 4mg pen for 1mg/wk total 4wks Comes with 4-6needles, dial air shot, inject sc (pinch, 90 angle) around stomach (rotate sites), hold for 5 sec, discard in sharps count. Same needles as insulins

Question 35

Saxenda initial titration and days supply

Answer 35

90mg/box = 44 days supply following usual dose schedule: Start at 0.6mg/wk and inc by 0.6mg every week until maintenance dose of 3mg.

Question 36

Saxenda Vs Victoza

Answer 36

Both liraglutide Victoza for diabetes 2x3ml pack Saxenda for weight loss 5x3ml pack