Diabetes

Question 1

signs and symptoms of hypreglycemia

Answer 1

thirst
increased urination
fatigue
headache
blurred vision
peripheral neuropathy 
like they have the flu

Question 2

reason for thirst and increased urination

Answer 2

cant take up glucose so blood becomes full of glucose and hypertonic so pulling water out of the body
body increases thirst to replace the water

Question 3

what levels are concerning in T2DM

Answer 3

high teens

not as concerned about DKA bc rare in type 2

Question 4

what is hyperosmolar hyperglycemia

Answer 4

event that is precipitated after long time of hyperglycemia, complication of type 2 with high mortality
high blood glucose and hyperosmolarity without increase ketones

Question 5

signs and symptoms of HHS

Answer 5

increased thirst
increased urination
dry mouth
warm skin
confusion, hallucination
convulsion, coma 
BG>33.3

Question 6

HHS provoking factors

Answer 6

flu 
not eating or drinking
stress
surgery 
trauma
penumonia , UTI

Question 7

glucose levels start to see symptoms

Answer 7

12

Question 8

drug causes of hyperglycemia

Answer 8

tacrolimus
corticosteroids
atypical antipsychotics 
high dose thiazide 
beta blocker
niacin
protease inhibitors

Question 9

pathophysiology of T2DM

Answer 9

decreased insulin sensitivity so glucose doenst enter skeletal, liver, adipose tissue

Question 10

why do type 2 require insulin

Answer 10

overtime the beta cells lose function and dont make as much insulin so require supplementation

Question 11

target <6.5%

Answer 11

low risk hypo

decrease risk of retinopathy and CKD

Question 12

target <7%

Answer 12

mostadults type 1 or 2

low risk of hypo

Question 13

when would you consider 7.1-8.5%

Answer 13

functionally dependent
high risk of hypoglycemia
hypo unawareness
in care home

Question 14

when would you not recommend A1C testing

Answer 14

end of life

just prevent symptoms

Question 15

what is novolin 30/70

Answer 15

30% regular

70% intermediate

Question 16

when to take novolin 30/70

Answer 16

30 min before meals

Question 17

efficacy of novolin 30/70

Answer 17

reach target levels

decrease microvascular complications but not CV!!!

Question 18

side effects of insulin

Answer 18

weight gain

hypoglycemia

Question 19

drug interactions of insulin

Answer 19

other agents that decrease blood glucose

Question 20

titration of novolin 30/70

Answer 20

start at 5-10units before breakfast and supper

increase 1-2units PM dose as needed

Question 21

dose of metformin

Answer 21

500mg daily increase to 500mg every 2weeks until 500tid

Question 22

efficacy of metformin

Answer 22

increases insulin sensitivity
decrease a1c 1%
decrease microvascular and CV complications

Question 23

side efffects of metformin

Answer 23

GI upset - diarrhea
lactic acidosis in renal impairment
decreased b12 - numbness tingling get tested

Question 24

CI of metformin

Answer 24

renal or liver dysfunction get tested before starting and during use

Question 25

dose of liraglutide

Answer 25

0.6mg increase to 1.2mg in 1 week to prevent nausea

Question 26

efficacy of liraglutide

Answer 26

decrease a1c .8-1% decrease micvorvascular decrease cv in high risk pts in 60s not sure about other peoplr weight loss NNT = 50? over 4 years to prevent 1CV event

Question 27

side effects of liraglutide

Answer 27

rare: pancreatitis, thyroid cancer nausea, headache, diarrhea, hives long term effects unknown low risk of hypo

Question 28

CI of liraglutide

Answer 28

personal or family history of thyroid cancer

Question 29

cost of liraglutide

Answer 29

400$ a month not covered

Question 30

dose of empagliflozin

Answer 30

10mg before first meal

Question 31

CI of empagliflozin

Answer 31

crcl<45

Question 32

efficacy of empag

Answer 32

``` decrease microvascular decrease a1c .4-.7 decrease Cv risk in high risk NNT 63 over 3 years not all the agents in the class are the same ```

Question 33

adverse effects of empag

Answer 33

UTI, pyleonephritis genital fungal infection - fourniers gangrene nausea, constipation, increased urinary frequency

Question 34

drug interactions with empah

Answer 34

drugs causing diuresis | furosemide and caffiene

Question 35

cost of empag

Answer 35

90$ a month covered part 3

Question 36

why dont you use gliclazide with insulin

Answer 36

increases insulin secretion so dont need if supplementing insulin

Question 37

positive endpoints

Answer 37

decreased microvascular and CVrisk A1C <7% no hypo

Question 38

negative endpoints

Answer 38

hypoglycemia | sideeffects of med

Question 39

do you use asa as primary prevention

Answer 39

no