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Flashcards in DM treatment Deck (55):
1

How to detect facticious hypoglucemia with insulin injections?

−High plasma insulin levels ( greater then 15 U/ml) −Undetectable C-peptide and proinsulin levels* Exception: Renal failure---High C-peptide but low proinsulin

2

How to detect factisious hypoglycemia with sulfonylureas?

−High C-peptide and proinsulin −High sulfonylurea level

3

What is the ADA's HbA1c goal level?

less then 7 perc. **Both groups advocate individualization of targets based on patient characteristics.

4

What is the AACE/ACE HbA1c goal level?

less then 6.5 perc. **Both groups advocate individualization of targets based on patient characteristics.

5

What are the ADA;s 2 goals for vascualr disease prevention?

1. prevent and retard microvascular complications 2. Reduce macrovascular complications

6

What are the 2 ways to Prevent and retard microvascular complications?

Optimal glycemic control Optimal blood pressure control

7

What are the 5 ways to Reduce macrovascular complications?

1. BP less then 130-140/80-90 mm Hg (ACEI, ARB)* 2. Dyslipidemia mgt. 3. Weight loss about 5-10 percent of body weight (type 2); exercise 4. No smoking 5. ASA (age greater then 50 M and F + 1 or more CV risk factors or CVD)

8

how often should a pt with DM have their HbA1c chedcked?

Q 3-6 months

9

how often should a pt with DM have their BP checked?

every visit

10

how often should a pt with DM have their Lipid profile checked?

annually

11

how often should a pt with DM have their urine microalbumin checked?

annually; type 1 greater then 5 year; type 2 at time of dx

12

how often should a pt with DM have their eye exam?

annually; type 1- 3-5 years; type 2- at dx

13

how often should a pt with DM have their foot examed?

annually

14

how often should a pt with DM have their pneumo vaccine?

once, but repeat after 65 if their first was younger then 65 and more then 5 years ago

15

how often should a pt with DM have their flu vaccine?

annually

16

Lispro/Aspart/ Glulisine is considered: 1. category 2. onset of action 3. peak 4. duration of action

1. rapid 2. 5-15 mins 3. 1-2 hours 4. 4-6 hours

17

Regular 1. category 2. onset of action 3. peak 4. duration of action

1. short 2. 30-60 mins 3. 2-4 hours 4. 4-10 hours

18

NPH 1. category 2. onset of action 3. peak 4. duration of action

1. intermediate 2. 1-2 hours 3. 4-8 hours 4. 10-20 hours

19

Glargine/ Detemir/Degluctec 1. category 2. onset of action 3. peak 4. duration of action

1. long 2. 1-2 hours 3. flat 4. about 24 hours

20

3 limitations of slow onset regular insulin?

Inconvenient administration (20-40 minutes prior to meal) Risk of hypoglycemia if meal is delayed Mismatch with postprandial hyperglycemic peak

21

3 limitations of long uration regular insulin?

Up to 10 hours’ duration Increased at higher dosages Potential for late postprandial hypoglycemia

22

SE of human NPH insulin?

weight gain

23

5 advantages of rapid acting insulin (Lispro, Aspart, Glulisine)?

Convenient administration immediately prior to meals Faster onset of action Limit postprandial hyperglycemic peaks Shorter duration of activity (Reduce late postprandial hypoglycemia and frequent late postprandial hyperglycemia) Need for basal insulin replacement

24

The ideal basal insulin willl....

1. Mimic pancreatic basal insulin secretion 2. Last ~24 hours 3. Smooth peakless profile 4. Reduce risk of nocturnal hypoglycemia

25

2 perks of insulin Glargine?

Gradual release pattern from injection site Peakless, long-lasting insulin proflie

26

Mimicking Nature with Rapid-acting and Basal Insulin....

Give lispro at every meal and Glargine as basal insulin

27

MOA of Sulfonyureas

Increase basal and postprandial insulin secretion

28

MOA of Meglitinides

Increase postprandial insulin secretion

29

MOA of alpha- Glucosidase Inhibitors?

Decrease postprandial glucose absorption

30

MOA of Metformin

Enhances hepatic response to insulin and thereby reduces hepatic glucose production

31

MOA of Glitazones (TZD’s)

Improve insulin action in peripheral tissues (muscle and adipose tissue) and enhance glucose uptake

32

What is the power of THE INSULIN SECRETAGOGUES?

Decreases HbA1c 1-2 percent

33

SE of the THE INSULIN SECRETAGOGUES?

weight gain

34

Main risk of THE INSULIN SECRETAGOGUES?

hypoglycemia

35

Metformin is NOT rec in?

Renal failure: creat. greater then 1.5 in men) and greater then 1.4 (women) CHF Liver disease

36

2 adv. of metformin?

Not associated with weight gain Does not cause hypoglycemia by itself

37

Power of metformin?

Decreases HbA1c 1-2 percent

38

SE of metformin?

Nausea, vomiting, diarrhea (less if taken with meals)

39

main risk of metformin?

Lactic acidosis

40

stop therpahy of metformin for....

Dehydration, surgery, IV radiocontrast

41

power of the Glitazone's?

Decreases HbA1c 0.5 to 1.5 percent

42

SE of Glitazone's?

Edema, increased weight, anemia, fractures

43

main risks of glitazone's?

Hepatotoxicity; inducing or increasing CHF, bladder cancer (after 1 year of therapy)

44

Power of THE alpha-GLUCOSIDASE IHIBITORS

Decreases HbA1c 0.5 to 1 percent

45

SE of alpha- glucosidase inhibitors?

flatuence

46

MOF of incretins?

1. stimulate insulin secretion 2. inhibit glucagon secretion 3. inibit gastric emptying and food intake **ll lower blood glucose levels

47

What is the MOA of DPP4?

inactivates incretins (causing increase in BS)

48

DPP-4 inhibitors moa?

blcok DPP4--> allows for the lowering of BS

49

What is the indiciation for DDP4 inhibitors?

Type 2 DM: Monotherapy or in combination with other antidiabetic drugs, including insulin

50

secondary failure rate in monotherpahy of DM type 2 is most commonly caused by....

decreasing beta cell function

51

over time, most pts will need....

BOTH basal and meal time insulin

52

Eventide (byetta and bydeuron) mimic....Power?

GPL-1; 0.8-1.0; given sq

53

What is the power of gliptins?

.6-.8; given PO **DDP-4 inhibitors**

54

what is the power to symlin?

.5

55

"-gliflozen's" are.....MOA; SE?

sodium-glucose co-transport 2 inhibitors - inhibits NA and glucose reabsorption - SE- genital mycotic infections