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PBL PY2 Fall > Diabetes Type 2 Therapeutics > Flashcards

Diabetes Type 2 Therapeutics Flashcards

1
Q

prediabetes involves impaired ____ and or impaired ___

A

fasting glucose (IFG); glucose tolerance (IGT)

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2
Q

t/f prediabetes puts you at higher risk for developing Type 2 diabetes

A

t

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3
Q

what is impaired fasting glucose?

A

elevated fasting blood glucose but normal post-meal levels

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4
Q

what is impaired glucose tolerance?

A

elevated post-meal glucose but normal fasting glucose

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5
Q

what FPG give a prediabetes diagnosis?

A

6.1-6.9 mmol/L (IFG)

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6
Q

what 2hPG after a 75g OGTT would give a diagnosis of prediabetes?

A

7.8-11.0 mmol/L (IGT)

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7
Q

what A1C would give a diagnosis of prediabetes?

A

6.0-6.4%

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8
Q

what is the goal of therapy for prediabetes?

A

to prevent or delay the progression to type 2 diabetes

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9
Q

what is used to manage prediabetes?

A
  1. intensive lifestyle modifications

2. medications may be considered

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10
Q

what medications and doses may be used in prediabetes?

A
  1. metformin 250-850mg BID
  2. orlistat 120mg TID
  3. acarbose 100mg TID
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11
Q

women are typically screened for gestational diabetes between weeks ___ and ___ of pregnancy

A

24 and 28; if other clinical factors, they may be screened sooner

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12
Q

how is gestational diabetes screened for?

A

usually a 50g OGTT with a 1 hour post glucose reading and then may do a 75g test depending on the result

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13
Q

how is gestational diabetes managed?

A

can sometimes be managed with diet, but usually requires insulin (most data with NPH, but long-acting also appears safe)

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14
Q

what is the FBG target for gestational diabetes?

A

<5.3 mmol/L

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15
Q

what is the target 1 hr post meal glucose in gestational diabetes?

A

<7.8 mmol/L

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16
Q

what is the target 2 hr post meal glucose for gestational diabetes?

A

<6.7 mmol?l

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17
Q

what is the diabetes diagnostic value for FPG?

A

7.0 mmol/L or greater

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18
Q

what is the diabetes diagnostic value for A1C?

A

6.5% or greater in adults

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19
Q

what is the diabetes diagnostic value for 2hPG in a 75g OGTT?

A

11.1 mmol/L or more

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20
Q

what is the diabetes diagnostic value for random PG?

A

11.1mmol/L or more

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21
Q

if a patient has one test value in diabetic range, but is asymptomatic, what do you do?

A

repeat the test on another day

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22
Q

what is the simplified pathology of Type 2 diabetes?

A

insulin resistance and Beta cell dysfunction

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23
Q

t/f in type 2 diabetes, the symptoms can be mild or even absent

A

t

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24
Q

t/f obesity is common in type 2 diabetes

A

t

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25
Q

in a hyperosmolar hyperglycemic state (HHS), there may be enough insulin to prevent ____, but not enough to prevent ___ or allow ____

A

lipolysis; gluconeogenesis; glucose uptake into tissues

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26
Q

there is typically an underlying cause to HHS, what is an example of an underlying cause?

A

infection

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27
Q

what are the symptoms of HHS?

A

volume depletion, dehydration, decreased GFR, electrolyte depletion

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28
Q

are ketones present in HHS?

A

may be minimal, or no ketones present

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29
Q

is there usually acidosis involved in HHS?

A

no

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30
Q

what is the typical target A1c for patients with type 1 and type 2 diabetes

A

7.0 or less

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31
Q

what is the A1c target of patients with type 2 to reduce risk of CKD and retinopathy if patient is at low risk for hypoglycemia?

A

6.5% or less

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32
Q

what is the goal A1c for patients who are functionally dependent?

A

7.1-8.0

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33
Q

what is teh goal A1c for patients with recurrent severe hypoglycemia and or hypoglycemia unawareness?

A

7.1-8.5%

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34
Q

what is the A1c target for patients with limited life-expectancy?

A

7.1-8.5%

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35
Q

what is the target A1c for patients who are frail, elderly or who have dementia?

A

7.1-8.5%

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36
Q

you should not target an A1c higher than ___

A

8.5

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37
Q

what is the target pre-meal FPG?

A

4.0-7.0

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38
Q

what is the target 2hr post-meal BG?

A

5.0-10.0 (5-8 if A1c targets not met)

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39
Q

what is the goal LDL?

A

2.0 mmol/L or less

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40
Q

what is the goal blood pressure?

A

<130/80 mmHg

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41
Q

what are the ABCDESSS of diabetes care?

A
  1. A1c targets
  2. BP targets
  3. cholesterol drugs
  4. drugs for CVD risk reduction
  5. exercise goals & healthy eating
  6. screening for complications
  7. smoking cessation
  8. self-management, stress
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42
Q

what medications make up the SADMANS list of medications to be held when sick?

A 
Sulfonylureas
ACE inhibitors 
Diuretics & direct renin inhibitors
Metformin
ARBs
NSAIDs
SGLT2 inhibitors
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43
Q

metformin belongs to what class of drugs?

A

biguanides

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44
Q

what is the name brand of metformin>

A

glucophage

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45
Q

how much does metformin reduce A1c?

A

1.0-1.5%

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46
Q

what is the general MOA of metformin?

A

decrease hepatic glucose production and increase insulin sensitivity

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47
Q

metformin has what effect on lipid levels?

A

positive effects (decrease LDL and TG and increase HDL)

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48
Q

what is the effect of metformin on weight?

A

neutral or loss

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49
Q

what is the risk of hypoglycemia with metformin?

A

rare

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50
Q

aside from diabetes, what is a nother use of metformin?

A

can improve ovulation in PCOS patients

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51
Q

metformin can cause malabsortion of what vitamin?

A

B12

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52
Q

metformin needs to be stopped if patient is getting contrast dye, how soon after can it be restarted?

A

2-3 days

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53
Q

what are the ADRs of metformin?

A

diarrhea and nausea (start low and go slow to avoid)

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54
Q

what is a rare ADR of metformin? Who is most likely to experience?

A

lactic acidosis; patients with renal or liver Dx

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55
Q

when is metformin C/i?

A
  1. renal or liver impairment
  2. alcohol abuse
  3. severe infection or septicemia
  4. shock
  5. hypoxic states
  6. CHF
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56
Q

what is the typical starting dose of metformin?

A

500mg BID

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57
Q

when can the initial effects of metformin be seen? When can we see max effect?

A

3-5 days; 1-2 weeks

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58
Q

special administration instruction for metformin

A

take with food

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59
Q

what is the max daily dose of metformin?

A

2550mg/day

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60
Q

what is the extended release formulation of metformin that can be dosed UID?

A

Glumetza

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61
Q

if a patient has ASCVD and MACE, what are the diabetis drugs of choice?

A

GLP-1 RA or SGLT2 inhibitor s

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62
Q

if a patient has ASCVD and HHF, what is the diabetic drug of choice?

A

SGLT2 inhibitor

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63
Q

if a patient has ASCVD and progression of nephropathy, what is the diabetic drug of choice?

A

SGLT2 inhibitor

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64
Q

is a patient has CKD and MACE, what is the diabetic drug of choice?

A

SGLT2 inhibitor or GLP-1 RA

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65
Q

if patient has CKD and HHF, what is the drug of choice?

A

SGLT2 inhibitor

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66
Q

if a patient has CKD and progression of nephropathy, what is the drug of choice??

A

SGLT2 inhibitor

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67
Q

if a patient has HF and HHF, what is the drug of choice?

A

SGLT2 inhibitors

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68
Q

if a patient is over 60 with CV risk factors and MACE, what is the drug of choice?

A

GLP-1 RA

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69
Q

if a patient is over 60 with CV risk factors and HHF, what is the drug of choice?

A

SGLT2 inhibitor

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70
Q

if a patient is over 60 with CV risk factors and progression of nephropathy, what is the drug of choice?

A

SGLT2 inhobitor (only initiate if eGFR <30mL/min)

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71
Q

give 3 examples of sulphonylurea secretagogues

A

glyburide, gliclazide, glimepiride

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72
Q

what is the name brand of glyburide?

A

Diabets

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73
Q

what is the name brand of gliclazide?

A

Diamicron

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74
Q

what is the name brand of glimerpiride?

A

amaryl

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75
Q

how much do sulphonylureas decrease A1c?

A

1.0-1.5%

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76
Q

what is the general MOA of sulphonylurea secretagogues?

A

increase the insulin secretion from beta cells

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77
Q

what is the risk for hypoglycemia in sulphonylureas

A

higher (no on/off switch, just always trying to squeeze out as much insulin from beta cells as possible)

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78
Q

what is the effect of sulphonylureas on weight

A

weight gain

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79
Q

sulphonylureas may have a small chance of having a cross allergy with what class of medications?

A

sulphonamide

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80
Q

what is the starting dose of glyburide?

A

1.25–2.5mg UID

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81
Q

what is the max dose of glyburide?

A

20mg/day (10mg BID)

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82
Q

how should the glyburide dose by titrated?

A

every 1-2 weeks

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83
Q

t/f glyburide may have more hypoglycemia risk than gliclazide

A

t

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84
Q

gliclazide comes in what 2 formulations?

A
  1. regular release (80mg tabs)

2. modified release tablets (30 or 60mg tablets)

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85
Q

what is the initial dosing of gliclazide?

A

40mg reg release or 30mg modified release

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86
Q

one 80mg regular release tablet = one ___mg MR tablet of gliclazide

A

30

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87
Q

what is the max dose of gliclazide?

A

160mg BID reg release or 120mg MR daily

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88
Q

how should gliclazide be titrated?

A

every 1-2 weeks

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89
Q

gliclazide is safe in what level of renal impairment?

A

mild to moderate

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90
Q

what is the starting dose of glimepiride?

A

1mg daily

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91
Q

what is the max dose of glimepiride?

A

8mg daily

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92
Q

how should glimepiride be titrated?

A

every 1-2 weeks

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93
Q

t/f glimepiride may have lower rates of hypoglycemia compared to gliclazide

A

t

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94
Q

Give an example of a Meglitinide

A

Repaglinide

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95
Q

what is the name brand for repaglinide?

A

Gluconorm

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96
Q

t/f repaglinide has a rapid onset and short half life

A

t

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97
Q

when should repalglinide (special admin instructions)

A

taken shortly before a meal

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98
Q

what do you do with you repaglinide dose if you skip your meal?

A

skip the repaglinide dose

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99
Q

what is the risk of hypoglycemia with repaglinide?

A

associated with less hypoglycemia

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100
Q

what is the effect of repaglinide on weight?

A

associated with less weight gain

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101
Q

what BG reading will repaglinide lower?

A

the postprandial BG

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102
Q

what is the starting dose of repaglinide?

A

0.5mg TID

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103
Q

what is the max dose of repaglinide?

A

4mg QID

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104
Q

how much does repaglinide lower A1c?

A

1.0-1.5%

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105
Q

how should repaglinide be titrated?

A

weekly; slowly in renal and hepatic impairment

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106
Q

repaglinide has a significant interaction with what drug?

A

gemfibrozil

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107
Q

hypoglycemia is a BG reading usually below ____mmol/L

A

4.0

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108
Q

what are the Sx of mild hypoglycemia?

A

tremors, palpitations, sweating, anxiety, tingling, anxiety, nausea, excessive hunger

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109
Q

what are the Sx of moderate hypoglycemia?

A

headache, mood changes, irritability, visual changes, dizziness

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110
Q

what are the Sx of severe hypoglycemia?

A

unresponsive, unconsciousness, seizures, coma

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111
Q

what is the treatment for hypoglycemia?

A

15g of carbs

112
Q

give some examples of 15g of carbs

A 
glucose tabs
3/4 cup of juice or soft drink
6 lifesavers
15ml honey 
15ml or 3 packs of table sugar dissolved in water
113
Q

give 4 examples of DPP-4 inhibitors

A
  1. sitagliptan
  2. saxagliptan
  3. linagliptan
  4. alogliptan
114
Q

brnad name of sitagliptan

A

Januvia

115
Q

Brand name of saxagliptan

A

Onglyza

116
Q

brand name of linagliptan

A

Trajenta

117
Q

brand name of alogliptan

A

Nesina

118
Q

general MOA of DPP-4 inhibitors

A

inhibits the enzyme DPP-4 that causes the degradation of GLP-1

119
Q

how much do DPP-4 inhibitors lower the A1c?

A

by 0.6-1.0%

120
Q

what is the effect of DPP-4 inhibitors on weight?

A

weight neutral

121
Q

what is the risk of hypoglycemia with DPP-4 inhibitors?

A

no risk for hypoglycemia

122
Q

DPP-4 inhibitors effect typically has an oset within ___ weeks, with a max effect at ____ weeks

A

4; 18

123
Q

what are the ADRs of DPP-4 inhibitors?

A

joint pain, muscle pain, muscle spasms, increased risk for HF, concerns about risk of pancreatitis

124
Q

t/f longterm safety data for DPP-4 inhibitors has not been established yet

A

true

125
Q

what is the dose of sitagliptan (Januvia)?

A

100mg UID

126
Q

dose adjustments are required for sitagliptan in what level of renal impx?

A

moderate to severe

127
Q

sitagliptan has fewer ___ interactions than saxagliptan

A

CYP3A4

128
Q

sitagliptan should be avoided in what chronic condition?

A

heart failure

129
Q

what is the dose of saxagliptan (Onglyza)

A

2.5-5.0mg UID

130
Q

what are the ADR of saxagliptan?

A

anemia, increased risk for upper respiratory infections, hypersensitivity rxn

131
Q

saxagliptan has interactions with what CYP enzyme?

A

3A4

132
Q

saxagliptan should be avoided in what chronic condition?

A

heart failure

133
Q

what is the dose of linagliptan (Trajenta)?

A

5mg UID

134
Q

which DPP-4 inhibitor does not require dose adjustment in renal or hepatic impairment?

A

linagliptan

135
Q

linagliptan has interactions with what enzyme/transporter

A

CYP3A4 and PgP

136
Q

Linagliptan should be avoided in what chronic condition?

A

heart failure

137
Q

the A1c decrease from linagliptan will be seen withing ____ weeks

A

4-6

138
Q

what is the dose of alogliptan (Nesina)?

A

6.25-25mg daily

139
Q

what are the ADRs of alogliptan (Nesina)?

A

upper respiratory infections, hypersensitivity reactions

140
Q

what are the drug interactions of alogliptan?

A

minimal CYP3A4

141
Q

what should be especially monitored when on alogliptan?

A

LFTs

142
Q

alogliptan should be avoided in what chronic condition?

A

heart failure

143
Q

what is the MOA of SGLT2 inhibitors in diabetes care?

A

decreases the renal absorption of glucose and decreases the renal threshold for glucose

144
Q

how long does it take for SGLT2 inhibitors to lower A1c?

A

3-6 months

145
Q

what are the ADRs of SGLT2-inhibitors?

A

increased yeast infections, UTI, urinary frequency, increased BUN and SCr, decreased BP, hypovolemia

146
Q

what is the effect of SGLT2 inhibitors on weight?

A

weight loss

147
Q

what is the risk of hypoglycemia of SGLT2 inhibitors?

A

low (only peeing out the extra glucose)

148
Q

how much can SGLT2 inhibitors decrease A1c?

A

0.5-0.8%

149
Q

what factors increase patient risk for experiencing DKA while taking an SGLT2 inhibitor?

A
  1. low carb intake/fasting
  2. acute serious illness
  3. elderly
  4. surgery
  5. decreased insulin dose
  6. type 1 diabetes
  7. excessive alcohol intake
150
Q

what is the starting dose of canagliflozin (invokana)?

A

100mg/day in AM

151
Q

what is the max dose of canagliflozin (invokana)?

A

300mg/day

152
Q

what is the brand name for canagliflozin?

A

invokana

153
Q

what are the drug interactions with canagliflozin?

A

UGT inducers may decrease the effectiveness (rifampin, carbemazepine, phenytoin), can increase digoxin levels

154
Q

the amputation risk with canagliflozin was higher in the ___ trial and neutral in the ____ trial

A

CANVAS; CREDENCE

155
Q

canagliflozin decreases ___ in patients with established CVD or CV risk factors

A

MACE

156
Q

what is the effect of canaglifozin on CKD and HF hospitalizations?

A

benefit in CKD and decrease HF hospitalizations

157
Q

what is the brand name for dapagliflozin?

A

Forixga

158
Q

what is the starting dose of dapaglifozin?

A

5mg daily AM

159
Q

what is the max dose of dapagliflozin (forixga)?

A

10mg/day

160
Q

dapagliflozin is c/i in patients with an eGFR of ____

A

30-45mL/min

161
Q

what is the effect of dapagliflozin on MACE?

A

neutral

162
Q

what is the effect of dapagliflozin on CKD?

A

beneficial

163
Q

what is the effect of dapagliflozin on CV mortality, all cause mortality and HF hospitalization?

A

decrease

164
Q

what is the brand name of empagliflozin?

A

Jardiance

165
Q

what is the dose of empagliflozin?

A

10-25mg daily

166
Q

empagliflozin is C/i when eGFR is less than ___ ml/min

A

30

167
Q

what are the beneficial effects of empagliflozin?

A
  1. decreased mortality
  2. decreased MACE
  3. decreased HF hospitalization
  4. decreased progression of CKD
168
Q

GLP-1 receptor agonists are mostly delivered by what route?

A

injection

169
Q

what is the MOA of GLP-1 RA?

A

binds to GLP-1 receptor resulting in increased insulin secretion

170
Q

GLP-1 RA reduce ___ glucagon release

A

post-meal

171
Q

what is the effect of GLP-1 on gastric emptying?

A

slows, which decreases food intake and lead to weight loss

172
Q

what is the effect of GLP-1 on weight?

A

weight loss of 1.5-4kg

173
Q

how much do GLP-1 lower A1c?

A

by 1-2%

174
Q

what is the risk level for hypoglycemia with GLP-1 RA?

A

no risk

175
Q

GLP-1 are C/i in what patients?

A

Hx or family Hx of medullary thryoid cancer or multiple endocrine neoplasia syndrome type 2 (MENS2)

176
Q

what are the rare ADRs of GLP-1 RAs?

A

gallbladder Dx, retinopathy with semaglutide injectable, possibly pancreatitis

177
Q

what are the common ADRs of GLP-1 RA?

A

GI (esp nausea), decreased appeitie, increased HR and increased PR interval

178
Q

use of GLP-1 should be done with caution in what conditions?

A

gastroparesis and GERD

179
Q

what are 5 GLP-1 RAs?

A
  1. Exenatide
  2. Liraglutide (Victoza)
  3. Semaglutide injectable and PO
  4. Dulaglutide
  5. Lixisenatide
180
Q

what is the dosing of regular release exenatide (Byetta)?

A

initial: 5mcg SQ BID and increase to 10mcg SQ bID after 1 month if tolerated

181
Q

what is the dose of extended exenatide (Bydureon)?

A

2mg once weekly

182
Q

does bydureon require reconstitution?

A

yes

183
Q

exenatide is c/i when eGFR is less than ____ and caution when its less than ____

A

30 ml/min; 50ml/min

184
Q

exenatide is stable at room temp for ___ days

A

30

185
Q

what are the CVD outcomes for exenatide?

A

neutral

186
Q

what is the brand name of liraglutide?

A

victoza

187
Q

what is the initial dose of liraglutide?

A

0.6mg SQ UID

188
Q

what is the max dose of liraglutide?

A

1.8mg SQ UID

189
Q

the dose of liraglutide should be titrated every ____

A

1-2 weeks

190
Q

liraglutide is stable at room temp for ___ days

A

30

191
Q

liraglutide is C/i in patients if eGFR is less than ____

A

15-30mL/min

192
Q

what is the effect of liraglutide in CVD?

A

decrease CVD mortality and decrease MACE

193
Q

what is the brand name of semaglutide?

A

ozempic

194
Q

what is the dsoing of semaglutide?

A

once weekly 0.25mg for 4 weeks then 0.5mg weekly

195
Q

what is the max dosing of semaglutide?

A

1mg SQ weekily

196
Q

semaglutide is c/i in eGFR less than ___

A

30mL/min

197
Q

semaglutide is stable at room temp for ___ days

A

56

198
Q

what are the effects of semaglutide on CVD?

A

decrease MACE in patients with established CVD

199
Q

what is the brand name for the oral semaglutide?

A

Rybelsus

200
Q

what is the dosing of Rybelsus (oral semaglutide)?

A

3mg daily for 30 days then 7mg daily

201
Q

what is the max dose of Rybelsus?

A

14mg daily

202
Q

how should rybelsus (oral semaglutide) be taken?

A

take 30 min AC with <120ml water

203
Q

rybelsus should be used with caution if the eGFR is less than ____

A

30mL/min

204
Q

what is the effect of rybelsus on CVD outcomes?

A

neutral

205
Q

what is the brand name of dulaglutide?

A

Trulicity

206
Q

what is the dose dulaglutide?

A

0.75mg once weekly; max 1.5mg weekly

207
Q

dulaglutide should be used in caution when eGFR is less than ____

A

15 mL/min

208
Q

dulaglutide is stable at room temp for ___ days

A

14

209
Q

what is the effect of dulaglutide on CVD?

A

decrease MACE in patients with established CVD

210
Q

what is the brand name of lixisenatide?

A

Adlyxine

211
Q

what is the dose of lixisenatide (including max dose)?

A

10mcg daily AC then increase to 20mcg daily after 2 or more weeks. Max: 20mcg daily

212
Q

lixisenatide is stable at room temp for __ days

A

14

213
Q

what are the CVD outcomes for lixisenatide?

A

neutral

214
Q

give an example of an alpha-glucosidase inhibitor

A

Acarbose

215
Q

what is teh brand name of acarbose?

A

Glucobay

216
Q

what is the MOA of acarbose?

A

delays digestion of carbs and absorption of glucose in the small intestine

217
Q

what glucose reading does acarbose decrease?

A

post-meal

218
Q

what is the initial dose of acarbose?

A

25mg UID

219
Q

what is the max dose of acarbose?

A

100mg TID

220
Q

what are the A1C lowering effects of acarbose?

A

0.4-0.9%

221
Q

what is the effect of acarbose on weight?

A

neutral

222
Q

what is the risk of hypoglycemia with acarbose?

A

rare

223
Q

what is the impact of acarbose on renal impairment?

A

can be used in mild renal impairment

224
Q

how should acarbose be taken?

A

with the first bite of food

225
Q

how should acarbose be titrated?

A

start low and go slow (titrate every 2-4 weeks)

226
Q

what are some ADRs of acarbose?

A

flatulence and diarrhea

227
Q

when will acarbose reach its max efficiacy?

A

8 weeks

228
Q

if you do get hypoglycemia while on acarbose, what is special about the way it has to be treated?

A

must be treated with pure glucose such as milk, honey or dextrose tabs

229
Q

acarbose is C/i in what conditions?

A

IBD, intestinal ulcers, cirrhosis and severe renal impx

230
Q

what are 2 examples of thiazolidinediones?

A
  1. pioglitazone (Actos)

2. rosiglitazone (Avandia)

231
Q

why are thiazolidinediones not recommended as first line therapy?

A

increased risk for edema, weight gain, CHF, fractures in women and concerns w/ CV outcomes

232
Q

what is the general MOA of thiazolidinediones?

A

increase insulin sensitivity and decrease hepatic glucose production

233
Q

what are the A1C lowering effects of thiazolidinediones?

A

1.0-1.5%

234
Q

what is the rissk of hypoglcemia with TZDs?

A

no risk

235
Q

TZDs start to work after ___ weeks and reach max effects after ____ weeks?

A

2; 6-12

236
Q

in what levels of renal impairment can TZDs be used?

A

mild to severe

237
Q

TZDs cannot be combined with ____

A

insulin

238
Q

aside from diabetes, what is another use for TZDs?

A

may cause ovulation in women w/ PCOS and premenopausal women

239
Q

what specific lab is required when starting a TZD?

A

LFTs

240
Q

what are the initial and max doses of rosiglitazone (Avandia)?

A

initial: 4mg UID
Max: 4mg BID

241
Q

what is the effect of rosiglitazone (Avandia) on lipids?

A

increase LDL and HDL (not ideal for pts with ASCVD)

242
Q

rosiglitazone is c/i in what condition?

A

NYHA classes (all)

243
Q

can rosiglitazone be used as monotherapy?

A

no, it is no longer approved for this

244
Q

is rosiglitazone approved for use in triple therapy?

A

no

245
Q

rosiglitazone has concerns that it may increase the rate of what heart condition?

A

MI

246
Q

what are the initial and max doses of pioglitazone (Actos)?

A

initial: 15mg UID
max: 45mg UID

247
Q

what are the effects of pioglitazone on lipids?

A

increase HDL and decrease TG

248
Q

pioglitazone (Actose) is c/i in what NYHA HF classes?

A

2, 3, 4

249
Q

there are concerns that pioglitazone (Actos) may increase risk for ___ cancer

A

bladder

250
Q

what dose is insulin typically started in type 2?

A

0.1-0.2 u/kg or 10u at bedtime

251
Q

how is the dose of insulin titrated in type 2?

A

adjust by 1-2 units every 2-3 days

252
Q

t/f consistent food intake and physical activity contribute to success in DMT2

A

true

253
Q

when possible, what medication should always be maintained in type 2 diabetes?

A

metformin

254
Q

when starting mealtime insulin, how should the oral meds be adjusted?

A

dose reduced or d/c with the exception of metformin

255
Q

how many times a day should a pregnant person monitor BG?

A

4 or more times a day

256
Q

how many times a day should a patient test their BG if they are starting a new med that is known to cause hyperglycemia (ex; steroids) or experiencing illness?

A

will be individualized, but likely at least 2 or more times/day

257
Q

which SGLT2 have been shown to improve outcomes in patients with HFrEF, even w/o diabetes?

A

dapagliflozin and empaglifozin

258
Q

what HF outcomes were seen in the DAPA-HF trial?

A

dapagliflozin reduced hospitalization and CV death

259
Q

what was shown by the EMPEROR reduced trial?

A

empagliflozin reduced hospitalization

260
Q

diabetes is pregnancy is almost always treated with ___

A

insulin (usually NPH)

261
Q

the diabetes targets in pregnancy are ___ (higher/lower)

A

lower

262
Q

what is the typcal treatment for HHS?

A

IV insulin, fluids and K depending on levels

263
Q

diabetics over 40 years old should be on what cardio med?

A

statin

264
Q

what meal do you typically start with when adding metformin to meals?

A

supper (bc it is usually the largest meal of the day)

265
Q

how often should B12 be checked in metformin patients?

A

yearly

266
Q

patients with what factors make lactic acidosis with metformin more likely?

A

liver or kidney impairment, meal insufficiency, heart failure

267
Q

metformin should be held during what type of diagnostic testing?

A

anything with contrast dye (increases risk for AKi)

268
Q

how much weight is it typical to gain when taking a sulphonylurea?

A

1-2 pounds

269
Q

1 80mg tablet of regular gliclazide is equal to 1 __mg modified release gliclazide tablet

A

30

270
Q

t/f DPP-4 only work in the presence of high BG

A

t

271
Q

which DPP-4 has been associated with poor outcomes in HF and should be avoided in this Dx?

A

saxagliptan

272
Q

why may SGLT2 not be a great option for elderly patients?

A

more risk for dehydration and falls when needing to get up to use the bathroom

273
Q

if SCr goes up by ___%, you should stop SGLT2

A

20-30%

274
Q

how does oral semaglutide need to be taken?

A

30min before any meal and with no more than 120ml of water

275
Q

metformin can be used in renal impairment as long as the eGFR is greater than ___

A

30ml/min

PBL PY2 Fall (21 decks)

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