Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical 2 (Sam) > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is the initial daily dosing for Type 1 diabetes?

A

0.5-1 unit/kg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is the daily dose divided for type 1 diabetes?

A

50% basal

50% rapid acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The number of units needed are adjusted based on ??

A
  • blood glucose readings
  • the amount of carbs consumed at each meal
  • expected exercise
  • presence of illness
  • changes in age
  • changes in weight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the A1C goal for <6 years old?

A

<8%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the A1C goal for 6-12 years old?

A

<7.5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the A1C goal for anyone over 12 years old?

A

<7%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the FPG goal for <6 years old?

A

6-10 mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the FPG goal for 6-12 year olds?

A

4-10 mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the FPG goal for those over 12?

A

4-7 mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the 2hr post prandial PG (plasma glucose) goal for those over 12?

A

5-10 (or 5-8 if A1C target not met)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why are the targets higher for those <6 ?

A

Caution is required to minimize hypoglycaemia bc that can cause cognitive impairment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In most cases, insulin adjustments should approximate a ___% change to the insulin causing the effect.

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the “Correction Factor” or “Insulin Sensitivity Factor” for rapid acting insulin?

A

100/TDD = how much one unit of rapid acting insulin should reduce their BG by.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the “Correction Factor” or “Insulin Sensitivity Factor” for short acting insulin?

A

85/TDD = how much one unit of short acting insulin should reduce their BG by.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do you adjust for if Pt wants extra slice of cake for dinner?

A

Use insulin to carbohydrate ratio (ICR)

500/TDD (or # carbs in a day/TDD)

This will give you the grams of carbs that uses 1 unit of insulin.

Ex.

500/33 units = 13.6 grams of carbs

1 unit is required for 13.6 grams of carbs

Say cake = 27.2 grams of carbs (no fibre),
Then tell Pt to inject 2 extra units of insulin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Subtract _____ from # of carbs.

A

fibre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Do you increase or decrease insulin for exercise?

A

decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When should a diabetic not exercise?

A
  • If they have hypoglycaemia (<4 mmol/L)
  • If their BG is > 14 mmol/L with ketones
  • If their BG is > 16.7 mmol/L
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Delayed hypoglycaemia can occur up to ___ hrs after exercise.

A

36

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which medications should someone not take if they are ill and are diabetic and why?

A

SADMANS

  • Sulfonylureas
  • ACEi
  • Diuretics, direct renin inhibitors
  • Metformin
  • ARBs
  • NSAIDs
  • SGLT2 inhibitors

ARB, ACEi, Direct renin inhibitors, NSAIDs, diuretics, and SGLT2 inhibitors increase risk for a decline in kidney function

Metformin and sulfonylureas have reduced clearance and increase risk for adverse effects.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

List examples of sulfonylureas

A

Gliclazide
Glimepiride
Glyburide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

If you become sick and are unable to drink enough fluid (risk of dehydration), which meds should you stop?

A
  • BP pills
  • Water pills (diuretic)
  • Metformin
  • Diabetes pills
  • Pain meds
  • NSAIDs

**important to tell patients who are buying OTC combo products that they should buy the one with tylenol and not advil !!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How does illness affect insulin?

A

Illness and infection allow the body to release counter regulatory hormones that oppose the action of insulin, and therefore can increase BG.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the objective of sick day management in diabetic patients?

A

to minimize metabolic imbalance, avoid severe hypoglycaemia and prevent hyperglycaemia and ketosis leading to the developing of DKA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Hyperglycemia is a risk factor for ______

A

DKA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is DKA?

And what is the treatment for DKA?

A
  • HYPERglycemia puts patients at risk for DKA.
  • This condition develops when your body can’t produce enough insulin.
  • Without insulin, your body starts to break down fat as a fuel bc it can’t break down sugar.
  • When fat breaks down, ketones can be present in urine and blood.
  • Treatment: Insulin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Should you stop insulin on sick days?

A

NO
NEVER
NO WAY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Symptoms of DKA?

A

nausea, vomiting, ab pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

When should a diabetic patient test their ketones?

A

When they are sick and BG levels remain elevated > 14 mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Illness:

Which insulins do you adjust?

A

Usually keep the long acting or intermediate acting dose the same.

Start by adjusting the rapid or short acting insulin.

Supplemental rapid or short acting insulin can be safely given every 3-4 hours without discussion with a physician

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What do you tell a diabetic patient for monitoring during illness?

A

Monitor BG and ketones every 2-4 hours around the clock as long as significant hyperglycaemia and/or ketonuria/ketonemia persist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the target ranges for BG for illness?

A
  • BG < 14 mmol/L
  • urinary ketones should be negative
  • blood ketones of 0.6 or less
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What if a patient can’t eat?

A

10-15 grams of carbs should be taken every 1-2 hours (to prevent starvation ketosis and hypoglycaemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Why do they need extra fluids in a time of illness?

How much fluids do they need?

A

To prevent dehydration and facilitate excretion of ketones in the urine.

2200 mL/day (9 cups)
Rule of thumb = 1 cup/hr while awake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

When would you need to communicate with the CDE or physician?

A

If patient:

  • Is unable to tolerate fluids
  • Has recurrent vomiting (more than once in 4 hours)
  • Has recurrent diarrhea (more than 5 times in a day)
  • Has taken extra insulin (2 additional doses) as recommended, but hyperglycaemia and ketones do not improve
  • Has an illness that is very severe, worsens, or lasts longer than 12-24 hours
  • Is unable to keep BG > 6
  • Shows sings or symptoms of DKA, dehydration or any other serious problem
  • Has any questions/concerns about sick day management
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How much do you change insulin by if:

  • BG > 14
  • Blood ketones 1.5-3
  • Urinary ketones are positive/moderate
A

10% increase of TDD. If this doesn’t work within 2-3 hours, try 10-15% of TDD

*If on an insulin pump, use 1.5 times usual correction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How much do you change insulin by if:

  • BG > 20
  • Blood ketones < 1.5
  • Urinary ketones are negative/small
A

10% increase of TDD. If this doesn’t work within 2-3 hours, try 10-15% of TDD

*If on an insulin pump, use 1.5 times usual correction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How much do you change insulin by if:

  • BG > 20
  • Blood ketones > 3
  • Urinary ketones are large
A

15% increase of TDD in additional to usual dose and/or consult with your HCT. If not improving, seek medical help

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How much do you change insulin by if:

-BG < 6

A

reduce usual dose by 5-10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How much do you change insulin by if:

  • BG 6-20
  • Blood ketones < 1.5
  • Urinary ketones are negative/small
A

usual dose at usual times with corrections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Are ketones detected earlier in blood or urine?

A

blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the acronym SICK stand for?

A 
S = blood sugar testing
I = insulin
C = Carb and fluid
K = ketone testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

MOA of Acarbose

A

Blocks alpha-glucosidases in GI tract - delays carb digestion

44
Q

Example of Acarbose

A

Glucobay

45
Q

Dose of Acarbose

A
  • 50mg once daily to start
  • Titrate up to 100mg TID with meals
  • Increase dose every 1-2 months
46
Q

Acarbose:

Takes approximately _______ for max effect

A

8 weeks

47
Q

Acarbose:

What change in A1C would you predict?

A

a decrease in A1C of 0.5-0.8%

48
Q

Acarbose:

How does it affect weight?

A

Weight neutral or slight weight loss

49
Q

Acarbose:

Risk of hypoglycaemia?

A

low risk of hypoglycaemia when used alone

50
Q

Acarbose:

SE ?

A

Associated with significant GI side effects:

  • flatulence > 40%
  • diarrhea approx 30%
51
Q

Acarbose:

What do you need to monitor while on this medication?

A

Liver function tests (AST, ALT)

52
Q

Acarbose:

Cost

A

$1/day

53
Q

Acarbose:

Pharmacare coverage?

A

part 1

54
Q

Acarbose:

Why does this medication cause problems for TREATING hypoglycaemia?

A

This medication works by delaying carb digestion, so you cannot tell them to have a snack or juice.

THEY MUST HAVE FAST-ACTING GLUCOSE
-food won’t be absorbed and broken down fast enough

55
Q

Example of Pioglitazone

A

Actos

56
Q

Pioglitazone:

When will you see effects?

A

Delayed onset of 4 weeks, max effect in 8-16 weeks

57
Q

Pioglitazone:

How will it change A1C?

A

decrease A1C by 0.8-1%

58
Q

Pioglitazone:

How does it affect weight?

A

weight gain (approx 4 kg)

59
Q

Pioglitazone:

Hypoglycemia?

A

no hypoglycaemia when used alone

60
Q

Pioglitazone:

Contraindicated in ?

A

any amount of HF

61
Q

Pioglitazone:

Not indicated for use with _____

A

insulin (due to increased risk of HF)

62
Q

Pioglitazone:

SE

A
  • edema (5%)
  • mild anemia (rare)
  • increased incidence of fractures
63
Q

Pioglitazone:

Must monitor ?

A

liver function (ALT, AST)

64
Q

Pioglitazone:

Associated rarely with ____ ______: monitor for blood in urine and dysuria

A

bladder cancer

65
Q

Pioglitazone:

Cost

A

$0.59-1.22/day

66
Q

Pioglitazone:

Pharmacare coverage?

A

Part 3 EDS

  • For use in patients who are not optimally controlled on MAX doses of metformin and either a sulfonylurea or repaglinide or with CI to the agents
  • Type 2 DM on high doses of insulin (over 2U/kg) and on MAX tolerated metformin who are not achieving optimal control
67
Q

DPP-4 inhibitors are known as ?

A

incretin enhancers

68
Q

List examples of DPP-4 inhibitors

A 
The "Liptins"
sitagliptin
saxagliptin
linagliptin
alogliptin
69
Q

DPP-4 inhibitors:

When do you expect results

A

delayed onset < 4 weeks, max effect approximately 18 weeks

70
Q

DPP-4 inhibitors:

What decrease in A1C would you expect?

A

decrease A1C by 0.7%

71
Q

DPP-4 inhibitors:

Hypoglycemia ?

A

not when used alone

72
Q

DPP-4 inhibitors:

Long term efficacy and safety ______

A

unknown

73
Q

DPP-4 inhibitors:

May want to avoid in ____ _____

A

heart failure (may not be as problematic as we once thought)

74
Q

DPP-4 inhibitors:

SE

A
  • urticaria
  • angioedema
  • arthralgias
  • joint pain
  • pancreatitis (rare)
  • increased incidence of sore throat/infection, headache, nausea (<10%), diarrhea (<10%)
75
Q

DPP-4 inhibitors:

cost

A

$3/day

76
Q

DPP-4 inhibitors:

Pharmacare coverage?

A

Part 3 EDS
-For the treatment of patients with T2DM who have previously been treated with metformin and a sulfonylurea. Should be used in patients with diabetes who are not adequately controlled on or are intolerant to metformin and a sulfonylurea, and for whom insulin is not an option.

77
Q

List examples of glucagon-like peptide-1 receptor agonists

A

The “tides”

  • Exenatide
  • Liraglutide (victoza - SC injectable)
  • Dulaglutide
  • Albiglutide
78
Q

Glucagon-like peptide-1 receptor agonists:

Indicated for?

A

in combination with metformin, or merformin and a sulfonylurea, or metformin and a basal insulin

79
Q

Glucagon-like peptide-1 receptor agonists:

What drop in A1C do you expecT?

A

0.8-1.4%

80
Q

Glucagon-like peptide-1 receptor agonists:

Treatment with liraglutide (victoza) showed benefit in what type of patients?

A

decreased risk of CV events in those that were at high risk of having a CV event

81
Q

Glucagon-like peptide-1 receptor agonists:

Liraglutide dose?

A

Titrate the dose upward: 0.6 mg SC once daily x 1 week, then 1.2mg SC once daily, may increase to 1.8mg SC once dialy

82
Q

Glucagon-like peptide-1 receptor agonists:

How does it affect weight?

A

weight neutral or slight weight loss (approx 3 kg)

83
Q

Glucagon-like peptide-1 receptor agonists:

Risk of hypoglycaemia?

A

lower risk of hypoglycaemia when used alone

84
Q

Glucagon-like peptide-1 receptor agonists:

Long term efficacy and safety _____

A

unknown

85
Q

Glucagon-like peptide-1 receptor agonists:

Associated with _____ cancer (contraindicated if person or family history)

A

thyroid

86
Q

Glucagon-like peptide-1 receptor agonists:

SE?

A
  • reports of pancreatitis (rare)

- increased incidence of nausea (39%), headache, diarrhea (21%), hives

87
Q

Glucagon-like peptide-1 receptor agonists:

Cost?

A

$2.98-8.95/day

very $$$$

88
Q

Glucagon-like peptide-1 receptor agonists:

Pharmacare coverage?

A

No pharmacare coverage

89
Q

List examples of SGLT-2 inhibitors

A

The “Flozins”

  • canagliflozin
  • dapagliflozin
  • empagliflozin
90
Q

SGLT-2 inhibitors:

MOA

A

causes increased urinary glucose excretion

91
Q

SGLT-2 inhibitors:

A1C decrease?

A

0.7-1%

92
Q

SGLT-2 inhibitors:

Reduces risk of ?

A

composite CV events and all cause death

93
Q

SGLT-2 inhibitors:

Dose of empagliflozin?

A

typically 10 mg daily with 1st meal of the day up to a maximum dose of 25 mg daily.

94
Q

SGLT-2 inhibitors:

Who is empagliflozin CI in?

A

renally impaired patients with eGFR less than 45 mL/min and ESRD patients or patients on dialysis

95
Q

SGLT-2 inhibitors:

Weight?

A

Weight neutral or weight loss (approx 4kg)

96
Q

SGLT-2 inhibitors:

SE ?

A
  • UTI (18% in females)
  • genital fungal infections (4%)
  • nausea
  • constipation
  • urinary frequency
  • light-headedness
  • increased K, Mg, P04
  • decreased BP
  • decreased intravascular volume
  • rare DKA
97
Q

Which 2 groups do we need to know well for the exam?

A

Glucagon-like peptide-1 receptor agonist

SGLT-2 inhibitors

98
Q

Patients with a prior history of genital infections are more likely to experience a genital infection event while on ________

A

jardiance

99
Q

Jardiance - cost?

A

$3/day

100
Q

Jardiance - pharmacare?

A

Part 3 EDS
-For the treatment of patients with T2DM who have previously been treated with metformin and a sulfonylurea. Should be used in patients with DM who are not adequately controlled on or are intolerant to metformin and a sulfonylurea, and for whom insulin is not an option.

101
Q

Exercise:

When should you monitor BG?

A

before, during and after exercise

102
Q

Exercise:

Adjust insulin or food?

A

preferred to adjust insulin

food - for unplanned activity

103
Q

Exercise:

How can hypoglycaemia be prevented?

A
  • adding food

- decreasing insulin

104
Q

Exercise:

Always carry ?

A

a source of fast acting glucose

105
Q

Exercise:
Vigorous activity, day-long activity or those with a history of delayed hypoglycaemia may need to adjust intermediate or long-acting insulin by ____5

A

30-50%

106
Q

Exercise:

An insulin pump may be disconnected during exercise for _____ hours

A

1-2 hours

*BG should be checked before disconnecting the pump and upon reconnecting.

107
Q

Exercise:

How do you determine the insulin adjustment?

A

ask pt the intensity and duration and adjust according to the chart

Clinical 2 (Sam) (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions