Brainscape's Knowledge GenomeTM

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


See full index

OSCE Study Guide > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

A1C

A

<7.0%

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

Preprandial capillary plasma glucose

A

80-130 mg/dL

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

Peak postprandial capillary plasma glucose

A

Postprandial glucose measurements should be made 1–2 hours after the beginning of the meal
<180 mg/dL

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

ABC-KEN-DIPS

A 
Aspirin if indicated
Blood pressure control
Cholesterol control
Kidneys –screen Scr and urine albumin excretion (UAE) / microalbumin:creatinine ratio
Eyes- dilated eye exam
Nerves-test for loss of sensation, bowel changes, balance issues, erectile dysfunction
Dental
Immunization
Psychological care
Smoking cessation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Some pt edu

A

Food intake
Focus on carbohydrates for glycemic management
Typically stay between 3-4 carbohydrate choices or 45-60 grams of carbohydrate per meal
Eat 3 meals or 5 smaller meals throughout day
If numeracy skills are low, consider plate method

Consider other dx states with medical nutritional therapy
Salt (2300mg/day max)and cholesterol to manage BP
and lipids
Caloric intake for weight management

150 min of moderate-intensity spread over at least 3 days and no more than 2 consecutive days without

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

If A1c > 9%

A

Consider dual therapy

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

If A1c > 10%

A

Consider combo inj therapy

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

Metformin

A

GI adverse events
Minimized with weekly titration
500mg po with largest meal and titrate by one tablet weekly if GI symptoms tolerable to target of 2000mg

Discontinue metformin if the patient’s eGFR later falls below 30 mL/minute/1.73 m2.

Upset stomach, gas, bloating, diarrhea but subsides with time. Take with food.

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

SU drugs and dosag3

A

Glipizide: 5mg-20mg* BID

Glimepiride: 1-8mg daily

Glyburide: 2.5-20mg daily
(divide BID if >10mg daily)

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

Meglinitide drugs and dosing

A

Nateglinide: 60-120mg TID AC

Repaglinide: 0.5-4mg TID AC

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

SU and GLN

A

Weight gain and Hypoglycemia
Esp: Glyburide-not for elderly
Eat 3 meals + snacks –> IMPORTANT because hypo risk
Watch for signs of low blood sugar. Educate on rule of 15.

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

Rule of 15

A

If feel weird, nervous, shaky, moody, sweating, chill, irritable, impatient, confused

Test BG

If BG < 70mg/dL: take 15-20g of Carb
_ 3,4 glucose tablet
_ 4 ounces ( or 1/2 a cup) juice or soda

Recheck in 15 mins to make sure BG > 70mg/dL

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

TZD side effects

A

Low risk of hypo
Weight gain, edema, HF, fracture

Watch for shortness of breath, lower leg swelling, weight gain. Takes 2-3 months to see full impact.

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

DPP-4 drugs and dosage

A

Januvia (sitagliptin): (25-100mg) 30-49 ml/min = 50mg
< 30ml/min = 25mg

Onglyza (saxagliptin): (2.5-5mg) (<50 ml/min = 2.5mg

Tradjenta (linagliptin): (5mg)

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

DPP-4

A

Weight neutral

POST-PRANDIAL glucose

NO titration necessary. Start at dose appropriate for renal clearance. EASY!!

AE: rare, joint pain, pancreatitis
Watch for severe nausea, vomiting and call PCP. May cause joint pain.

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

SGLT-2

A

Work at kidney: Block sodium reabsorption, block glucose reabsorption

AE:
Genital mycotic infections
UTIs
Hypotension
Hypoglycemia w/ insulin or secretagogues
Renal impairment
DKA
Increased fractures
Decreased HF and CV benefits*

Watch for vaginal infections or difficulty/painful urination.

17
Q

Invokana

A

SGLT-2

Canagliflozin: 100mg to 300mg. CrCl Cutoff <45mL/min. 100mg dose for those 45-60mL/min

18
Q

Farxiga

A

SGLT-2
dapagliflozin: 5mg-10mg
CrCl Cutoff <60mL/min

19
Q

Jardiance

A

10mg-25mg
Empagliflozin:
CrCl Cutoff <45mL/min

20
Q

GLP-1 AE

A

GLP-1 don’t go with DPP-4

Nausea: 
Injection site rxn
Pancreatitis
Renal: No dose adjustment
Black Box-Thyroid-C cell tumors

Nausea, diarrhea, vomiting may occur but subsides over time. Provide injection education. Injection site may be sore (nodule with Bydureon likely). If difficulty swallowing, call PCP.

21
Q

Trulicity

A

GLP-1
Dulaglutide
0.75mg SC, with or without meals, once weekly. Dose can be
increased to 1.5 mg once weekly.

22
Q

Initiate basal insulin

A

10 U/day or 0.1-0.2 U/kg/day

10-15% or 2-4 U once or twice weekly

23
Q

If basal alone does not work

A

Add GLP-1 RA
OR
Add bolus

24
Q

Add 1 bolus ins inj before largest meal

A

Start 4 units, 0.1 u/kg/day, or 10% basal

Dose increases 10-15% once or twice weekly until reach target

25
Q

Type 2 After TRIPLE Therapy for 3 months with Continued Elevated A1C

A

Continue metformin unless contraindicated

Consider cost of the triple therapy and addition of another agent (bolus or GLP-1)

Typically the DPP4, TZD, SGLT2 are stopped if GLP-1 or bolus is being added to basal

Lower dose of TZD or stop with insulin addition

Stop SU if adding mealtime insulin

Stop DPP4 if starting GLP-1

26
Q

Ins edu in type 2

A

Watch for signs of low blood sugar. Educate on rule of 15. Provide injection education. For new starts, call in 3 days. Call if 2 unexplained lows.

A1c-3 months**
fingersticks-daily 7x daily depending on regimen. For titration, call weekly for glucoses

27
Q

Type 2 Diabetes f/u

A

A1c in 3 months

Fingerstix: daily to 3x weekly

28
Q

Ins in type 1

A

No upper limit of glucose lowering

Flexibility to tailor insulin doses to meet the individual patient’s needs
Activity changes
Eating changes
Stress changes

Hypoglycemia and weight gain primary AEs

Reminder to rotate sites of injection

Inquire on where these are and LOOK at the tissue

Reminder to emphasize appropriate use of syringe/device

Storage and Expiration dates for in-use vials/pens

Length of needle is getting smaller and smaller
Adults-8mm longest recommended regardless of body habitus

29
Q

How to calculate start dose for ins

A

0.5 - 0.6 units/kg/day

50% basal and 50% bolus

30
Q

When to start ins?

A

A1C >10% or glucoses >300mg/dL-start insulin

Consider using similar weight based dosing as in type 1 (0.5-0.6 units/kg/day)

31
Q

Long-acting insulin

A

Glargine (Lantus)

Detemir (Levemir)

32
Q

Rapid-acting insulin

A

Lispro (Humalog)
Aspart (Novolog)
Glulisine (Apidra)

33
Q

Questions to ask pat

A

What numbers are you seeing when you check your sugars? Are these numbers before/after meals? How often a day?

What medication? OTC? dose? taking normally? When do u take it? extra or missed dose?
Notice any SE?

Notice signs of hypo? cranky, sweating, hunger, confusion, night sweats
Notice sign of hyper? Increase thirst, headache, fatigue, wt loss

Any change in diet?

Any changes in activity level?

Tobacco? Alcohol?

34
Q

Pt edu if type 2 w/o ins

A

PT Edu:
SE of drugs

Rule of 15
May need glucagon (1mg IM/SQ for >20kg pt)

Fingerstix technique? frequency: daily to 3,4x QW. When? Record

Healthy diet + snack to prevent hypo, keep a food log

150min moderate intensity exercise QW

Check their feet regularly

Dental and eyes exam

Lab: A1c in 3 months, baseline eGFR and annually, LFT 6-12 months

35
Q

Pt edu if type 1 or type 2 w ins

A

PT Edu:
SE of drugs

Rule of 15
May need glucagon (1mg IM/SQ for >20kg pt)

Fingerstix technique? frequency: 4x/day, before breakfast, lunch and dinner and HS. Keep record

Injection technique, DO NOT REUSE SYRINGE

Healthy diet + snack to prevent hypo, keep a food log

150min moderate intensity exercise QW

Check their feet regularly

Dental and eyes exam

CHECK BACK OR F/U IN 1 WEEK FOR TITRATION

Lab: A1c in 3 months, baseline eGFR and annually, LFT 6-12 months

36
Q

Factors when picking diabetic drugs

A 
Cost
Weight issue
Hypo risk
AE
Needle phobia

OSCE Study Guide (6 decks)

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