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Therapeutics 2 Exam 3 -Diabetes pt 2 > Special Populations > Flashcards

Special Populations Flashcards

1
Q

What are the maternal risks associated with diabetes during pregnancy?

A

-Retinopathy
-Pre-eclampsia

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2
Q

How do we prevent pre-eclampsia?

A

Aspirin 81-150 mg/day
-start at 12-16 weeks if no contraindications

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3
Q

What is the goal A1C for a patient with diabetes pre-conception?

A

<6.5%

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4
Q

What is the target FBS during pregnancy?

A

70-95

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5
Q

What is the 1-hr postprandial target during pregnancy?

A

110-140

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6
Q

What is the 2-hr postprandial target during pregnancy?

A

100-120

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7
Q

What is the goal A1C during pregnancy?

A

<6% ideally
<7% if necessary to prevent hypoglycemia

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8
Q

In early pregnancy, how does the body react to insulin?

A

Sensitivity increases
*hypoglycemia can occur
(less insulin required)

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9
Q

In late pregnancy, how does the body react to insulin?

A

Resistance increases and Total daily Insulin dose increases
(more insulin required, about 2-3 times more)

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10
Q

What may a rapid reduction in insulin requirements during pregnancy indicate?

A

Placental insufficiency

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11
Q

What changes occur to previous Type 1 diabetics during pregnancy?

A

-Increased hypoglycemia risk in first trimester
-Decreased hypoglycemia awareness
-Increased risk of DKA (increases stillbirth risk)
-Insulin sensitivity increases and eventually returns to normal after placenta delivery

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12
Q

What changes occur to previous Type 2 diabetics during pregnancy?

A

-Co-morbidity risk is higher
-More common to have pregnancy loss in 3rd trimester than with Type 1
-Need to control weight!!!
-Require high insulin doses during pregnancy (may require concentrated insulin)
*Discontinue ACEIs, ARBs, and Statins

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13
Q

What is the preferred diabetes treatment in pregnancy?

A

Insulin

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14
Q

What is the starting dose of insulin in pregnancy?

A

0.7-1 units/kg/day

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15
Q

What medication can be used if patient is pregnant and cannot receive insulin?

A

Metformin

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16
Q

For patients with gestational diabetes and prediabetes, what treatment plan should they follow to decrease the progression to diabetes?

A

Lifestyle Changes and Metformin

17
Q

For patients with gestational diabetes, what test should be run postpartum?

A

OGTT 4-12 weeks postpartum

Check for diabetes every 1-3 years

18
Q

How does Type 2 diabetes in children differ from Type 2diabetes in adults?

A

-More rapid decline in B-cell function
-Accelerated development of complications

19
Q

What is the target A1C for pediatric populations?

A

< 7% (similar to adults)

20
Q

For Type 1 diabetes in pediatric populations, what is the preferred treatment?

A

Insulin
*pump therapy preferred

21
Q

what is the treatment for Type 2 diabetes in pediatric populations?

A

A1C < 8.5%: Metformin!

A1C > or = 8.5% or BS > or = 250mg/dL without acidosis who are symptomatic: Basal Insulin + Metformin

22
Q

In pediatric populations, if the patient is not at goal on metformin and insulin, what is the next treatment we use?

A

GLP-1’s

23
Q

In pediatric populations, if the patient is not at goal on metformin, basal insulin, and a GLP-1 what is the fourth treatment we can add?

A

Bolus insulin
(or change to insulin pump therapy)

24
Q

At what glucose level should insulin be initiated at the hospital?

A

> or = 180 mg/dL

25
Q

What is the target glucose level in the hospital?

A

140-180 mg/dL

*do not want control to be too tight because it could lead to hypoglycemia

26
Q

What insulin is preferred for noncritically ill hospitalized patients?

A

Bolus

-along with use of correction factor/insulin sensitivity factor

27
Q

What is the A1C target for elective surgery?

A

<8%

28
Q

What is the target blood glucose during the perioperative period?

A

100-180 mg/dL

29
Q

How much should basal insulin be reduced before surgery and when?

A

Reduce basal insulin the evening before surgery by 25%

30
Q

When should metformin be withheld before surgery?

A

On the day of surgery

31
Q

When should SGLT2 inhibitors be held before surgery?

A

3-4 days before

32
Q

When should other oral glucose-lowering medications be held before surgery?

A

The morning of surgery

33
Q

How should other forms of insulin be adjusted before surgery?

A

NPH: give half dose the morning of

Long-Acting or Pump Basal: Give 75-80% the morning of

Therapeutics 2 Exam 3 -Diabetes pt 2 (8 decks)

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