Diabetes Mellitus (Therapeutics) Flashcards
(30 cards)
Which of the following statements is true?
A. Goal of fasting glucose is 70-130 mg/dL
B. Goal of HgA1c is individualized, but in general should be
(D) A & B only are true
C - Goal BP for a diabetic patient is 140/80, not 140/90
All of the following statements are true, except?
A. If you are screening a patient for diabetes, that patient is asymptomatic
B. You should perform a foot exam at every diabetes visit
C. The LDL goal for a diabetic who had an MI would be
(C) The LDL goal for a diabetic patient who had an MI would be
How often should you perform a HgA1c test for a diabetic patient?
every 3-6 months
What is the goal lipid profile for a diabetic patient (LDL, TG, HDL)?
LDL < 100
TG < 150
HDL > 50
All of the following statements are true, except?
A. Diet and exercise is a therapy and Tx for diabetes
B. Nearly all carbohydrates enter the bloodstream as glucose
C. Sucrose does not increase hyperglycemia to a great extent
D. It is not necessary for a diabetic to inspect their feet after every time they exercise
E. Diabetic patients should get 30 min of exercise 3-4 times per week if they’re able
(D) - It IS NECESSARY for a diabetic to inspect their feet after every time they exercise
C - this is a correct statement according to DM therapeutic lecture -slide #3
Give the brand name of the following insulins and categorize it as rapid, short, or long acting:
Glargine Glulisine Regular NPH Detemir Lispro Aspart
Glargine (Lantus ®) Long Glulisine (Apidra ®) Rapid Regular (Humulin R ®, Novolin R ®) Short NPH (Humulin N ®, Novolin N ®) Long Detemir (Levemir ®) Long Lispro (Humalog ®) Short Aspart (Novolog ®) Short
Which insulins are available OTC?
Regular (Humulin R ®, Novolin R ®)
NPH (Humulin N ®, Novolin N ®)
Which insulin is the most concentrated with 500 units/ml? Is this OTC or Rx?
Humulin R ®
This is Rx only!
All of the following are matched correctly, except?
A. Glulisine: Apidra B. Lantus: Humalog C. Detemir: Levemir D. Novolog: Aspart E. NPH: Humulin N
(B) Lantus ® : Glargine
Humalog ® : Lispro
All of the following are advantages of rapid acting insulins compared to regular insulin, except?
A. Can be injected with the first bite of the meal
B. Less likely to cause hypoglycemia b/c duration of action is more consistent with digestion time
C. Comes in a 10ml vial
D. A & B only
E. All of the above
(D) A & B only
Which of the following insulins is a cloudy suspension?
A. NPH B. Glargine C. Levemir D. A & B E. A only
(E) A only - NPH is the only cloudy suspension. ALl other insulins are clear solutions
This long-acting insulin forms a depot underneath the skin (micro-precipitates) b/c of pKa and pH and releases insulin consistently over 24 hours?
Glargine (Lantus ®)
All of the following statements are true, except?
A. About 50% of insulin is cleared by the kidneys
B. Rapid insulin can be mixed with NPH in the same syringe
C. Regular insulin can be mixed with NPH in the same syringe
D. Glargine and Detemir can be mixed with NPH in the same syringe
E. C & D
(D) Glargine and Detemir CANNOT be mixed with NPH in the same syringe. They must be given SQ by themselves
Which of the following statements is true?
A. One insulin injection is usually sufficient for a type 1 DM patient
B. Primary complication outcome of the DCCT trial was nephropathy
C. DCCT trial showed that intensive Tx (inject 4x/day) had a 2-3x higher risk of hypoglycemic episodes compared with conventional Tx (inject 2x/day)
D. HgA1c goal of
(E) C & D are both correct
A - Type 1 DM patients require multiple injection daily (at least 2) to mimic normal insulin release from pancreas.
B - The primary complication outcome of the DCCT trial was retinopathy
Which of the following statements is false?
A. When a type 1 DM patient is feeling ill, they will require a larger dose of insulin than normal
B. Treat-to-Target algorithm insulin dosing for a type 2 diabetic patient starts with 10 units of a long acting insulin given HS
C. Insulin administered IV has a faster onset than insulin administered IM or SQ
D. SQ injection of insulin has a shorter DOA than insulin administered IV
E. Renal failure decreases insulin clearance
(D) SQ injection of insulin has a LONGER DOA than insulin administered IV
Onset of action rapid and DOA shorter for…
IV > IM > SQ
B - Glargine (Lantus ®), Detemir (Levemir ®), and NPH (Humulin N ®, Novolin N ®) are all options here
When should insulin be added to a type 2 diabetic’s regimen?
When oral meds aren’t working that well.
Note that patient continues to take oral meds in addition to the insulin
What is the initial dose of insulin for a type 1 DM patient? What is the dose for the “honeymoon phase?”
Type 1 initial insulin dose 0.5-0.6 Units/kg (use actual body weight)
Type 1 “honeymoon phase” dose 0.1-0.4 Units/kg (use actual body weight)
How would you change the dose of insulin for a type 2 DM patient with a FPG diary that reads…
Today: 150 Yesterday: 142 2 days ago: 155 3 days ago: 159 4 days ago: 144
Based on the TTT (treat-to-target):
Take the average FPG of the preceding 2 days [(150 + 142)/2] = 146
Algorithm suggests to increase dose of insulin by 6 units per day
Mean FPG Increase insulin dose (units/day) > 180 mg/dL 8 140-180 6 120-140 4 100-120 2
Which of the following statements regarding a DM patient is false?
A. Patients who are sick with N/V should continue taking basic dose of insulin
B. Smoking decreases absorption of insulin
C. It is important to test urine for ketones when patient is sick
D. B & C
E. None of the above
(E) None of the above
A - When a patient gets sick, BS can rise very quickly so patient must continue taking basic dose of insulin and monitor BS frequently. If indicated, give supplemental dose of insulin (for every 50 mg/dL above normal BS - give 1-2 units of rapid)
What are the (3) AE of injecting insulin?
- hypoglycemia
- weight gain
- injection site reaction
All of the following are appropriate courses of action if a patient finds themselves with BS
(E) A & C only
B - patient is unconscious so they can’t eat. Hypoglycemic patients that are still conscious should be advised to eat between 10 - 25g of carbohydrates
D - D5W does not have enough sugar to raptly rise from dangerous levels
Which of the following medications is indicated for both type 1 and type 2 DM?
A. Metformin B. Symlin ® C. Starlix ® D. Miglitol E. Both B & D
(B) Symlin ® (Pramlintide), an amylin analogue, is indicated as an adjunct to Tx with mealtime insulin for both type 1 and type 2 DM patients
All others are indicated for type 2 DM
Metformin (Glucophage ®)
Nateglinide (Starlix ®)
Miglitol (Glyset ®)
All of the following medications have NO EFFECT on insulin secretion, except?
A. Glipizide B. Pioglitazone C. Avandia ® D. Repaglinide E. Both A & D
(E) Both A & D
Glipizide (Glucotrol ®) and Repaglinide (Prandin ®) both increase B-cell secretion of insulin.
Glipizide (Glucotrol ®) is a Sulfonylurea
Repaglinide (Prandin ®) is a Meglitinide
Which of the following medications would NOT require a dose adjustment in the treatment of a type 2 DM patient with renal insufficiency?
A. Invokana ® B. Sitagliptin C. Byetta ® D. Victoza ® E. Onglyza ®
(D) Liraglutide (Victoza ®) does NOT require any dosage adjustment in renal impairment
A - Canagliflozin (Invokana ®)
CrCl 45-60 ml/min: 100mg po once daily
CrCl
