fnp exam 2 Flashcards
Prediabetes glucose and A1c levels
BG: 101-125 mg/dL (fasting plasma glucose) & 140-199 (oral glucose tolerance test)
HgbA1C: 5.7-6.4
Metabolic syndrome triglycerides, HDL, and fasting glucose levels
Triglycerides: >150 mg/dL
HDL: <40 mg/dL in men, <50 mg/dL in women
Fasting glucose: >100 mg/dL
Diabetes glucose and A1c levels
BG: 126 or above (fasting plasma glucose) & 200 or above (oral glucose tolerance test)
A1C: 6.5 or above
What weeks of pregnancy is gestational diabetes tested for
between 24th and 28th
Rule of 15 for hypoglycemia
-give 15 grams CHO (1 serving) in liquid or readily absorbed form
-re-check blood glucose 15 minutes later
*follow with a snack or meal once youve reached >70
Sick Day management for diabetics
-8 oz fluid every hour (every 3rd electrolytes)
-monitor BG every 2-4 hours
-ketone testing every 4 hours until negative (for type 1 only)
-continue meds as usual
When to contact pcp for diabetic sick symptoms
-more than one episode of vomiting
-more than 6 hours of diarrhea
-bg>200 on 2 measurments
-moderate to large urine ketones
What patients are acceptable to have an A1c of 8%
elderly, limited life expectancy, h/o hypoglycemia, extensive CVD complications
how many times a day to type 1 diabetics need to check sugar (if not on continuous)
4 times daily
Starting total insulin dose
0.4 to 1.0 units/kg/day
Metformin and renal failure causes? What must GFR be to start?
can cause lactic acidosis, GFR must be 30 or greater
Best dose and time to start metformin at
500 mg at bedtime (try XR if this still causes GI upset)
GLP 1 Receptor Agonists name and action
TIDES!
-injectables that cause glucagon suppression and delay gastric empyting
pros and cons of glp-1 agonists
Pros:
-reduce a1c
-low risk of hypoglycemia
-weight loss
cons:
-expensive
-GI side effects
SGLT2 inhibitors names and action
FLOzin! oral meds that curb the action of proteins called “sodium-glucose cotransporter 2” that help your kidneys reabsorb glucose from the blood > causes urination of excess glucose
Pros and cons of SGLT2 inhibitors
Pros:
-helps with volume in those with h/o CHF
-weight loss
-Prevents progression of CKD
-CV benefit
Cons:
-UTIs and Yeast infections
-decrease in eGFR
-euglycemic DKA
DPP4 inhibitors name and action
GLIPTIN! oral meds that works similarly to GLP1 agonists by delaying breakdown of GLP-1
DPP-4 pros and cons:
Pros:
-moderately effective in reducing A1C
-low risk hypoglycemia
-neutral weight loss
-few side effects
Cons:
-expensive
-CANNOT use w h/o medullary thyroid cancer
-reports of pancreatitis and hypersensitivity reaction including SJS
sulfonylureas names and action
IDES! stimulates insulin release from the pancreas
pros and cons of sulfonylureas
pros:
- effective and cheap
cons:
-moderate hypoglycemia risk
-possible weight gain
-No CV benefit
Thiazolidinediones (TZDs) names and action
GLITAZONES! (rosiglitazone and pioglitazone) sensitize peripheral tissue to insulin and decreases gluconeogenesis in the liver
pros and cons of TZDs (glitazones)
pros:
-effective in lowering A1C
-lowers risk of hypoglycemia then SUs
cons:
-weight gain
-r/o edema and HF
-several weeks to be effective
-more expensive
-bladder cancer risk!
what 2 diabetes meds do you consider giving for patients with high risk ASCVD?
GLP-1s and SGLT-2s
what diabetes med do you consider giving for patients with HF or CKD? even though given for CKD, what GFR is contraindicated with this med?
SGLT-2s
Cannot give if GFR < 45
What conditions should make you avoid SGLTs?
frequent UTIs, yeast infections, decreased bone density, foot ulcers, increased r/o dka
What diabetes med should you avoid using for patients with HF?
TZDs (glitazones)
Along with insulin, what other diabetes medication has a hypoglycemic risk?
Sulfonylureas (IDES)
Which 3 types of diabetes meds cause weight gain? which one is weight neutral?
-insulin, SUs, TZD
DDP4 is weight neutral
When do you start insulin therapy? and what type of insulin is usually started first?
-insulin therapy is started when glycemic goal hasnt been reached from other meds, or A1C is >9.0%
-usually basal insulin is added first along with oral meds
Dawn phenomenon
early morning INCREASE in BG between 2am-8am
Somogyi effect
DECREASE in BG during 3am-7am (usually increases at 7am
what time to check BG to distinguish between dawn and somogyi effect?
check at 3 am. if low, decrease insulin needs. if high, increase
what is the honeymoon phase?
after diagnosis if type 1 DM, the first few months seem to be “better” and dont need much insulin
what dose does insulin usually start at?
0.4 to 1.0 units/kg/day for type 1
5 diagnosis from pituitary dysfunction
Glactorrhea, Gynecomastia, hirtisuism, hypogonadism, PCOS
what TSH level is levothyroxine usually started? and how often is it rechecked to reach euthyroid? what is the usual dose? usual dose for elderly or cardiac pts?
> 10
q 4-6 weeks
75 mcg for every 100 lbs
12.5-25 mcg/day
what is subclinical hypothyroidism? when to start treatment?
-normal t4 with mildly elevated tsh (>4.5)
-start treatment if patient is symptomatic and TSH is 4.5-10
when/how to take levothyroxine?
early morning on an empty stomach with NO other meds
treatment for hyperthyroidism?
PTU, methimazole (preferred), beta blockers (for symptoms), radioactive iodine, or surgery
what is the diagnosis if T3, T4, and TSH are all low?
pituitary gland abnormality
what are the 2 types of cushings?
endogenous - adrenal tumor
exogenous - steroid therapy
diagnostic tests for cushings
-24 hour urine free cortisol
-dexamethasone suppression test
-serum ACTH
-AM plasma cortisol test
lab values associated with addisons
hyperkalemia, hyponatremia, hypoglycemia and plasma cortisol <5mg/dL at 8 am
tests to order for galactorrhea
Prolactin and TSH labs
mammogram to rule out mass
MRI r/t pituitary adenoma
tests for PCOS
lipid panel, endocrine labs (tsh, LH, prolactin, testosterone), US *string of pearls
PCOS is diagnosed with a pt has 2/3 of what 3 symptoms?
-irregular periods
-excess androgen
-polycystic ovaries
labs to check for hirsutism? what to rule out before starting therapy?
-testosterone, FSH, LH, prolactin
-rule out ovarian or adrenal tumor
GLP-1 agonists in pediatric patients
Liraglutide is a XR exenatide approved for peds > 10 yo
what test is required to make definitive diagnosis of GHD?
GH stimulation tests
