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Diabetes Flashcards

(59 cards)

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1
Q

Diabetes Diganosis

A

Random Plasma Glucose (RPG)=>=200
Fasting Plasma Glucose (FPG) >=126
Tolerance (OGTT) >=200
HbA1C >=6.5%

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2
Q

HbA1C Postprandial Glucose

A

Major contributor to hyperglycemia at HbA1c <7.3 contributes 69.7%

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3
Q

HbA1C Fasting Plasma Glucose

A

Major contributor to hyperglycemia at HbA1c >10.2

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4
Q

Gestational Diabetes Mellitus

A

Insulin is the preferred medication; Requires frequent titration

Most Pregnancy B; Noninsulin Rxs cross placenta (Glyburide and Metformin)

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5
Q

Types of Insulin

A

Regular, Rapid-acting and NPH insulin

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6
Q

Insulin category C

A

Glragine and Glulisine

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7
Q

Mild Hypoglycemic Stage Treatment

A

Glucose = 60-70mg/dL

TX ; 15-15-15

15 G of CHO Glucose— Wait 15min. —– 15 G again

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8
Q

Moderate Hypoglycemic Stage Treatment

A

Glucose= 41-59 mg/dL S/S; Adre/neuro

Tx; 30-15-30

30 G of CHO —– wait 15min. —- 30G again

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9
Q

Severe Hypoglycemic Stage Treatment

A

Glucose= <40 mg/dL S/S; Adre/neuro (Req. Assist.)

Tx; Glucagon 1mg Subq/IM or 50mls D50W IV
6.5 min and 4 min.

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10
Q

Hyperglycemic Complications

A

Acidosis; Large Ketonemia or ketonuria ; Glucose >600mg/dL ; Ph>7.30; Onset over days to wks

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11
Q

Hyperglycemic Complication Treatment

A

Insulin: Regular

.1 U/Kg/ as I.V Bolus then .1 U/kg/hr infusion

.14 U/Kg Bwt/hr IV infusion

Serum Glucose Not <10% in 1st Hr .14 U/Kg IV bolus then continue previous infusion

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12
Q

Post Hyperglycemic treatment DKA Tx

A

Serum Glucose reduced 200mg/dL then .02-.05 U/kg/hr IV Add 20-30 mEq/L on fluid if K+ < 3.3

Rapid Acting Insulin at 0.1 U/kg SC every 2 hrs (Keep 150-200) until resolution

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13
Q

Post Hyperglycemic treatment HHS Tx

A

Serum Glucose reduced 300mg/dL then .02-.05 U/kg/hr IV keep glucose between 200-300 for 2 hrs then SC

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14
Q

Hyperosmolar Hyperglycemic State (HHS)

A

Significantly higher plasma glucose (600mg/dL)
Serum pH> 7.30

Onset occurs several days to wks

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15
Q

Metabolic Syndrome

A

Pts have a 5 fold increased risk fro T2DM

Has 3-5 components

  • Abd. Obesity - HDL Low -Triglycerides 150
  • BP SBP>130 DBP >85 -Fasting Glucose >100mg
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16
Q

DOC for Diabetics for Dyslipidemia

A

Statin Moderate to High intensity

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17
Q

Insulin

A

Replaces hormone in T1DM and supplements in T2DM
Facilitates Glucose uptake; reduces glucose in plasma

AE; Hypoglycemia, Weight Gain, lipodystrophies

Basal V.S Bolus

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18
Q

Rapid Acting Insulin

A

Lispro- Before or immediately after meals (CS II w/ NPH)

Aspart- Before meals (IV and CSII w NPH)

Glulisine- Before or w/in 20min after meals (IV and CSII w/NPH)

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19
Q

Short Acting Insulin

A

Regular (Humulin/Novolin)

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20
Q

Intermediate Acting Insulin

A

NPH intermediate-acting insulin with onset of action in 1 to 3 hours, duration of action up to 24 hours, and peak action from 6 to 8 hours

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21
Q

Long Acting Insulin

A

Glargine and Detemir

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22
Q

Afrezza

A

Inhaled

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23
Q

Afrezza

A

Tx; T2DM Hypergl Oral Inhaled insulin; At beginning of a meal.

CI; COPD, Asthma, smoke, lung cancer; T1DM needs a long acting insulin; Not for Ketoacidosis DKA

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24
Q

Humilin R-

Novolin R

Study These Flashcards
A

Short Acting Insulin (Can mix w/ NPH) U100 and U500

U500= >200 U/day; 30 min. before meal. (Clear before cloudy) Duration 13-24 hrs

U100=Conyinous SC infusion CSII (duration=4-12 hrs)

DOC for infusion; IV drips preferred; Keep refrigerated

25
U500
Highly concentrated form of human regular insulin. Use; Pts w/ severe insulin resistance; Requires insulin doses> 200 Units/day Onset and duration = that of NPH
26
NPH (Humulin N) NPH BNovolin
Intermediate Acting Tx : Fasting Hyperglycemia Basal (Not in relation to meals; Duration 16-24 hrs Can Mix w/ Lispro, Aspart, Glulisine
27
Insulin Glargene Insulin Demetir (Albumin bound)
Long acting Insulins; Basal (Not in relation to meals) Not to be mixed w/ other insulins or dilute
28
Insulin Mixture 70/30 Aspart/Protamine Insulin Mixture 75/25 Lispro/Protamine Insulin Mixture 50/50 Lispro/Protamine
Tx; Hyperglycemia Meal timing w/15 min. before a meal (Cloudy) onset 30min. Duration <=24 hrs or > 22 hrs (50/50) Do not mix
29
NPH/Regular 70/30 | Humulin) (Novolin
Tx : Hyperglycemia Meal time 30-40 before meal (Cloudy) Do not Mix
30
Summary Bolus
Rapid acting-LAG= Less risk of Postpandrial hypoglycemia compared to insulin Short-acting Regular U-100= DOC IV infusion Regular U-500= Insulin resistant pts >200 units/day Intermediate acting- NPH= Greater risk of nocturnal hypoglycemia (Cloudy) Long Acting- Detemir/Glargine= Less nocturnal hypoglycemia comapred to NPH
31
Type 1 DM Insulin Mgnt
- Traditional Split - Split-Injections (Modified) - Basal Bolus (X1 Basal) - Basal Bolus (X2 Basal)
32
Traditional Split
Intermediate Basal Morning and Afternoon/evening X2 Rapid short-acting Morning Evening X2
33
Split-Injections (Modified)
Intermediate Basal morning and Night X2 Rapid short acting morning and Evening X2
34
Basal bolus (Once daily basal)
Intermediate or long acting Evening X1 Rapid-short acting Morning-afternoon-evening X3
35
Basal-Bolus (Twice Daily Basal)
Intermediate acting Morning and Evening X2 Rapid or Short-Acting M-A-E X3
36
Insulin Basal-Bolus Regimen
75kg .4 U/kg/day =30 U TDD 1/2=15 1/2=15 Basal=15 U Bolus=15/ 3 meals =5 U/Meal
37
Insulin Basal-Bolus Regimen
75kg .4 U/kg/day =30 U TDD 1/2=15 1/2=15 Basal=15 U Bolus=15/ 3 meals =5 U/Meal
38
Insulin to carbohydrate calculation
Often 1 U for every 15G of Carbs Obese= 1 U for every 5 G of carbs (1:5) Lean= 1 U for every 20 G of carbs (1:20) W/ Rapid Acting insulin Estimated 500/TDD=CHO cover 500/62= 8 G = For every unit insulin covers 8G Carbs
39
Corrective or supplemental Dose
Added to bring glucose into desired range Regular insulin Correction Factor= 1500/TDD Rapid Acting Insulin correct factor= 1800/TDD Correction Dose= Current BG - Desired BG 160-120 TDD=45 --> RAI Factor= 1800/TDD 1800/45=40 160-120= 40/Correction factor =40 =1 U Total corrective daily dose TDD=30+5/meal =5+1/meal
40
Dawn phenomenon
Hyperglycemia in AM from Insufficient evening Basal Insulin Solution= Increased. evening basal insulin 0200-0300 SMBG normal or elevated
41
Somogyi Effect
Hypoglycemia at midnight from Too much evening basal insulin Solution= Decrease evening Basal insulin 0200-0300 SMBG decrease BG
42
T2DM Starting Dose of insulin
1st Line = Biguanides and insulin 0.1-0.25 units/kg 100% Basal e.g. - 10 U NPH or 0.1-0.2 Units/kg at bedtime - 10 U Glargine 0.1-0.2 Units/kg once daily - 10 U Detemir or 0.1-0.2 Units/kg once daily Consider 0.2-0.3 Units/kg/day initial in severe hyperglycemia BG 250> RPG >300 or A1C>10; not met--> 5-10% titration weekly
43
Biguanides (Metformin)
Decreases Hepatic Glucose production; (Glycogenolysis) Enhances insulin sensitivity; 1st Line T2DM and PC Ovary System; Give w/ largest meal min. GI SE; Caution renal Dysfx; Risk of Hypoglycemia; Lactic acidosis (rare) CI; Scr>1.4 Lactic acidosis such as CHF, Elderly w/ dec. CrCl, liver disease; alcoholism ; sepsis; No I^131, 2-3 day and cimetidine
44
Sulfonylureas
"Insulin secreteagogues" Binds to specific Recep. --> stimulation of Beta cells --> Insulin secretion Use: 1st and 2nd Line T2DM; Reduced efficacy over time : AE-Hypoglycemia; Weight gain; Cholestasis; GI, hyponetremia DI: Warfarin, phenytoin, Salicylates;; CYP2C9 Hepatic;; Chloropramide w/ renal dysfx;; GLP-1 Agonist and DPP-4 inhibitors=Consider dec. Sulfornylureas by 50%
45
Sulfonylureas Agents 1st Generations
- Chlorpropamide; Highest Hypoglycemic potential - Tolazamide - Tolbutamide (Shortest acting)
46
Sulfonylureas Agents 2nd Generation
2nd Line therapies added to Metformin if A1C not met 1st Line if cannot take Metformin - Glipizide - Glyburide (Highest rates of hypoglycemia) Prego B - Glimepiride; Safe in renal Dysfx
47
Meglitinides
1st Line if Sulfonylureas or Metformin/combo AE or CI Stimulates insulin secretion from the B cells. Requires presence of Glucose to stimulate insulin secretion Less risk of hypoglycemia; Useful for pts who skip meal Consider insulin if hx of skipping meals; Weight neutral;; Less hypoglycemia than sulfonylureas;; URI Flu like
48
Meglitinides Agents
- Nateglinide; TID before meals CYP 2c9 | - Repaglinide; TID before meals CYP 2c8
49
Thiazolidinediones (TZDs)
Enhances insulin sensitivity in muscle and fat by increasing glucose transporter. binds PPAR-Y Inc sensi. 2nd /3rd Line for T2DM AE: Weight Gain, avoid in CHF, MI; Inc Fx rate; Fatal Hepatofailure; Inc. Bladder cancer; CHF inc. w/ insulin; MI risk w/ nitrates
50
Thiazolidinediones (TZDs) Agents
Pioglitazone Rosiglitazone
51
Dipeptidyl Peptidase-4 (DPP-4)
Inhibits an enzyme which prevent incretin degradation GLP-1 and GIP, which in crease insulin secretion 2nd and 3rd line for T2DM Weight neutral, pancreatitis assoc, Incr of infx URI/UTI worsen HF; Dec. sulfonyluria by 50% if combo
52
Dipeptidyl Peptidase-4 (DPP-4)
- Linagliptin; No adjust for renal or hepatic; CYP3A4 - Alogliptin; Adjust for renal and hepatic - Salxagliptin; CYP3A4 substrate (URI, UTI, CHF) - Sitagliptin; Adjust for renal and hepatic
53
Glucagon-like peptide (GLP-1)
Stimulates Receptors which increase insulin production and secretion in response to BG; 2nd 3rd Line AE; Hypoglycemia; Assoc. w/ renal insuff; Thyroid cell cancer; Pancreatitis; CI-T1DM ; Delays GI absorp. May decrease BP and improve lipid profile
54
Glucagon-like peptide (GLP-1) Agents INJectables
- Dulaglutide; No adjust for renal imapirment - Albiglutide; - Liraglutide; Weight loss (Weight mgnt) - Exanatide;not for renal impairment; reconstitute; less nausea; weight loss indicated
55
Pramlitidine INJ (Synthetic Amylin Analogue)
Adjunct to insulin meal time SQ; Suppress innapropriate high prostprandial glucagon secretion; Increase satiety= weight loss T1 and 2DM Compound hypoglycemia 2 fold in T1DM, dec. insulin 50%; may delay absorption of drugs; Skip dose if meal skipp
56
Alpha Glucosidase Inhibitors - Acarbose - Miglitol
Inhibit enzyme in small intestine, delays breakdown of carbs and sucrose--> reduce post-prandial; 3rd Line T2DM Glucose, lactose, fructose not affected AE: Weight neutral; GI bloating, gas, diarrhea, pain CI- Short bowel syndrome, IBS, Cirrhosis; Beano helps but decreases efficacy; No use w/ Scr>2mg/dL
57
Selective sodium dependent Glucose Transporter Inh. - Dapagliflozin; Inc risk of bladder cancer - Empagliflozin - Canagliflozin; Inc risk of stroke
Inhibits transporter reducing reabsorption of filtered glucose In Nephron 3rd Line agent AE; genital fungal infections and UTI; Incr. LDL; Polyuria Do not use in renal dysfx
58
Colesevalem (Bile Acid Sequestrans)
Bile acid binding agents T2DM; may reduce hepatic insulin resistance and reduce glucose absorption Reduce CHD mortality, major coronary events May increase TG concentration; Dec absorption of Rxs
59
Bromocryptine (Dopamine Agonist)
May centraly reverse metabolic changes assoc w/ insulin resistance and obesity Reduce A1C 1% AE; Nausea/vomiting and hypotension; Rhinitis and sinusitis

Pharmacology (5 decks)

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