Diabeatus

Question 1

Criteria for dx DM

Answer 1

1) HcbA1c >6.5 or
2) FBG >126 or
3) 2 hour BG >200 after 75 g OGTT or
4) Random BG >200 in pt w/ hyperBG sx
5) In abscence of sx of hyperBG, the first 3 options should be confirmed with repeat testing

Question 2

Drugs to stim insulin release

Answer 2

Sulfonureas/glucotrol/amaryl

Meglitinides/repaglinide/prandin

Question 3

Insulin sensitizers

Answer 3

Biguanides/metformin/glucophage

Thiazos/actos

Question 4

Alpha glucosidase inhibitors

Answer 4

CHO blockers
acarbose/precose
Miglitol/glyset

Question 5

DPP-4 inhibitors

Answer 5

-gliptins

Question 6

How to start Metformin

Answer 6

Begin with 500 mg before largest meal

Increase 500 mg weekly, before bfast and dinner

Question 7

Maximum rec metformin dose

Answer 7

2550 mg/d (most clinicians stop at 2 g)

Question 8

Traditional rec tx order of DM2

Answer 8

Lifestyle changes
Oral agents
Bedtime humulin N (NPH)

Question 9

Newer rec tx

Answer 9

Once daily peakless, long acting insulin glargine/lantus at bedtime

(after lifestyle, oral agents)

Question 10

How to start bedtime insulin

Answer 10

Giver intermed Humulin N
or long acting Lantus/glargine
0.15 units/kg (max 15) or 10-15 units and monitor

Question 11

Lispro

Answer 11

humalog

Question 12

Aspart

Answer 12

Novolog

Question 13

Glulisine

Answer 13

Apidra

Question 14

Regular

Answer 14

Humulin R

Question 15

NPH

neutral protamine Hagedorn

Answer 15

Humulin N

Question 16

Glargine

Answer 16

Lantus

Question 17

Detemir

Answer 17

Levemir

Question 18

Onset <15 min
Peak 1 hour
Duration 2-4 hours

Answer 18

Rapid

Lispro/humalog

Question 19

Onset 0.5-1 hr
Peak 2-3 hours
Duration 3-6 hours

Answer 19

Regular/humulin R

Question 20

Onset 2-4 hours
Peak 6-12 hours
Duration 10-16 hours

Answer 20

NPH

Question 21

Onset 1-2 hours
Peak NONE
Duration 20-24+ hours

Answer 21

Glargine/Lantus

Question 22

70/30

Answer 22

NPH/regular

Question 23

75/25

Answer 23

NPL/lispro

Question 24

Calculate insulin dose

• start with 50% predicted daily dose and gradually increase
• Give 2/3 before bfast and 1/3 before dinner

Answer 24

1-1.2 u/kg/day OBESE

0.5-0.7 u/kg/d non-obese

Question 25

Basal insulin should meet

Answer 25

50% of daily needs

Question 26

Bolus insulin should provide

Answer 26

10-20% of daily insulin requirement per meal

Question 27

More proactive approach that is replacing reactive approach of SSI

Answer 27

Carb counting

Question 28

Waning of insulin action (morning hyperglycemia)

Answer 28

Prior evening insulin fx wore off | Tx: increase dose or change timing

Question 29

Dawn Phenomenon (morning hyperglycemia)

Answer 29

D/t increase in GH btwn 3-7am | Tx: increase evening insulin dose or change timing

Question 30

Somogyi phenomenon (morning hyperglycemia)

Answer 30

Rebound hyperglycemia d/t nocturnal hypoglycemia Tx: reduce supper or bedtime insulin dose and/or have bedtime snack

Question 31

Newer regimen for insulin

Answer 31

Peakless as basal insulin | rapid acting before each meal