DM Flashcards
how long until ketosis and then DKA develops in T1DM without insulin
8-16 hours until ketosis
12-24 hours until DKA
what are the main acute symptoms of DMT1
rapid weight loss
polydipsia
polyuria
polyphagia
fatigue
blurred vision
Glargine or lantus is what kind of insulin
long acting
determir or levemir is what kind of insulin
long acting
lispro is what kind of insulin
short acting
what is the goal A1C for T1DM
</= 7.0
what specialty should be consulted for T1DM
endocrinology
what things should be regularly monitored in the diabetic client
opthalmologic exam
A1c
lipids
urinary microalmbumin
BP
when is a diabetic client most likely to present with DKA or HHS
when they are ill
when might a patient still have DKA despite only a normal blood glucose level
in pregnancy or using a SGLT2 inhibitor
how is DKA and HHS treated
IV fluids
IV insulin
Potassium
which diabetic emergency may lead to encephalopathy
HHS
which diabetic emergency causes kussmal breathing
DKA
DKA or HHS causes higher levels of glucose
HHS
what are the macrovascular end results of chronic DM
stroke
CAD/MI
PAD
claudication/ulcers
what lab results would indicate microvascular complications
increased albumin
decreased GFR
what A1C level is diagnostic for DM
> /= 6.5%
if you are unsure if it is Type 1 or 2, what lab work will you get
C peptide = low in type 1 and high in type 2
Antibodies = (+) in type 1 and (-) in type 2
what is the peak and duration of rapid acting insulin
peak 1 hour
duration 3-4 hours
what is the name of rapid acting insulins
lispro
aspart
when would you use short acting insulin
in diabetic emerggencies like for an insulin infusion
what is NPH, what is the name, what is the peak and duration
intermediate
humullin
peak 6-10 hours
duration 10-16 hours
what is the peak and duration of long acting insulin
no peak
duration 24 hours
how do you determine total daily dose of insulin for treatment of T1DM
weight (KG) X variable factor (0.3-1) = total dose
divide TDD by 2 and do half in long action and the other half in short acting divided over 3 meals
what is 1st line for T2DM
metformin
how soon after starting metformin should you get follow up A1C
3 months
what is next step if, after 3 months of metform, A1C is >9.5%
start basal insulin (long acting)
what is next step if, after 3 months of metformin, A1C is between 7-9.5%
add second antidiabetic medication
what are options for add on antidiabetics
GLP-1 agonists
SGLT2 inhibitors
Thiazolinediones
DPP4 inhibitors
what antidiabetic add on should be used for patients with CHF
SGLT2 inhibitors
when is next follow up after starting a 2nd antidiabetic
3 month
if after 3 months of metformin and 2nd antidiabetic, A1C is >9.5%, what is next step
start basal insulin
if after 3 months of metformin and 2nd antidiabetic A1C is between 7-9.5%, what is next step
add 3rd antidiabetic medication
if after 3 months of 3 antidiabetic medications A1C is >7%, what is next step
start basal insulin
what needs to be checked before starting insulin infusion in DKA and HHS
potassium must first be corrected
what medication should be used for proteinuria and/or HTN with DM
ACE-I or ARBs
what medication can be used for neuropathic pain in DM
gabapentin
pregabalin
TCAs
SSRIs
when should patients be taking their own POC BG
when they are taking insulin more than once a day
when should DM patients do ketone testing
Type 1 pts during periods of illness with high BG levels or symptoms of DKA
when should you screen asymptomatic people for DM
obese with at least 1 risk factor:
ethnicity
cardiovascular disease
HTN
DLD
PCOS
sedentary
family history of DM
indication of insulin resistance
what are indications of insulin resistance
acanthosis nigricans
severe obesity
what A1C level would be considered prediabetes and how often should you screen prediabetic individuals
> 5.7%
test yearly
if no indications to screen for DM earlier, at what age should all patients start to have screening for DM and how often should you repeat screening if normal
age 45
repeat every 3 years
what type of DM occurs in older adults with a slow surreptitious onset
latent autoimmune diabetes of adulthood (LADA)
which type of DM may be associated with thyroid disease
type 1
what is a normal A1C level
<5.7%
true or false: carb restricted diets are best for control of diabetes
false, reduced calories with lots of veggies is helpful but reducing carbs is no more helpful
when would you target an A1C <6.5% and less then 7%
7% = most people with DM
>6.5% = T2DM with low risk of hypoglycemic events
what class of medication is metformin
biguanide
what are the main side effects of metformin
GI upset
anorexia
lactic acidosis
What are the contraindications for metformin
liver and renal dysfuction
how often do you increase metformin dosage and what is the max
gradually increase every week to a max of 2550mg
when would you start with lifestyle changes instead of metformin
if A1C is <1.5% over target
true or false: if new diabetic initially presents with symptoms (polyuria, polydipsia, weight loss, volume depletion) then you should start with insulin +/- metformin
true
liraglutide and semaglutide are what class of medication
GLP-1 receptor agonists
dapagliflozin is what class of medication
SGLT2 inhibitor
what oral antidiabetic medication should be stopped once you decide to start insulin and why
sulfonylureas as they are more likely to cause hypoglycemia
when should you start a GLP1-RA or SGLT2I even if A1C is at target
patients >60 with multiple risk factors, ASCVD, CHF, CKD as they provide cardio-renal protection
if weight loss is a priority, which medication should be chosen
GLP1RA or SGLT2I
what should GFR level be at in order to safely use a SGLT2I
> 30
which medications should be witheld during acute illness
metformin and SGLT2I and insulin
what is the first priority for newly diagnosed diabetics if they are asymptomatic
getting BP to <130/80
what is the preferred first line HTN tx for DM
ACE-I or ARBs
what is 2nd and 3rd choice for HTN in DM
2nd = CCB
3rd = diuretic
what should you be aware of with thiazides and DM
should be used in low doses as large doses may worsen glucose control
why are beta blockers often not used in DM
they may mask the symptoms of hypoglycemia
which DM patients require statin treatment
CV disease, microvascular disease, >40 years old
which DM patients require statin and ACE-I/ARB therapy
Microvascular disease or >55 with additional risk factors
which DM patients require Statin, ACE-I and ASA therapy
CV disease (Cardiac ischemia, PAD, CVD, carotid disease)
what is the pneumonic SADMANS
the medication that should be held with vomiting/diarrhea
Sulfonylureas
Ace inhibitor
Diuretics
Metformin
ARBS
NSAIDs
SGLT2I
what are lipid control goals for DM
LDL-C <2.0
when should you suspect LADA and how will you check for it
normal weight individuals who do not respond to treatment as well as normal T2DM
order C-peptides which will be greatly reduced with LADA
