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NAPLEX Prep > Diabetes > Flashcards

Diabetes Flashcards

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1
Q

The main problems of diabetes

A

Insulin insensitivity or Insulin deficiency

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2
Q

Cells that release insulin and glucagon?

A

Insulin: beta
Glucagon: alpha

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3
Q

What is the difference between Type 1 and Type 2 diabetes

A

Type 1: autoimmune destruction of beta-cells → insulin defiecny → Body goes into starvation mode and ketones are metabolized from fat

Type 2: Insulin resistance due to over secretion of insulin due to obesity, physical inactivity, and family history

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4
Q

Labs associated with Type 1?

A

Very low or absent C peptides

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5
Q

Criteria of prediabetes

A

A1c: 5.7-64
FGP: 10-125
OGTT: 140-199

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6
Q

When is metformin indicated for pre diabetes?

A

BMI >35
25-49 YO
Hx of gestational diabetes

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7
Q

Preferred medication for gestational diabetes

A

Insulin

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8
Q

Major RF of diabetes

A

Age
Physical inactivity
Overweight
Race or ethnicity
Hx of gestational diabetes
A1c ≥5.7%
First-degree relatives with diabetes

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9
Q

Classic sx of diabetes

A

Polyuria
Polydipsia
Polyphagia

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10
Q

How often should someone be screened for diabetes?

A

Starting at 35YO
Asymptomatic who are overweight or obese with 1 risk factor

Q3Y

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11
Q

Diagnosis for diabetes

A

A1c ≥6.5%
FPG ≥126
Random BP ≥200 w/ symptoms
OGTT ≥200

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12
Q

What are the treatment goals for non pregnant diabetics

A

A1c: <7%
Preprandial: 80-130
2-hr PPG: <180

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13
Q

What are the treatment goals for pregnant diabetics

A

Preprandial: <95
1-hr PPG: <140
2-hr PPG: <120

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14
Q

How often should you check A1c

A

Uncontrolled: Q3M
Controlled: Q6M

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15
Q

How to interpret A1c and eAG

A

A1c 6% = 126 mg/dL of glucose
↑ in 1% → ↑ in 28

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16
Q

Lifestyle modifications for diabetes

A
  1. Weight loss ≥5% of BW (10-15% is recommended(
  2. Eat natural forms of carbs
  3. Exercise 150 min/wk
  4. Smokking cessation
  5. Cinnamon, alpha lipoic acid, chromium
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17
Q

Types of microvascular disease

A

Retinopathy
Diabetic kidney disease
Peripheral neuropathy
Autonomic neuropathy

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18
Q

Types of microvascular disease

A

CAD
CVA
PAD

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19
Q

Vaccninations recommended for diabetes

A

HBV
Flu
PCV

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20
Q

ANtiplatelet management in diabets

A

Aspirin 81 mg is indicated for secondary ASCVD prevention

Not recommended for primary prevention

Used in pregnancy to reduce preeclampsia

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21
Q

Retinopathy management of diabbetes

A

Annual eye exam

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22
Q

Neuropathy management of diabetes

A

10-g monofilament test for sensation Q1Y

Comprehensive foot exam annually

Tx: Gabapentin, Pregabalin, Duloxetine

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23
Q

Bone assessment for diabetes

A

BMD DXA scan every 2-3Y for >65Y

Consider tx if T-score ≤2.0 or fragility

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24
Q

Cholesterol management of diabetes

A

High-intensty:
- Comorbid ASCVD: LDL<55
- 40-75 YO with ≥1 ASCVD risk factor: LDL<70

Moderate-intensity:
- 40-75 YO with no ASCVD
- 20-39 YO with ASCVD RF

Add-on Eztimibe or PCSK9 inhibitor if LDL remains above goal

Monitor 4-12 weeks after initiation → annually afterwards

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25
Management of diabetic kidney disease
eGFR <60 and/or albuminuria ≥30 Tx: - ACEI or ARB - SGLT2i - Finerenone
26
HTN management of diabetes
No albinuria: ACEI, ARB, Thiazode, Non-DHP Albuminuria or CAD: ACEI, ARB
27
When to start 2 drugs
A1c baseline is 8.5-10%
28
Preferred agent for ASCVD
GLP1a or SGLT2
29
Preferred for CKD
SGLT2I or GLP1 (with CVD benefit)
30
Preferred for HF
SGLT2i
31
MOA of GLP-1 agonsits
analogs of incretin → ↑ glucose-dependent insulin secretion, reduce glucagon secretion, and slows gastric empyting
32
Liraglutide
Victoza Weight loss: Saxenda
33
Dulaglutide
Trulicity
34
Semaglutide
Ozempic Weight loss: Wegovy
35
Exenatide
Byetta
36
Tirzepatide
Mounjaro Weight loss: Zepbound
37
BBW of GLP1
MTC or MEN (Risk of thyroid C-cell carcinoma)
38
ADR of GLP1
Pancreatitis Not recommended for gastroparesis or GI distress Weight loss, N/V/D (reduces with titration)
39
GLP1 given weekly? Daily
Weekly: Ozempic, Trulicity, Bydureon, Mounjaro Daily: Rybelsus, Victoza
40
Counseling of GLP1?
Avoid DPP4-inhibtiros Byetta: give 60 min before meals Rebelsus: ≥30 min before first meal/drink of the day (4oz of water) Pen needles are not provided (Byetta, Victoza)
41
Inj counseling of GLP1
SubQ in the ambodme (back of upper arm, outer thigh, or upper buttocks) Attach new pen needle for each injection Rotate injection site Press the injection button and hold for 5-10 sec Dispose needle in sharps contaier
42
Where does SGLT2i work on
PCT → ↑ glucose excretion
43
Canagloflozin
Invokana
44
Dapagliflozin
Farxiga
45
Empaglifloxen
Jaurdiance
46
ADR of SGLT2
Ketoacidosis, increased urination Genital necrosis, yeast infection, UTI, risk of foot and leg amputations and fractures ↑ thirst
47
Dosing of metformin
Titrate weekly to 1000 mg BID Take with food to reduce GI upset Max: 2000-2550 mg/day
48
ADR of metformin
Diarrhea, nausea, vitamin b 12 deficiency
49
CI and warning of metformin
Can cause lactic acidosis with contrast dyes and renal impairment eGFR <30 and metabolic acidosis Not recommended eGFR < 45
50
When can metformin b restarted post-procedure using contrast dyes
48hrs
51
Metformin
Fortamet, Glumetza, Glucophage
52
MOA of SUs
Stimulates insulin secretion however, looses effect in the future
53
Glipizide
Glucotorl
54
Glimepirmide
Amaryl
55
Gluburide
Glynase
56
CI of SU
Sulfa allergy
57
ADR of SU
Weight gain, hypoglycemia, nausea
58
Why are SU on the Beers list
Hypoglycemia risk
59
Diabetic meds that release a ghost tablet
Metformin ER, Glucotrol XL
60
How is SU taken
With breakfast, hold dose if NPO Glipizide IR is given 30 min before meals
61
ADR of meglitinides
Hypoglycemia, weight gain
62
Counseling of Repaglitide
Skip if meal is skipped Take 30 min before meals
63
MOA of DPP-4 inhibitors
Prevent from breaking down incretin hormone (GLP-1) → ↑ glucose-dependent insulin secretion
64
Sitagliptin
Januvia
65
Linagliptin
Tradjenta
66
ADR of DDP4 inhibitors
Pancreatitis, arthralgia, acute renal failure Do not use with GLP1
67
Drugs that ↑ or exacerbate HF
Actos, Saxagliptin, alogliptin
68
ADR of Pioglitazone
Edema, fractures, can stimulate ovulation, peripheral edema and weight gain
69
ADR of alpha-glucidose inhibitors
Hypoglycemia (can't be treated with sucrose) Farts, diarrhea, ab pain
70
Counseling of alpha-glucidase inhibotrs
Each dose should be taken with the first bite of each meal
71
Types of alpha glucosidase inhibitors
Miglitol Acarbose
72
Types of BAS indicated for diabetes? ADR
Colsevelam Constipation
73
Counseling for patient on amylin
Hypoglycemia risk: reduce mealtime insulin by 50% when starting
74
What is bromocriptine
Dopamine agonist
75
Metformin/sitagliptin
JanumetN
76
Metformin/canagliflozin
Invokkamet
77
ADR of insulin
Weight gain, lipoatrophy (loss in fat), lipohypertrophy (accumulation of fat) → rotating inj sites Hypoglycemia, hypokalemia
78
Standard insulin concenration
100 u/mL
79
How much is in a standard vial of insulin? Pens?
Vial: 10 mL Pen: 3 mL
80
Storage and admin of insulin
Do not shake or freeze Unopened should be in the fridge Open vials can be stored at room temp Pen should not be shared In NPH/regular mixture: draw clear regular first then cloudy NPH
81
Aspart
Novolog
82
Lispro
Humalog
83
Regular insulin
Humulin R, Novolin R
84
When to inject rapid
15 min before meals
85
CI of Afreza
Lung disease
86
Fast acting insulin
Aspart (Humalog) Lispro (Novolog) Afreeza
87
Short acting
Regular (HumulinR, Novolin R)
88
When to inject short acting
30 min before meal
89
How to prepare insulin infusion
non-PVC container
90
Type of insulin used for infusions
Regular
91
When is U-500 insulin used
Pts requiring >200 uint per day
92
Quantity of U-500 insulin
500 units per mL
93
Intermediate insulin
NPH
94
NPH
Humulin N, Novolin N
95
When is NPH given
BID
96
OTC insulin
Regular and NPH and NPH/Reg Mix (70/30)
97
Long acting insulin
Detemir (Levemir) Glargine (Lantus, Toujeo)
98
Determir
Levemir
99
Glargine
Lantus, Toujeo
100
Difference between Lantus and Toujeo
Lantus: 100 u/mL Toujeo: 300 u/mL
101
When is long acting insulin dosed
QD
102
Degludec
Tresiba
103
How is Tresiba formulated
Vials: 100 u/mL Pens (Flextouch): 100 u/mL and 200 u/mL
104
What is in a Novolin, Humilin 70/30 Mix
NPH 70% Regular 30%
105
What is in a Novolog 70/30 Mix
Aspart protamine 70% Aspart 30%
106
How are premixed insulin given
BID: If containing rapid, give 15 min before meals If containing short, give 30 min before meals
107
When to initiate insulin
A1C ≥10% BG ≥300
108
How to initiate insulin for T2DM
Basal: 10 units or 0.1-0.2 u/kg/day If not at goal initiate prandial insulin: 4 u or 10% of basal QD for largest meal If not at goal: add on doses to other meals if needed then full basal/bolus regimen
109
How to initiate insulin for T1DM
Starting dose 0.5 u/kg/day (TBW): 50% basal 50% bolus divided into 3 meals
110
Why shouldn't you use NPH or Regular insulin as a starting regimen
Doesn't have the profile that can mimic natural insulin as well as basal and rapid
111
How should insulin be adjusted if, Low fasting BG
↓ basal or NPH
112
How should insulin be adjusted if, high fasting BG
↑ basal or NPH
113
ICR ratios
Regular: 450/TDD Rapid: 500/TDD
114
CF ratios
Regular: 1500/TDD Rapid: 1800/TDD
115
Correction dose
[(BG now) - (BG target)]/CF
116
How to convert NPH BID to glargine QD
Use 80% of NPH
117
How to convert Toujeo to glargine
Use 80% of Toujeo dose
118
Pen formulations of Toujeo
1.5 and 3 mL
119
Rapid-acting pens that come in 200 u/mL
Humalog KwikPen, Lymjev KwikPen
120
Levemir stoarge duration
42 days
121
Humulin R U-500 vial? pen?
Vials: 40 days Pen: 28 days
122
Tresiba stoarage duration
56 days
123
Toujeo storage duration
56 days
124
Quantity of 0.3 mL
<30 units
125
Quantitity of 0.5 mL
30-50 units
126
Quantity of 1 mL
51-100 unitis
127
Difference between U-100 and U-500 syringes
U-500: dark green covers U-100: orange covers
128
Stardarn pen needle of insulin
8mm
129
Needle for obese patients
12.7 (1.2 inch)
130
What is hypoglycemia
BG <70
131
Sx of hypoglycemia
Anxiety/irritability, shakiness, sweating, hunger, confusion
132
Sx of severe hypoglycemia
Sz, coma, death
133
Tx of conscious hypoglycemia
Rule of 15: 1. Ingest 15-20 g of glucose 2. Recheck BG 3. Repeat is still hypoglycemia 4. Once normal, eat small meal or snack
134
Things that contain 15 g of glucose
4 oz of juice 8 oz of milk 4 oz of regular soda 1 TBS of sugar, honey, or corn syrup 3-4 glucose tabs or 1 glucose gel pack
135
Tx of unconscious hypoglycemia
IV dextrose or glucogon Glucagon 1 mg Sc inj Glucagon nasal spray
136
Drugs that can ↑ BG
Thiazides and loops Tacrolimus, cyclosporine PI FQ Antipsychotics Statins Steroids Cough syrups Niacin
137
Drugs that can ↓ BG
B-blockers (mask hypoglycemia) FQ Tramadol
138
Target glucose range of noncritaclly ill pts
100-180
139
Target glucose range of critically ill pts
140-180
140
Difference between DKA and HHS
DKA is associated with T1D but can occur in T1D HHS is common in T2D
141
DKA presentations
Ketones are present (fruity breath, abdominal pain, n/v, dehydration) BG >250 Anion gap (pH <7.35, >12)
142
Presentation of HHS
Confusion, delirium BG >600 Extreme dehydration pH >7.3, bicarb >15
143
DKA and HHS treatment
1. Fluids (NS), when BG is 200 change to D5W1/2NS 2. Regular insulin: - 0.1 u/kg bolus, then 0.1 u/kg/hr continuous infusion OR 0.14 units/kg/hr continuous infusion 3. Monitor K+ and keep within 4-5 mEq/L 4. Treat acidosis pH <6.9 with sodium bicarb

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