Test #5 Flashcards
For diagnosis in diabetes, what must the fasting plasma glucose be? random plasma glucose? oral glucose tolerance test?
greater than 126; greater than 200 with symptoms of diabetes; greater than 200 after 2h of glucose intake
How often should you monitor the A1 C
Every 3 to 6 months depending on previous value
In addition to high blood sugar what secondary disease should be corrected when treating diabetes
Hyperlipidemia
When are medications started in diabetic treatment
Upon diagnosis
What is included in step two of type II diabetes treatment
Add a second drug and consider a sulfonylurea for basal insulin if patient does not achieve goal with these drugs
What is included in step three of type II diabetes treatment
Progress to a three drug combination
What is included in step 4 of diabetes management
If a three drug combination therapy including insulin does not achieve treatment goals after 3 to 6 months, proceed to a combination injectable regimen including insulin and possibly a GLP 1 receptor agonist
What stuff do you start out if a patient has an A1 C of 9% or higher at the time of diagnosis
Step two, 2-drug therapy
What step do you start at if the patient has an A1 C of 10% or greater, has a fasting blood glucose of 300 or more, or is markedly symptomatic?
Start at step 4 - combination injectable therapy
What are the target values for a blood glucose before meals and at bedtime
before meals - 70-130
at bedtime - 100-140
The A1 C a should be measured every ___ months until the value drops below 7 percent in at least every ___ month thereafter
3,6
The presence of what in the blood indicates the pancreas is still producing some insulin of its own
The presence of C-peptide
Activation of beta2 adrenergic preceptors in the pancreas ___ secretion of insulin and activation of alpha-adrenergic preceptors in the pancreas ____ insulin release
promotes; inhibits
Insulin is responsible for what metabolic actions
Increased glucose uptake and storage, increased amino acid uptake and synthesis, and conversion of fatty acids into triglycerides
Stewart acting insulins must be used in conjunction with what in patients with type I diabetes
Intermediate or long acting insulin
What kind of insulin is insulin lispro and how long does it take for effects to begin and how long do they last
Rapid acting analog; 15 to 30 minutes; 3 to 6 hours
Which insulin is administered 30 to 60 minutes before a meal
Regular insulin
What is the onset time and the duration of insulin aspart
10 to 20 minutes and lasts 3 to 5 hours
How long does regular insulin last
Up to 10 hours
Which insulin is the only one suitable for mixing with short acting insulin
NPH
What is the onset and duration of lantus
70 minutes, 18 to 24 hours
In pregnancy, when are insulin needs increased and decreased
Increased after the first trimester and decreased during the first trimester
What is defined as hypoglycemia
Blood sugar less than 70
What does alcohol do to blood sugar
Lowers it
What is a fatal complication of metformin
Lactic acidosis
does metformin stimulate the release of insulin from the pancreas?
no
who shoudl you be cautious in prescribing metformin to? why?
renally impaired patients because it is excreted unchanged
What is the mechanism of action metformin
inhibits glucose production in the liver, reduces glucose absorption in the gut, and sensitizes insulin receptors in target tissues resulting in increased glucose uptake
Metformin decreases absorption of which two vitamins
Vitamin B 12 and folic acid
What are the early signs of lactic acidosis
Hyper ventilation, myalgia, malaise, and unusual somnolence
What are the two major side effects of sulfonylureas
Hypoglycemia and weight gain
With regard to sulfonylureas, hypoglycemic reactions are more common in which patients?
Liver and renally impaired
sulfonylureas are contraindicated in which patients
Pregnant and breast-feeding
What is the difference between sulfonylureas and meglitinides
The glinides are shorter acting and are taken with each meal
A patient who does not respond to a sulfonylurea will likely not respond to which other class
Glinides
It is imperative that patients eat no later than 30 minutes after taking which drug
glinides
How do TZDs work
Reduce glucose levels by decreasing insulin resistance
how does pioglitazone work
Enhances responses to insulin
What is the black box warning for Pioglitazone
Heart failure secondary to renal retention of fluid so discontinue or use in reduced dosage
Which antidiabetic medication has been associated with heart attack
rosiglitazone
Which antidiabetic medication can cause ovulation
pioglitazone
Which antidiabetic medication may causing an increased risk for bladder cancer
pioglitazone
Which antidiabetic medication can cause increased risk for fractures in women
pioglitazone
Monitor which labs with pioglitazone admin?
liver function tests
Which antidiabetic medication delays the absorption of carbohydrates
a-glucosidase inhibitors
Which antidiabetic medication G.I. upset and a risk for anemia
Acarbose
When the patient is taking acarbose and develops hypoglycemia, the patient must receive what and not what?
Glucose and not sucrose
What labs should be monitored when acarbose is administered
lfts
Which antidiabetic medication enhances the actions of incretin hormones by preventing incretin breakdown
gliptins
which antidiabetic medication enhances the actions of incretin hormones by mimicking incretin actions
GLP-1 receptor agonists
Inform the patients taking which medication for diabetes about fatal pancreatitis and hypersensitivity reactions
sitagliptin
Which medication for diabetes is used only as adjunct therapy
sitagliptin
Which medication for diabetes reduces resorption of filtered glucose and causes all glucose to be excreted in the urine
canagliflozin
What are the most common side effects of canagliflozin?
Female genital fungal infections, urinary tract infections, and increased urination
What can happen if you combine rifampin, phenytoin, or phenobarbital with canagliflozin?
Decreased efficacy of canagliflozin
What will happen if you combine canagliflozin and a diuretic?
Risk for dehydration and hypotension
Which antidiabetic medication slows gastric emptying, stimulates glucose-dependent release of insulin, inhibit postprandial release of glucagon, and suppresses appetite– all to mimic the incretin actions?
Exenatide
hypoglycemia is common when exenatide is combined with what and not common when combined with what?
sulfonylurea; metformin
In addition to sitagliptin, which other antidiabetic medication carries a risk for pancreatitis and hypersensitivity reactions/
exenatide
exenatide can cause what? especially when what?
renal impairemnt; dehydration is present
exenatide and pregnancy?
dont do it
