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Naplex 2025 > Diabetes > Flashcards

Diabetes Flashcards

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1
Q

What is the central problem related to diabetes?

A
  • Blood glucose remian high because of decreased insulin secrestion, decreased insulin sensitivity
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2
Q

Where is Insulin produced from and where does it go?

A
  • Made from Beta Cells in the pancreas; helps move glucose OUT of the blood & into the body
  • Goes to Mucsle cells, liver cells [Glycogen], Fat Cells
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3
Q

What is the “opposite” of insulin, where is it made, and what does it do?

A
  • Glucagon
  • Made from alpha cells in the pancreas; helps move glucose INto the blood & body from glycogen

NO Glycogen = break down of ketones

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4
Q

What are the types of diabetes?

A
  • Type I
  • Type II
  • Pre-diabetes
  • Diabetes in Pregnancy
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5
Q

What is Type I Diabetes and when does it most likely occur?

A
  • Autoimmune destruction of the beta-cells = NO insulin to be made (causes ketones to be broken down resulting is DKA)
  • Normally found in childhood
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6
Q

What is Type II Diabetes?

A
  • Due to insulin resistance or insulind deficiency [or both] (Beta cells slowly make less and less insulin as they become damaged)
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7
Q

What is Pre-diabetes?

A
  • You have increased risk of getting diabetes
  • BG is HIGH but not high enough to = diabetes
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8
Q

What are the Risk Factors asscioated with Diabetes?

A
  • Age
  • Physical Inactivity
  • Overwieght
  • Race [AA, Asian-American, Latino…]
  • Gestational Diabetes [Pregnancy]
  • A1C > 5.7%
  • First degree relative
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9
Q

What are the Classic Symptoms see in diabetes?

A
  • Polyuria [increased urination]
  • Polyphagia [increased hunger]
  • Polydipsia [increased thurst]
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10
Q

What are the three types of test that are used to diagnosis diabetes?

A
  • A1C [gluc over 3 months]
  • Blood glucose & Fasting glucose
  • OGTT
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11
Q

What is the diagnostic criteria for diabetes?

A1c? FPG? Random BG? OGTT?

A
  • A1c > 6.5
  • FPG > 126
  • Random BG > 200
  • OGTT > 200
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12
Q

What is the diagnostic criteria for pre-diabetes?

A1c? FPG? Random BG? OGTT?

A
  • A1c 5.7 - 6.4
  • FPG 100 - 125
  • Random BG —
  • OGTT 140 - 199
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13
Q

When should someone get their A1c testing?

A
  • x 3 months if not controlled
  • x 6 months if controlled
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14
Q

What is important to know about individualized Medical Nutrition Therapy when talking about Lifestyle modifications?

A
  • Eat natural forms of Carbs [Fruits, Vegs, W. Grains, Dairy]
  • Type 1 should count carbs at mealtimes [15g]
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15
Q

How much physical activity shoould someone get to help reduce or prevent diabetes?

A
  • 150 mins per week & standing every 30 mins
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16
Q

What are some natural products that could be used for diabetes?

A
  • Cinnamon
  • Alpha Lipoic acid
  • Chromium
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17
Q

Why is it important to have glycemic control?

A
  • Prevention any other complications that diabetes could lead too [Micro & Macro events]
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18
Q

What is the ADA monitoring, preventing and treating recommendations over Antiplatelet Therapey [Aspirin]?

A
  • Aspirin 81 mg for 2nd prevention
  • NOTHING for 1st prevention
  • Used in pregnancy for decrease preeclampsia
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19
Q

What is the ADA monitoring, preventing and treating recommendations over Cholesterol Control?

A
  • High intensity statin for those with ASCVD [LDL < 55] or 40 - 75 yo with one risk factor [LDL < 70]
  • Moderate intensity statin for 40 - 75 [NO ASCVD] or 20 -36 [w/ ASCVD]
  • Add on: Ezetimibe or PSCK-9
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20
Q

What is the ADA monitoring, preventing and treating recommendations over Diabetic Retinophaty?

A
  • Eye exam AT diagnosis
  • if Retinopathy; exams annually
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21
Q

What is the ADA monitoring, preventing and treating recommendations over Vaccinations?

A
  • GET Hep B, Flu, Pnumoccoal
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22
Q

What is the ADA monitoring, preventing and treating recommendations over Diabetic Kidney Disease?

A
  • is an eGFR < 60 and/or albuminuria
  • Treatment: ACEi, ARB, SGLT-2, Finerenone
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23
Q

What is the ADA monitoring, preventing and treating recommendations over Neuropathy?

A
  • Annual: 10-g monofilamient test = assess sensation
  • Foot Exam annually
  • Treatment: Gabapentin, Pregabalin, Duloxtine
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24
Q

What is the ADA monitoring, preventing and treating recommendations over Bone Health?

A
  • Monitor bone mineral density x 2-3 yearsq
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25
What is the **ADA monitoring, preventing and treating** recommendations over **Blood Pressure Control**?
- GOAL BP: **< 130/80**
26
What are the **ADA Guidelines** recommendations for initial treatments based on other comorbidities?
- Start **GLP-1 or SGLT-2** if **ASCVD, HF, or CKD** - Start **TWO** drugs if **A1c 8.5 - 10%** - Insuing start for severe Hyperglycemia [A1c > 10 or BG > 300] but **GLP-1/GIP** are best
27
What are some of the **drug classes** that are used in **diabetes**/
- GLP-1 agoinsts - GLP-1/GIP agoinsts - SGLT2 Inhibitors - Metformin - Sulfonylureas - Meglitinides - DPP4 inhibitors - TZDs (Thiazolidinediones) - Insulins
28
What are the **GLP-1 Agonist & Dual GLP-1/GIP Agoinst** that are used for the treatment of **Type II Diabetes**?
- Liraglutide [Victoza] (Saxenda - Weight Loss) - Dulaglutide [Trulicity] - Semaglutide [Ozempic] (Wegovy - Weight Loss) - Tirzepatide [Mounjaro] (Zepbound - Weight Loss) ## Footnote LDS = GLP-1 Mounjaro = Dual
29
What is the way that the **GLP-1/GIP** work within the body?
- Increase Insulin secreation - Decrease glucagon secreation - Slow gastric emptying = weight loss
30
What are the **Boxed Warnings** for the **GLP-1/GIP agonist** used in diabetes?
-ALL [except Byetta] have a risk of **thyroid C-cell carcinoma**
31
What are some of the warnings for the **GLP-1/GIP agonist** that are used in **diabetes**?
- Pancreatitis - NOT recommended in those with severe GI disease [Gastroparesis]
32
What are some of the **Side effects** for the **GLP-1/GIP agonst** used in **Diabetes**?
- **Weight Loss, N**/V/D [should decrease dose], Hypoglycemia
33
What are some **additional note** to know about the **GLP-1/GIP agonist** used in **diabetes**?
- Decease A1c by **0.5 - 1.5%** - DO NOT USE with **DPP-4 inhibitors** - Liraglutide, Dulaglutide, Semaglutide are best for ASCVD or CKD
34
What is the **MOA** of the **SGLT-2i** that are used in **Diabetes**?
- SGLT-2 in found in the **proximal tubule**; so inhibiting it will **decrease glucose reabsorption**, **increase urinary glucose** = decrease in BG
35
What are the **SGLT-2i** that are used in **diabetes**?
- Canagliflozin [Invokana] - Dapaglifozin [Farxiga] - Empaglifozin [Jardiance]
36
What are the **warnings** for the **SGLT-2i** that are used in **Diabetes**?
- Ketaoacidosis [when BG < 250] - Genital Mycotic infection, Urinary tract infections - Hypotension, AKI - Increase risk of leg and foot amputations; increase fractures
37
What are the **Side effects** of the **SGLT-2i** used in **Diabetes**?
- Increased urination - increase thirst - Hyperkalemia risk with Canag
38
What are some other **additional note** about the **SGLT-2i** used in **Diabetes**?
- Decrease A1c by **0.7 - 1%** - Canag, Dapag, Empag are best in patient with **HF, CKD and/or ASCVD**
39
What are the **Biguanide** that is used in **diabetes**?
- Metformin [Fortamet, Glumetza]
40
What is the **dosing** for **Metforin**?
- IR: 500 mg QD or BID - ER: 500 - 1000 mg QD [with food] - MAX: 2000 - 2550 mg/day ## Footnote Titrate doses weekly to maintance of 1000 mg BID
41
What is the **Boxed warning** for **Metformin** used in diabetes?>
- Lactic Acidosis - increased risk with renal issues, dyes, alcohol
42
What are the **contraindicaitons** of **Metformin** used in **diabetes**?
- eGFR < 30 [is dependent on this]
43
What are some of the **warnings** for **Metformin** used in **diabetes**?
- NO start is eGFR is 30 - 45 - Vitamin B12 Deficiency
44
What are the **Side effects** of **Metformin** used in **diabetes**?
- GI: Diarrhea, Nausea, Farting
45
What are some of the **additional notes** to know about **Metformin** used in **diabetes**?
- Decrease A1c by **1 - 2%** - ER: can leave **Ghost Tablet** - Decrease dose = decrease GI issues
46
What are the **2 insulin secretagogues** that are used in **diabetes**?
- sulfonylureas [SUs] - Meglitinides
47
What are the **Sulfonylureas** that are used in **diabetes**?
- Glipizide [Glucotrol XL] - Glimepiride [Amaryl] - Glyburide [Glynase]
48
What are the **contraindications** for the **Sulfonylureas** used in **diabetes**?
- Sulfa Allergy
49
What are the **warnings** for the **Sulfonylureas** used in **Diabetes**?
- Hypoglycemia
50
What are some of the **side effects** for the **Sulfonylureas** used in **Diabetes**?
- Weight gain, nausea
51
What are some of the **additional notes** for the **Sulfonylureas** used in **Diabetes**?
- Decrease A1c **1 - 2%** - Glipizide IR should be taken **30 mins b4 meals** - Glucotrol XL can leave Ghost Tablet - Glimepiride, Glyburide = **BEERS CRITERIA** for hypoglycemia
52
What are the **Meglitinides** that are used in **diabetes**?
- Repaglinide 30 mins before meals - Nateglinide 1-30 mins before meals
53
What are some of the **warnings** for the **Meglitinides** used in **Diabetes**?
- Hypoglycemia
54
What are some of the **Side Effects** for the **Meglitinides** used in **Diabetes**?
- Weight Gain
55
What are some of the **additional notes** for the **Meglitinides** used in **Diabetes**?
- Decrease A1c by **0.5 - 1.5%** - Skip dose if meal is skipped
56
What are the **Dipeptidyl peptidase 4 inhibitors** that are used for **diabetes**?
- **Sitagliptin (januvia)** - **Linagliptin (tradjenta)** - Saxagliptin (onglyxa) - Alogliptin (nesina)
57
What are the **warnings** for the **DPP4s**?
- **Pancreatitis, Arthralgia, Renal Failure** - **Risk of Heart Failure** (more common with Saxagliptin & Alogliptin)
58
What are some **additional notes** for the **DPP4s**?
- DO NOT use with GLP-1 agoinst (overlapping MOAs)
59
What is the **MOA** for the **Thiazolidinedione** used in **Diabetes**?
- PPAPy agonist that **increase peripheral insulin** (basicailly increase Insulin sensitivity)
60
What are the **Thiazolidinediones** that are used in **diabetes**?
- Pioglitazone [Actos]
61
What are the **Boxed Warnings** for the **Thiazolidinediones** used in **diabetes**?
- Can cause or exacerbate **HF** - **DO NOT** use in NYHA III/IV HF
62
What are some of the **warnings** for the **thaizolidinediones** used in **diabetes**?
- Edema - Increased Fracture risk - Can stimulate ovulaiton [unintended pregnancy]
63
What are some of the **Side Effects** of the **Thiazolidinediones** used in **Diabetes**?
- Weight Gain - Peripheral Edema
64
What are some **additional notes** about the **thiazolidinediones** used in **diabetes**?
- Decrease A1c by **0.5 - 1.4%**
65
What are the **Basas Insulins** that are used?
- Glargine - Detemir - Degludec [Ultra long]
66
What is important to know about the **Basal Insulins**?
- Typically **"peakless"** with an onset of **3 - 4 hr** and a duration on **> 24 hr** - Mainly affects **fasting glucose**
67
What are the **intermediate-acting insulins** used?
- Insulin NPH
68
What is important to know about the **intermediate-acting insulins** used?>
- Kinda "basal" with onset of **1 - 2 hr**; peaks at **4 - 12 hr** [risk of hypoglicemia]; and lasts **14 - 24 hr** ## Footnote "P" = Protamine which helps it extend the time and delay absorption
69
What are the **Rapid Acting Insulins** that are used?
- Aspart, Lispro, Glulisine - Regular insulin = short acting
70
What is important to know about the **rapid acting insulins** that are used?
- Bolus; just like a pancreas burst - Onset of **15 mins**; peak within **1 - 2 hr** and lasts about **3 - 5 hr**
71
What is important to know about **short acting insulin**?
- Very similar to Rapid acting - Slightly slower onset and lasts longer [Onset **30 mins**; peak **2 hr**; duration **6 - 10 hr** ## Footnote Regular Insulin
72
What are some **warnings** for **all injectable insulin**?
- Hypoglycemia - Hypokalemia (insulin moves K into cells - helping with HYPERkalemia)
73
What are some **side effects** for **all injectable insulin**?
- **Weight Gain** (increased glucose moving into cells) - **Lipoatrophy** (decrease fat tissue) & **Lipohypertrophy** (Fat lumps under injection site [**why we rotate sites**])
74
What are some **stroage and administration notes** for **all injectable insulin**?
- Most vial are **10 ml** - **DO NOT** shake, freeze or extreme heat - **Unopened** insulin = refrigderated & **Opened** can be at room temp
75
What are some of the **rapud acting (Bolus) Insulins** that are used?
- **Aspart (Novolog)** - **Lispro (Humalog)** - Inhaled Insulin (Afrezza)
76
What are some **additional notes** for **rapid acting (bolus) insulin**?
- Inject SubQ **5 - 15 mins** before meals - Used as **prandial insulin** (preventing high BG after meals) & for **correcitons** (i.e.; sliding scale) when HG is high
77
What are some **additional notes** for **Afrezza**?
- **Contraindicated** in lung cancer (inhaled duh) - Required **FEV1** tests
78
What are the **short acting (bolus) insulin** that is used for **diabetes**/
- **Regular (Humulin R, Novolin R)** - Humulin R U-500
79
What are some **additional notes** for **Regular (Humulin R, Novolin R) Insulin**?
- Inject SubQ **30 mins** before meals - Used as **Prandial** & **Correction** (for high BG) - Regular is preferred for **IV stuff** (like parenteral nutrition used in non PVC containers)
80
What are some **additional notes** for **Humulin R U-500**?
- **FIVE TIME** more concentrated than regular = **increased safety risks** - **DO NOT** mix with other insulins
81
What are the **intermediate acting (basal) insulins** that are used for **diabetes**
- **NPH (humulin N, Novolin N)** ## Footnote **OTC & RX**
82
What are some **additional notes** for **imtermediate acting (basal) Insulin**?
- Dosed **BID** as add on to oral meds (but is causes more **HYPOglycemia** - Cloudy and comes in Rx or OTC
83
What are some **long acting (basal) insulins** that are used for **Diabetes**
- **insulin detemir (levemir)** - **Insulin glargine (Lantus, Toujeo)** ## Footnote Clear and colorless
84
What are some **additional notes** for **long acting (basal) insulin**?
- **once daily** - Lantus is **100 units** & Toujeo is **concentrated** (300 units) - **DO NOT** mix with other insulins
85
What are some **ultra long acting (basal) insulins** used for **diabetes**
- Insulin Degludec (Tresiba)
86
What are some **additional notes** for **ultra long acting (basal) insulin**?
- FlexPens come in **100 units or 200 units**
87
What are some **drug interactions** with **insulins**?
- AVOID with **sulfonylureas or meglitnides** - Pramlintide - **must reduce mealtime dose by 50%** = severe hypoglycemia
88
Which **insulins** can be given as **OTC**
- Regular - NPH - Premixed 70% NPH/30% Regular Insulin
89
What is the **recommended insulin start** that is used to help **reduce A1c levels** in someone that has **type II diabetes**?
- Start with **GLP-1 agonist** 1st; then consider **insulin** - Start with **insulin** when **A1c > 10% or BG > 300**
90
What is the **starting dose** for a **basal insulin**?
- 10 Units OR - 0.1 - 0.2 units/kg/day
91
What is the **recommended insulin start** for someone that has **type I diabetes**?
- ALL should be on **insulin** (either insulin pump or multiple injections) - **Rapid acting or Long acting Basal** are preferred ## Footnote Typical starting dose is **0.5 units/kg/day**
92
What is the way that we **adjust basal insulin dosings**?
- Low Fasting BG = **decrease** basal or NPH - High Fasting BG = **increase** basal or NPH ## Footnote Fasting BG is just showing trends (spikes after eating)
93
What is th way that we **adjust mealtime insulin**?
- Postpreandial BG (after meals) is HIGH [**increase** Regular or Rapid] or LOW (**decrease** regular or rapid] - Preprandial BG (before meals) is HIGH [**increase** regular or rapid] or LOW [**decrease** reuglar or rapid] ## Footnote Insulin taken before the meals for both
94
What is the way that we do a **insulin to carb ratio** for calculating **insulin doses**/
- Carb ratio = **1g of carb covers 1 unit of insulin** - Need to use **ICR Formula** (450 for regular and 500 for rapid) to find the right units
95
What is the **ICR rule of 450 & 500** for doing an **ICR**?
- 450 (if regular) or 500 (if rapid) / total daily insulin = grams covers - Then divide total grams of card eaten by ICR = how much insulin
96
What is the **correction dose** and what is the way that we **find it**?
- Find **correction factor** = how much will the BG be lowered by **1 unit of insulin** - Use either **correction factor 1500** (for regular) or **corection factor 1800** (for rapid acting) - Then find the correction dose
97
What is the **equations** for the **correction factor 1500 rule & 1800 rule**?
- 1500 (if regular) or 1800 (if rapid) / total daily insulin = correction factor
98
What is the **equation** for **correction dose for BOTH types** (regular or rapid)?
- **(**(BG now) - (Targer BG [normally 120]**)**/ correction factor [from 1500 or 1800 rule] = Correction dose
99
What **insulins** are only stable for ** 10 days at room temperature** after **opening**?
- Humalog Mix 50/50 and 75/25 pens - Humulin 70/30 pens ## Footnote Pens have a shorter duration than vials
100
What **insulins** are only stable for **14 days at room temperature** after **opening**?
- Humulin N Pen - Novolog Mix 70/30 Pen
101
What **insulins** are only stable for **28 days at room temperature** after **opening**?
- Apidra, **Humalog, Novolog**, Admelog, Lyumjev, Fiasp vials and pens - Humalog Mix 75/25 vial - Novolog Mix 70/30 vial - Novolin **R** U-100, N and 70/30 pens - Humulin **R** U-500 Pen - **Lantus, Basaglar,** Semglee vials and pens
102
What **insulins** are only stable for **30 days at room temperature** after **opening**?
- Humulin **R** U-100, N and 70/30 vials
103
What **insulins** are only stable for **40 days at room temperature** after **opening**?
- Humulin R **U-500 vials**
104
What **insulins** are only stable for **42 days at room temperature** after **opening**?
- Novolin R U-100, N and 70/30 vials - **Levemir** vials and pens
105
What **insulins** are only stable for **56 days at room temperature** after **opening**?
- **Tresbia** pen - **Toujeo** pen
106
What is **hypoglycemia**?
- when the **BG < 70** - Each episode causes **irreeversible cognitive impairment**
107
What are some **signs & symptoms** of **hypoglycemia**? ## Footnote Think about when you have low blood sugars
- Dizziness, **Anxiety/Irritability, Shakiness**, Headache, **Sweating, Hunger, Confusion**, Nauseam **Tremors, Palpitations**/Tachycardia, Blurred Vision
108
What is the **Treatment** for **Hypoglycemia**?
- Pure **Glucose** (in tabs or gel) or any carbs contains glucose - If unconscious; **dextrose** or **glucagon** give IM or Nasally
109
what is the **rule of 15s** and what are some **carbs** that can help with it?
- Ingest **15** - 20 g of Carbs; check BG in **15 mins**; still low repeat; if Normal eat a snack - **4 oz of OJ, 8 oz of Milk, 4 oz of REGULAR soda, 1 tbsp sugar, honey, corn syrup, and 3 - 4 glucose tabs or 1 glucose gel** = **~15 g** of carbs
110
What are some **drugs** that can cause **HYPERglycemia**?
- Thiazides & Loop Diuretics - Tarcolimus, Cyclosporine - Protease Inhibitors - Quinolones ***** - Antipsychotics (i.e.; Olanzapine, Queitapine) - Statins - Steroids (systemically) - Cough Syrups - Niacan (Vit B3) ## Footnote ***** cause both HYPER and HYPO
111
What are some **drugs** that cause **HYPOglycemia**?
- Beta-Blockers ***** - Quinolones ***** - Tramadol ## Footnote ***** cause HYPER and HYPO
112
In the **inpatient** setting, what is the **recommended ranges** of **BG** where treatment should be started?
- NON-ICU: **100 - 180** - ICU: **140 - 180**
113
What is **diabetic ketoacidosis**?
- Life-threatening crisis where **High BG, Ketoacidosis & Ketonuria** (Ketones are presents because Trigylcerides and amino acids are being used for energy - Most common in Type I Diabetes patients - Look for **BG > 250, Ketones** (urine/serum = "fruity" breath"), **Ab pain, N/V, Dehydration & Anion Gap**
114
What is **hyperosmolar hyperglycemic state**?
- Most common in **Type II diabetes** patients caused by an **illness** that leads to **less fluid intake** = **severe dehydration and altered consciousness** - Look of **confusion/delirium, BG > 600, Extreme dehydration, pH > 7.3** ## Footnote **NO KETONES**
115
If **Thyroid cancer, including medullary throid carcinoma** is present, whcih **diabetes medications** should be **AVOIDED**?
- GLP-1 Agonist - GLP-1/GIP Agonist
116
If **Gastroparesis, GI Disorders** is present, whcih **diabetes medications** should be **AVOIDED**?
- GLP-1 Agonist - GLP-1/GIP Agonists - Pramlintide
117
If **Genital Infections/UTI** is present, whcih **diabetes medications** should be **AVOIDED**?
- SGLT2 Inhibitors
118
If **Heart Failure** is present, whcih **diabetes medications** should be **AVOIDED**?
- TZDs - Alogliptin - Saxagliptin
119
If **Hypoglycemia** is present, whcih **diabetes medications** should be **AVOIDED**?
- Insulins - Sulfonylureas - Meglitinides - Pramlintide
120
If **Hypotension/Dehydration** is present, whcih **diabetes medications** should be **AVOIDED**?
- SGLT2 Inhibitors
121
If **Hypokalemia** is present, whcih **diabetes medications** should be **AVOIDED**?
- Insulin
122
If **ketoacidosis** is present, whcih **diabetes medications** should be **AVOIDED**?
- SGLT2 inhibitors (can occur when BG < 250)
123
If **lactic acidosis** is present, whcih **diabetes medications** should be **AVOIDED**?
- Meformin; increased risk with renal impaorment, alcoholism
124
If **Osteopenia/Osteoporosis** is present, whcih **diabetes medications** should be **AVOIDED**?
- Cangliflozin & Bexagliflozin (decreased BMD, fractures - TZDs (fractures)
125
If **Pancreatitis** is present, whcih **diabetes medications** should be **AVOIDED**?
- DPP4 Inhibitors - GLP-1 Agonists - GLP-1/GIP Agonist
126
If **Peripheral nueropathy, PAD, Foot Ulcers** is present, whcih **diabetes medications** should be **AVOIDED**?
- Cangliflozin - Bexagliflozin
127
If **Sulfa allergy, severe** is present, whcih **diabetes medications** should be **AVOIDED**?
- Sulfonylureas (or use cautiously)
128
If **Renal insufficieny (eGFR or CrCl < 30)** is present, whcih **diabetes medications** should be **AVOIDED**?
- Metformin - Exenatide - Glyburide - May need to start insulin at low dose
129
If **weight gain/obseity** is present, whcih **diabetes medications** should be **AVOIDED**?
- Sulfonylureas - Megalitinies - TZDs - Insulin

Naplex 2025 (72 decks)

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