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ISBP IIB1 Exam 2 > Part B DM Insulin (Lecture 3) > Flashcards

Part B DM Insulin (Lecture 3) Flashcards

1
Q

At 1st prenatal visit what should you do?

A

Test blood sugar to rule out any undiagnosed DM

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2
Q

At 24-28 weeks of gestation what should you do?

A

Test blood sugar in pregnant women with no history of DM

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3
Q

4-12 weeks post partum, what should you do?

A

Test blood sugar for persistent DM using 75g OGTT criteria

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4
Q

How often should women with a H/O GDM be screened?

A

Every 3 years

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5
Q

What are the two strategies for GDM Diagnosis?

A
  • One step: 75 g OGTT
  • Two step: 50 g (non fasting) screen filled by a 100-g OGTT for those with a positive screen
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6
Q

When should a One step strategy be performed?

A

In the morning after a overnight fast (8 hr minimum)

At 24-48 weeks in women NOT previously diagnosed with DM

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7
Q

One step abnormal fasting value?

A

≥ 92 mg/dL

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8
Q

For 2 step: 1st step non fasted 50 g after an hour a blood glucose of ____ is considered normal

A

<130

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9
Q

For 2 step: 1st step non fasted 50 g after an hour a blood glucose of ____ is considered abnormal

A

≥ 130 mg/ dL

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10
Q

What must be done if blood glucose level is ≥ 130 after 1 hour after 1st step

A

Must be followed with a fasted 100-g, 3 hr, OGTT

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11
Q

How many abnormal values makes a GDM diagnosis using the 2nd step?

A

2 abnormal values makes a diagnosis

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12
Q

2nd step fasting abnormal value

A

≥95 mg/dL

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13
Q

2nd step 1-hour abnormal value

A

≥180 mg/dL

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14
Q

2nd step two-hour abnormal value

A

≥155 mg/dL

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15
Q

2nd step three hour abnormal value

A

≥ 140

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16
Q

One step abnormal one hour value?

A

≥ 180

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17
Q

One step abnormal Two hour value?

A

≥ 153

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18
Q

Fasting glucose goal for GDM

A

<95

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19
Q

One hour post prandial goal for GDM

A

<140

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20
Q

2 hour postprandial goal for GDM

A

<120

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21
Q

A1C goal in pregnancy

A

<6% (may be relaxed to <7% if necessary to prevent hypoglycemia)

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22
Q

True or False: “lifestyle behavior change is an essential component of management of GDM and may suffice as treatment”

A

TRUE

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23
Q

____ is the preferred over metformin or glyburide in GDM

A

Insulin

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24
Q

True or False: Metformin or glyburide should NOT be used as first line agents in GDM

A

TRUE

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25
Q

When can metformin be used in GDM?

A

Can be used for PCOS and to induce ovulation, but must be discontinued by the end of the 1ST Trimester

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26
Q

True or False” Telehealth visits for pregnant women with GDM improve outcomes compared with standard in person care”

A

TRUE

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27
Q

SE of Sulfonylureas in GDM

A
  • neonatal hypoglycemia
    -macrosomia
  • increased neonatal abdominal circumference
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28
Q

How often & when should pts on insulin check BG?

A

-3-4 times/day
- check fasting and premeal BG

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29
Q

How often & when should pts on oral therapy check BG?

A
  • 1-3 times/day
  • Fasting & Premeal BG
30
Q

What are advantages of SMBG?

A
  • Detects glycemic excursion
  • quick feedback
  • helpful for sick days
31
Q

What are disadvantages of SMBG?

A
  • cost
  • discomfort from finger stick
32
Q

Hypoglycemia definition

A

Blood glucose < 60 mg/dL (but symptoms may be felt at higher levels)

33
Q

Symptoms of Hypoglycemia (5):

A

Anxious
Hungry
Headache
Thirsty
palpitations

34
Q

Hypoglycemia Level 1 BG

A

<70

35
Q

Hypoglycemia Level 1 Signs and Symptoms (6):

A

Neurogenic:
Palpitations
Tremor
Hunger
Sweating
Anxiety
Paresthesia

36
Q

Hypoglycemia level 2 BG

A

<54

37
Q

Hypoglycemia level 2 signs and symptoms (4):

A

Neuroglycopenic:

Behavioral changes
Emotional liability
Difficulty thinking
Confusion

38
Q

Hypoglycemia level 3 BG

A

** Severe event

39
Q

Hypoglycemia level 3 signs & symptoms: (5)

A

Severe confusion
Unconsciousness
Seizure
Coma
Death
*** requires help from another individual

40
Q

What is the treatment for severe hypoglycemia treatment BG <54?

A

Glucagon (Glucagen)

41
Q

Glucagon pen dosing

A

1 mg SQ (may dose again in 15 minutes)

42
Q

CI of Glucagon pen?

A

Hypersensitivity to glucagon, lactose, or any other components of the pen

43
Q

ADEs of Glucagon pen?

A

Vomiting (especially if rapid and frequent administration)

44
Q

Chronic hyperglycemia BG

A

> 126

45
Q

Chronic hyperglycemia symptoms (5)

A

Polydipsia
Polyphagia
Polyuria
Blurry vision
Palpations

46
Q

T1DM Complication (acute)

A

Diabetic Ketoacidosis

47
Q

T2DM complication (acute)

A

Hyperglycemic hyperosmolar state

48
Q

Most important sick day rule for insulin therapy?

A

NEVER STOP INSULIN

49
Q

Assess urinary albumin yearly, except when urinary albumin >______, then assess______

A

30, twice yearly

50
Q

Test eGFR yearly, except when eGFR < _____, then assess ____

A

60, twice yearly

51
Q

In T2DM when should an eye examination be done?

A

At dm diagnosis.
If += annual exam
If -= 1-2 years

52
Q

In T1DM when should an eye exam be done?

A

Within 5 years of T1DM diagnosis

53
Q

Diabetic autonomic neuropathy

A

Gastroparesis
Urinary retention
Erectile dysfunction

54
Q

Cardiovascular neuropathy

A

Silent angina
Resting tachycardia
Orthostatic hypotension

55
Q

DM marcovascular complications

A

Coronary artery disease
Cerebrovascular disease
PAD (leading cause of non traumatic lower limb amputations)

56
Q

What are the ABC’S of Diabetes?

A

A: A1C + anti-platelet therapy
B: blood pressure control + blood glucose monitoring
C: cholesterol + cessation of smoking

57
Q

Anti platelet recommendation for DM+ H/O ASCVD

A

Aspirin 75-162 mg/day

58
Q

Antiplatelet recommendation for pts with ASCVD and aspirin allergy

A

Clopidogrel 75 mg/day

59
Q

BP goal in DM

A

<130/80

60
Q

BP goal in GDM?

A

110-135/85

61
Q

When is CGM used?

A

In pts who are experiencing:
- frequent hypoglycemia
- nocturnal hypoglycemia
- unawareness

62
Q

What does CGM measure?

A

Interstitial glucose rather than capillary bs

63
Q

Statin recommendation for: 40-75 years DM W/O ASCVD

A

Moderate intensity

64
Q

Statin recommendation for 20-39 yrs DM W/ ASCVD risk factors

A

May initiate statin therapy

65
Q

Statin recommendation: 40-75 yrs DM w/ 1 or more ASCVD risk factors

A

High intensity

66
Q

Cholesterol new goal

A

Reduce LDL by ≥ 50% of baseline or LDL <70

67
Q

Statin recommendation: 40-75 yrs DM w/ multiple ASCVD risk factors

A

In addition to high intensity and LDL ≥70 may add ezetimibe or PCSK9i

68
Q

Statin recommendation: >75yrs + DM

A

May initiate moderate intensity

69
Q

High intensity statins

A

Rosuvastatin 20/40
Atorvastatin 40/80

70
Q

Moderate intensity statins:

A

*** RASP LF
Rosuvastatin 5-10
Atorvastatin 10-20
Simvastatin 20-40
Pravastatin 40-80
Lovastatin 40
Fluvastatin 80
Pitavastatin 1-4

71
Q

Statin secondary prevention: pt of all ages DM + ASCVD

A

High intensity

72
Q

Secondary prevention: pt of all ages w/ DM +ASCVD considered very high risk

A

If LDL ≥70 (max dose statin): consider adding ezetimibe or PCSK9i

ISBP IIB1 Exam 2 (3 decks)

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