Diabetes Flashcards
(182 cards)
1
Q
risk factors for diabetes
A
family history and ethnicity overweight BMI > 25kg/m2 prediabetes history of gestational diabetes poor diet and low physical inactivity HTN Hx cardiovascular disease
2
Q
which two drug classes are most commonly cause hyperglycemia?
A
protease inhibitors and corticosteroids
3
Q
which atypical antipsychotic is most likley to cause hyperglycemia?
A
olanzapine (zyprexa)
4
Q
which two anti rejection meds cause hyperglycemia?
A
cyclosporine and tacrolimus
5
Q
symptoms of hyperglycemia
A
polyphagia polyuria polydypsia blurred vision fatigue
6
Q
macrovascular complications of diabetes
A
CAD (HTN, MI, HF)
CVD (TIA/stroke)
PAD
7
Q
microvascular complications of diabetes
A
retinopathy
nephropathy
peripheral neuropathy
autonomic neuropathy
8
Q
why do patients with diabetes get erectile dysfunction and gastroparesis?
A
they are suffering from autonomic neuropathy,which is damaget to autonomic nerves that control digestion, HR, prespiration, blood pressure
9
Q
three best ways to lose weight
A
reduce calorie intake
choose nutrient dense foods
exercise
10
Q
goal of weight loss?
A
lose 10% over 6 months which is about half to 2 pouonds per weeks
waist circumference less than 35 woemn and <40 males
11
Q
what are some nutrient dense foods to eat?
A
vegetables fruits whole grains fat free or low fat milk seafood lean meats eggs beans and legumes nuts and seeds
12
Q
what is one serving of carbohydrates?
A
15grams
13
Q
how many carb servings for diabetics to eat
A
3-4 servings per meal and 1-2 per snack
14
Q
why should diabetics avoid alcohol?
A
it exacerbates hypoglycemia and can calso cause hyperglycemia depending on the alcohol
15
Q
max intake for alcohol in diabetics
A
1 drink for women
2 drinks for men (per day for both)
16
Q
what are the recommended exercise for diabetics?
A
aerobic exercise: 30 minutes x 5 days per week
Resistance : 2 times per week
17
Q
what does the A1c measure
A
it measures the average blood glucose of the past 2-3 months
18
Q
how often should the a1c be measured?
A
if they are not controlled: quarterly (every 3 months)
If they are controlled (at a1c goal) then twice per year
19
Q
what does the ADA says are the goal for A1c for diabetics?
A
7.0%
20
Q
ADA goal for blood glucose before and after eating
A
before eating 70-130 mg/dl
1-2 hours after the start of the meal <180mg/dL
21
Q
AACE a1c goals
A
<= to 6.5
22
Q
AACE blood glucose goal before and after meals
A
before <140mgdl
23
Q
when should the a1c goal be more stringent ? when should you aim toward the lower end?
A
when the patients are younger adults and not experiencing hypoglycemia
24
Q
when should your a1c goal be less stringent?
A
people with severe hypoglycemia limited life expectancy extensive comorbid conditions advanced complications longstanding diabetes hard to reach goal
25
what is the estimated average glucose for patients? eAG goal?
goal is less than 154 mg/dl
26
correlation of a1c with blood sugars (average)
```
a1c 6 to 126
7 to 154
8 to 183
9 to 212
>10 to 200+
```
27
first line bp meds for diabetics? why?
ACE inhibitors
ARBs
because they decrease progression to diabetic nephropathy
28
LDL goal for diabetics
< 100mg/dL in patient without overt CVD. if patients have overt CVD goal 40 in men goal and >50 in women
TGs should be less than 150
29
what is the usual ASA dose for dm patients to take daily?
75- 162 mg daily (usually ASA 81mg EC) .
30
what is an alternative to ASA if allergy?
clopidogrel 75mg po qd
31
which diabetes patietns should receive ASA tx?
if 10 year risk is >10% which includes men > 50, women > 60 with at least one major risk factor: fan history of CVD, htn, smoking, syslpidemia, or albuminuria
32
how often should patients receive a urine test for albumin?
once every year starting at the time of diagnosis for ppl with dm 2. for ppl with DM1 starting with 5 years after diagnosis
33
define microalbuminuria?
if protein found in urine is 30-299 mg/day
34
what defines macroalbuniuria?
urnie protein level > 300mg/day
35
how often should a comprehensive eye esame be performed?
once a year. Longer intervals of 2-3 years ok if if patin has had normal eye exams and is well contorlled
36
how often should diabetics get a foot exam?
once a year
37
how often should diabetics inspect their feet?
once daily
38
foot care for diabetics
look for any new changes
clean feet and dry, apply lotion sparingly, not between the toes, trim nails carefully
don't walk barefoot
wear proper fitting comfortable shoes
39
which vaccines should diabetics receive? and how often
influenza every year
pneumococcal: every patient > 2yo one time. Repeat the vaccination if patient is 65 or older and their first vaccination was more than 5 years ago.
hepatitis B in patients 19-59 years of age
40
for how long do you try each agent in order to try adding another one?
3 motnhs.
41
MOA of metformin
decreasing hepatic glucose production primarily
| also knone to decrease intestnal absorption of glucose and improve insulin sensitivity
42
brand metformin
Glucophage, fortamet, glumetza
43
available metformin strengths
500, 850, 1000
| ER: 500, 750, 1000
44
max daily dose of metformin allowed?
2550mg (850 TID)
45
Combo brand with met + glyburide?
Glucovance
46
combo brand with sitagliptin?
janumet
47
what dose start for metformin
IR : 500mg po daily to BID or 850 mg daily
| ER: 500 - 1000mg with dinner
48
what is the black box warning for metformin?
can cause lactic acidosis
49
what is lactic acidosis? symptoms?
```
having an acidic ph in the blood with a buildup of lactate
Sx: muscle soreness
hyperventilation
abdominal pain
lethargy
slow heart rate
```
50
when is metformin contraindicated?
in males Scr > 1.5mg/dl or >1.4 females
if Clcr < 60ml/min
if metabolic acidosis
stop if patient in a state of hypoxia, such as resp failure, sepsis, decompsated heart failure
51
metformin side effects
NVD
flatulence
long term vit b12 deficiency
52
advantages of metformin
weight neutral
| no hypoglycemia!
53
labs to monitor for metformin
A1c
SCR
BUN
FBG
54
what category for pregnancy for metformin
B
55
what should you do if a patient is going to get IV contrast dye and is on metformin?
hold the met prior to dose, and wait 48hrs after procedure to take the next dose
56
what two agents taken with metformin have drug interacitions?what is the interaction
alcohol and iodinated contrast dyes increase the risk of lactic acidosis
57
patient counseling for metformin
take with meals (morning and evening). for once daily take with evening meal
GI sx: N/V/D abd discomfort
58
MOA of Sulfonylureas?
stimulate insulin secretion from beta cells
59
chlorpropamide brand name
diabinese
60
glipizide brand name
glucotrol
61
glimepiride brand
amaryl
62
glyburide brand
DiaBeta
63
max glipizide per day
20 mg
64
normal dose of glipizide
IR 5-10mg bid
| XL 2.5-10 po daily
65
normal dose of glyburide
1.25-5mg daily
66
max glyfuride dose
20mg/day
67
side effects of sulfonylureas
hypoglycemia
| weight gain
68
monoitoring for SUs
FBG, A1C
69
what not used the first generation SUs?
they cause long-lasting hypoglycemia
70
what is the pregnancy category for SUs
C
71
how does renal funciton affect glyburide?
it has an active metabolite that is renally cleared. IT accumlates if dysfunciton so doent use in pateints with CrCl < 50ml/min
72
should glyburide be used in the elderly population?
no because it has an increased risk of hypoglycemia
73
what time of the day to take sulfonyl ureas?
if once daily: with BF
| if twice daily: with
74
which bile acid binding resing can lower blood glucose ?
welchol
75
dosing for welchol
6 tabs po daily with meal and liquid
3 tabs po bid with meal and liquid
3.75 g packed daily
1.875g bid dissolved in water
76
how much does the welchol lower A1C?
0.5%
77
common side effects of welchol?
constipation
dyspepsia
nausea
abdominal pain
78
pregnancy category of welchol?
B
79
which medications should be taken 4 hours before welchol?
```
levothyroxine
glyburide
cyclosporine
oral contraceptives
take welchold 4-6 hours before niaspan
```
80
what is the MOA of bromocriptine to lower BG?
dopamine agaonist and works in the CNS to decrease insulin resistance
81
can a pregnant women use bromocriptine?
yes preg category B but contrainidicated if she is nursing
82
which is the only insulin that does not have a concentration of 100Units/ml?
Humulin R has U-500 or 500Units/ml
83
name the three rapid acting insulins?
Aspart (Novolog)
Lispro (Humalog)
glulisine (Apidra)
84
when should someone inject themselves with rapid acting insulins?
inject up to 15 min prior to eating or may inject immediately after a meal
85
what are the names of the regular insulin?
humulin R
| Novolin R
86
when should you inject the regular insulin?
30 minutes before a meal but not after a meal due to risk of hypoglycemia
87
duration of action of reuglar insulin?
4-6 hours
88
Name of NPH insulins?
Humulin N
| Novolin N
89
what is the onset of action of NPH?
1-2 hours
90
what is the duration of action of NPH?
8-12 hours Up to 24 hours
91
what are the names of hte long-acting or basal insulins?
```
insulin detemir (Levemir)
insulin glargine (lantus)
```
92
how often per day to dose NPH?
once or twice daily
93
how often to dose long acting insulins?
once or twice daily
94
how long is the onset of detemir vs glargine?
detemir is 4 hours
| glargine is 2 hour
95
duration of rapid acting insulins?
3-5 hours
96
what is the starting dose for a patient with type 1 diabetes?
0.6 units/ kg/day which is the TDD
97
if using basal-bolus insulin combination ofr type 1 diabetes, how do you divide up the insulin?
50% of the TDD is the basal
| 50% is the bolus insulin (which again is divided TID for each meal)
98
if using NPH-Regular insulin combination ofr type 1 diabetes, how do you divide up the insulin?
2/3 of TDD is NPH
| 1/3 is the regular insulin (which is usually dosed BID
99
what is the rule of 500 and how do you use it?
is the rule that allows patients to calculate how many grams of carbs are covered by 1 unit of insulin
Equation-- 500/TDD = grams of carbs covered by one unit of insulin
100
correction factor 1800 rule
1800/TDD = correction factor
101
Corrrection dose:
(Blood glucose now- Target blood glucose) / correction factor = correction dose
102
what is the starting dose of insulin for long acting or NPH insulin for type 2 diabetes?
10 units QHS
| or 0.2 U /kg
103
what do you if a patient is getting hypoglyecemic episodes wit htheir isnulin or is getting a FPG of < 70?
reduce bedtime dose by 4 units or 10% whichever is greater
104
what is the target range for blood glucose for patients?
70-130 mg/dl
105
what is the target A1C?
< or = to 7%
106
by how much do u increase the insulin when not at BG?
can increase by 2 units about ~ 3 days utlnil FPG are at target range.
107
when do you check again if the A1C is at goal?
in 2-3 months
108
insulin administration teaching
1. wash hands and lay out supplies
2. check insulin for any discoloration, crystals or lumps
3. clean skin site of injection and wipe top of insulin vila with alcohol swab
4. Inject equal volume of air into vial that is going to be taken out to avoid negative pressure. Avoid bubbles in syringe
5. Inject in abdomen at least 1 inch away from navel. Rotate injection site.
109
why rotate injection site of insulin administration?
avoid inflammation and atrophy
110
what other areas can you inject the insulin?
the lateral thighs and the posterior upper arm
111
whats the goal A1C in gestational diabetes?
<6%
112
what are the goal BG for gestational dm
pre prandial < 140
| 2 hours after eating <120
113
what constitutes 15 g of rapidly absorbed carbs?
```
1/2 cup of juice or soda
1 cup of milk
1 tablespoon of sugar or honey
2 tables spoons of raisns
4-5 saltine crachkers
3-4 glucose tabs
```
114
what is the dose for an unconscious patient with hypoglycemia?
glucagon 1mg SC, IM or IV
115
symptoms of DKA
hyperglycemia, polyuria, polyphagia, polydypsia, blurred vision
metabolic acidosis (fruity breath, dyspnea) and dehydration
116
DKA lab abnormaltiels
```
Glucose >300
ketones in urine and lbood
pH, 7.2,
HCO3 <15meq/l
WBC 15-40 cells /mm3
```
117
what is the treatment for DKA?
IV fluids and insulin and electroltes
Usually given Normal Saline, then 1/2 NS then correcting potassium
118
what does insulin do to potassium levels?
drives the potassium into the cell
119
MOA of meglitinites?
stimulate insulin secretion
120
side effects of meglitinites?
hypoglycemia
weight gain
URTI
121
which is more effective prandin or starlix?
prandin is slightly more effective than starlix
122
pregancy category for meglitindes
C
123
what medications can be used in pregnant women for BG control?
insulin (NPH and regular are FDA approved but others are used too)
Metformin :)
GLyburide (but not in the first trimester)
124
what tow atnibitoic types can cause hypoglycemia?
FQs
| SMX/TMP
125
how do you take meglintinides
15-30 min before meals. If you skip a meal, skip your dose
126
symptoms of hypoglycemia
```
hunger
shakinees
irritability
headache
sweaty
confusion
fast heartbeat
```
127
MOA of TZDs
increase insulin sensitivity
128
by how much does each drug class lower A1C?
```
metformin 1-2%
SU- 1-2%
Meglitinides 0.5-1.5%
TZDs 0.5-1.4%
Alphaglucosidase 0.5-0.8%
DPP4= 0.5-0.8%
GLP-1= 0.5-1%
```
129
pioglitazone strengths
15, 30, 45 mg (max ) once daily
130
bbw for actos?
Can excacerbate HF NYHA class 3/4
131
SE of pioglitazone
```
peripheral edema
WT gain
CHF
increase fracture risk
increase risk of bladder cancer if used for longer than 1 year
```
132
preganancy category pioglitazone?
C
133
how long does ti take to lower blood glucose with TZDs
several weekas
134
MOA of Alpha glucosidase inhibitors
inhibits alpha glucosidase inhibitorswhic leads to delayed absorpiton of glucose
135
how do you take the alpha glucosidase inihbitors (carbose dosing)
start at 25mg wti first bite of each meal. Increase by 25 mg every 1-2 months (max 300mg/day ) divided dose
must take with food and wit hfull glass of water
136
side effects of acarbose?
flatulence
diearrhea
abdominal pain
contraindicated in IBD , colonic ulceration or complete bowerl obstruction
137
advantages of acarbose?
increase HDL, dec TG, dec TC
weight neutral
Pregnancy category B
138
how often do you check LFTs with acarbose?
q 3 montht in the first year
139
does flatulence stay with acarbose?
goes away with time
140
MOA of DPP 4 inhibitors
inhibits dPP4 enzymes which mormall break down increntin hormones. As a result, there are more incretin hormones and this leads to increase insulin secretion, decreases glucagon secretion, decrease hepatic glucose production
141
advantages of sitagliptin
pregnancy category B
| weight neutral
142
januvia dose
100mg po qd if clcr <30ml/min use 25mg po qd
143
Side effects of januvia?
p
144
symptoms of pancreatitis
severe stomach pain that does not go away +/- vomiting
145
when should you take januvia?
in the morning plus or minus food
146
MOA GLP-1 Agonists
```
analogs of GLP-1
increase insulin secretion
decrease gluacong secreation
slow gastric emptying
increase satiety
can have weight loss!
```
147
brand name exenatide?
byetta or bydureon
148
what is the brand name for liraglutide?
victoza
149
where do you inject exenatide?
abdomin, SC, count to five
150
how long is exenatide stable at room temperature?
30 days
151
which patients are at risk for pancreatitis with exenatide?
history of pancreatitis
alcoholism
high triglycerides
gallstones
152
when should you avoid exenatide?
clCr<30 ml/min
| pancreatitis risk
153
exenatide pregnancy category
C
154
SE exenatide?
*Nausea
V/D
hypoglycemia
weight loss
155
when to take byetta?
twice daily QAM and QPM, 30-60 min before meals
156
stroage of exenatide?
room temperature after fisrt use at 25 degrees C but not more
dont freeze and protect from light
remove needles when storing to avoid air bubbles in pen`
157
what to do about the nausea caused by byetta?
consume adequate liquids if vomiting
| decreases with time
158
MOA of pramlintide?
synthetic analog of amylin. Amylin slows gastric emptying prevents glucagon increase after a meal, increases satiety
159
BBW of pramlintide?
if co administered with insulin , can lead to severe hypoglycemia
160
when how to take pramlintide?
inject in the abdomen prior to meals
161
main SEs of pramlintide?
hypoglycemia*
Nausea
anorexia
162
if you are taking pramlintide and insulin, how do you adjust the dose?
decrease the insulin dose by 50% of the rapid acting, short acting and mixed insulins
163
what is the ADA definition of PRE diabetes?
FPG between 100 but < 126 or A1C from 5.7 to 6.4 %
164
how can pre-diabetics prevent or delay diabetes?
> 150minutes exercise per week with healthy eating
if above IBW , goal is to lose 5% weight
adding metformin is optional
165
what does the ADA define as impaired glucsoe tolerance?
level of 140-199 mg /dl from 1-2 hours post 75g OGTT
166
if a person has gestational diabetes, when should they be screened for diabetes?
6 weeks after delivery and then at least annually after that
167
what screening tests are good for diabetes and prediabetes?
FPG after 8 hour fasting
| A1C is acceptable as an alternative
168
who should receive aspirin therapy?
type 2 diabetics with > 20% 10 year risk for CVD and may prescribe if 10-20% 10 year risk
169
where do you calculate the 10 year risk?
2009 ADA guideline criteria
170
how does the ADA define Pre-diabetes?
FBG between 100 and 126 or A1c between 5.7 and 6.4%
171
what does the ADA define as Diabetes?
FBG > 126 or a1c >= 6.5%
172
which diabetics should receive ASA therapy?
if > 20% 10 year risk for CVD
maybe if risk is 10-20%
not if risk <10
173
how do you prevent or delay the onset of diabetes?
1. physical activty > 150minutes / week and healthy eating storgnly recomommended
2. if you are above your ideal body weight, aim for sutstained body weight loss of 5%
3. Adding metformin is OPTIONAL
174
how often should a women with gestational diabetes be screened for diabetes?
6 weeks after delivery and then annually after that.
175
which population of individuals should be screened annually for diabetes?
patients with HLD > 130 LDL
HTN
Pre diabetes
history of gestational diabetes or a baby >9lbs
176
who should be screened every 5 years?
1. if you are 45 years or older
2. if you are < 45 and BMI > 25 with addional risk factors: physical inactivity, first-degree relative with diabetes, high risk ethnic population, HDK < 35 or tG> 250, PCOS,
177
which diabetics should receive ASA therapy?
if > 20% 10 year risk for CVD
maybe if risk is 10-20%
not if risk <10
178
when mixing insulins which goes first?
clear before cloudy (alphabetical)
179
whats the typical starting dose for type 1 diabetes patietns
0.6 U/kg/day (total daily dose)= TDD
| 50% basal dose, 50% mealtime (divided each by 3)
180
rule of 500 for Insulin to Carb Ration
500/ TDD = grams of carbohydrate covered by 1 Unit of insulin
181
1800 rule to find correction factor
1800/tdd = correction factor
182
correction dose w/ 1800 rule
(BG now- target BG )/correction factor = correction dose
