Type II Diabetes Mellitus Flashcards
Fasting Glucose Values: Normal, Pre-Diab DM
Normal: <100 mg/dL (5.6 mmol/L)
Pre: 100-125 (5.6-5.9)
DM: >126 (7 mmol)
2H PG Normal, Pre-Diab, DM
Normal: <140 mg/dL (7.8 mmol)
Pre: 140-199 (7.8-11.0)
DM: >200 (11.1)
HbA1C Normal, Pre-Diab, DM
Normal: <5.6%
Pre: 5.7-6.4%
DM: >6.5%
How does the A1C goal differ in older individuals w/ Diabetes
Healthy: 7.5%
Complex DM: 8.0%
Very complex DM: 8.5%
Conditions that increase A1C
- Hypothyroidism
- Splenectomy
- Aplastic Anemia
- Fe Deficiency
Conditions that DEC A1C
- Anemia
- Blood loss
- Abnormal Hb
- Hemolysis
- Liver Dx
- Caucasian
- Pregnancy
- EPO Tx
How should treatment be adjusted following lab values in DM
- Persistently abnormal trends in BG are more important
- Look at glucose trends, NOT just A1C, as A1C can be affected by multiple factors
First step in treating DM
FFF Fix Fasting glucose First
What is the appropriate choice for individual w/ Ok fasting BG, Heavy pre-Dinner time hyperglycemia, Who takes Metformin, Insulin glargine, + Apidra w/ meals?
A. INC Dose of Insulin Glargine (Basal Insulin)
B. INC Apidra at all meals
C. Intensify regular insulin correction scale
D. Get an endocrinology consult
E. D/C Glargine and start Glargine 300U/ml (Toujeo)
E. D/C Glargine and start Glargine 300U/ml (Toujeo)
Toujeo is a mixed glargine product that is ultra-lasting
INC Pre-diner unit could be viable but INC likelyhood of bedtime hypoglycemia
Tx for A1C > 10%; BG>300
Insulin Therapy and oral agent after sugar/toxicity comes down
Tx for Newly Dx DMII + A1C>9%
Metformin + Another medication
When should you add additional medication to DMT2 w/ CV disease
If no response to mono or dual Tx after 3 months
What DMT2 meds DEC CV outcomes?
SGLT-2 Inhibitors (-glifloxin) and injectable GLP-1s (-glutide)
Starting dose of Basal insulin
10 U/Day or 0.1-0.2 U/Kg/D (0.1 for elderly)
SE + Contraindications metformin
SE: Diarrhea
Contra: Renal impairment, CHF, + Liver impairment
