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Therapeutics 2 > ENDOCRINE WEEK 1- diabetes > Flashcards

ENDOCRINE WEEK 1- diabetes Flashcards

1
Q

What types of drugs can interfere with blood glucose in patients with diabetes?

A

beta blockers (atenolol, metoprolol)
Statins (HMG-CoA reductase inhibitors)
Thiazide/ loop diuretics
Steroids
Anti-rejection drugs
Atypical Antipsychotics

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2
Q

What are some clinical features that can distinguish type 1 diabetes from type 2?

A

In type 2 there are physical signs of insulin resistance such as obesity and Acanthosis nigricans

is a skin condition that causes a dark discoloration in body folds and creases.

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3
Q

How often do you screen for type 2 diabetes?

A

For individuals aged 40 + with minimal risk factors the screening is every three years

For individuals with presence of high risk factors you screen every 6-12months

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4
Q

What are the vascular risk factors for T2DM?

A
  • abdominal obesity
  • HDL-C less than 1 in males, less than 1.3 in females
    -HTN
    -being over weight
  • TG above 1.7
  • smoking
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5
Q

what diseases increases an individual for T2DM?

A
  • psych
  • cystic fibrosis
  • pancretitis
    -gout
    -sleep apnea
  • pcos
  • HIV
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6
Q

what are some other risk factors for T2DM

A
  • 40 +
  • gestational DM
  • first degree relative to T2DM
    -delivery of macrocosmic infant
  • presence of end organ damage
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7
Q

what is lab values indicate pre-diabetes?

A

fasting plasma glucose 6.1 -6.9 mmol/L
HBA1C = 6-6.4%

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8
Q

what FPG and A1C lab values are considered normal?

A

FPG less than 5.6 mmol/L
HbA less than 5.5%

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9
Q

what lab values are used to diagnose diabetes

A

A fasting plasma glucose of ≥ 7.0 mmol/L
Glycated hemoglobin (A1C) of ≥ 6.5 %
Random Plasma Glucose ≥ 11.1 mmol/L
2 hour plasma glucose (PG) value in a 75 g oral glucose tolerance test of ≥11.1 mmol/L

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10
Q

Jane is 45 years old and her Fasting plamsa glucose level is 7.5 mmol/L

She denies having any polydipsia/polyuria

Can you diagnose her with T2DM based off this one lab value and clinical observation?

A

No.

In order to diagnose a pt with diabetes they must have any of the following:

  • symptomatic hyperglycemia + A1c above 6.5% OR FPG above 7.0
  • X2 FPG lab values above 7.0
  • X2 A1C above 6.5%
  • A1C above 6.5% and FPG above 7.0
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11
Q

what is metabolic syndrome?

A
  • abdominal obesity
  • HTN
  • dyslipidemia
  • elevated BG
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12
Q

What are macrovascular complications of T2DM?

A
  • stroke
  • heart attack
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13
Q

what are microvascular complications of type 2 diabetes

A

neuropathy
kidney disease
erectile dysfunction
vision changes

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14
Q

what would be your first line treatment for T2DM if Jane’s A1C target is 8.0% and her current A1C is 6.8%?

A

first line would be non pharm for any patient that is less than 1.5% above target

BUT you must check in 3months, and if A1C is not met in 3 months pharmacotherapy should be initiated

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15
Q

what are non pharm measures for t2DM

A
  • self management education
  • individualized nutrition management
  • self monitoring of blood glucose
  • exercise: aerobic more than 150 min/week and resistance training twice a week
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16
Q

For an individual with T2/T1DM what screening/assessments must you perform as their primary care provider?

A
  1. BP at all visits
  2. Annual monofilament foot exam
  3. Annual CKD screening (creatine, urine ACR)
  4. Annual examination of patient BG meter and comparing to phlebotomy draw (within 15% accuracy)
  5. Ophthalmology eye exam at the time of diagnosis (T2DM) and then every 1-2 years
  6. Optho exam 5 years after T1DM diagnosis then annually
  7. HBA1C q3 months in those who have not reached their target
  8. Lipid screening at the time of diagnosis, then annually if results are normal, if treatment is initiated lipids should be checked q 3-6 months
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17
Q

what vaccines are advised for individuals with diabetes?

A

annual influenza
Pneumococcal 23 18-64

A second pneumococcal vaccination is recommended for patients over 65 and had their vaccine more than 5 years ago.

18
Q

How do you treat mild to moderate hypoglycemia?

A

oral source of sugar:
-15g of glucose
- 6 life savers
- 3/4 cup of juice or regular soft drink

this will raise bg up to 2mmol in 20 mins

19
Q

how do you treat severe hypoglycemia?

A

pt will have neuroglycopenic symptoms, confusion ,odd behaviour, disorientation

IF conscious:

  • oral glucose preparation consisting of 20g of carbs
  • preferably glucose tablet
20
Q

what are the adverse affects of insulin?

A
  • hypoglycemia
  • localized fat hypertrophy
  • allergic reaction
  • immune-mediated resistance
21
Q

If an individual is MORE than 1.5% above their a1c target, what treatment would you consider?

A

initiate metformin immediately and consider adding a second antihyperglycmic

22
Q

how would you treat an individual with symptomatic hyperglycemia and metabolic decompesition?

A

initiate insulin and maybe metformin

23
Q

What class of medication is metformin?

A

Metformin is a Biguanide and is the first choice for uncomplicated t2dm

24
Q

how does metformin work?

A

Metformin lowers a1c 1-1.5%
it is NOT associated with weight gain
It decreases hepatic glucose production and lowers glucose absorption

25
Q

when is metformin contraindicated?

A

hepatic impairment
severe renal impairment
previous lactic acidosis

26
Q

what is the dosage for metformin?

A

500-2500mg/day
Start low and go slow to minimize GI side effects

little benefit shown if you go above 1500mg

27
Q

can you drink on metformin?

A

NO!!

28
Q

What is the function of sodium-glucose co transporter 2 Inhibitors ?

A

SGLT2 inhibitors (canagliflozin, all end in FLOZIN)

prevents glucose from being reabsorbed in the kidneys and increases excretion of glucose in urine

can cause weight loss

29
Q

What is the function of glucagon-like peptide Agonists?

A

They cause a pharmacologic increase in GLP-1 which lowers blood sugar

stimulates the pancreas to increase insulin secretion
Decreases glucagon secretion
increases insulin synthesis

30
Q

List the GLP-1 agnoists

A

dulaglutide
Exenatide
Lixisenatide
Semaglutide (ozempic)

ENDS WITH TIDE

31
Q

What is the function of DPP-4 inhibitors?

A

This medication creates a physiological increase in GLP-1

Its not as effective as GLP-1 agonists

lowers A1C by less than 1 percent

32
Q

What are examples of long acting insulin ?

A

insulin degludec
Insulin Detemir
insulin Glargine

33
Q

What are contraindications to GLP-1 antagonists such as liagluTIDE?

A
  • pregnancy
  • personal/family history of medullary thyroid carcinoma
  • multiple endocrine neopasia syndrom
34
Q

If a T2DM patient has renal impairment what would your be your first option for pharm therapy?

A

GLP-1 agonist such as liraglutide

35
Q

Which class of medications should be avoided in patients with heart failure?

A

DPP-4 inhibitors ( sitagliptin for example)

They all end in LIPTIN

And “Glitazones”

36
Q

what pharmacologic alternatives can be used in diabetic patients to reduce cardiovascular morbidity and mortality?

A

GLP-1 (ends with TIDE) OR SGLT-2 (ends with flozin)
ACE/ARB >55 (regardless of BP - PRIL/TAN)
Statin -> all above 40
ASA-> 2nd ary prevention

37
Q

in patients with T2DM when would you consider starting insulin?

A

when you have reached the maximum dose for oral medications

38
Q

If you decided to initiate a long acting insulin for T2DM what is the starting dose?

A

starting dose of lantus (insulin glargine)

  • 10 units once daily

you can increase the dose by 2-4 units EVERY 2-3 days until the fasting plasma glucose has reached the patients target level

39
Q

what is the LDL-C target for an individual with diabetes?

A

less than 2.0

40
Q

What are the A1C targets for an individual with diabetes?

A

typically less than 7.0% or if they have kidney issues less than 6.5%

Therapeutics 2 (12 decks)

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