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78 Cards in this Set

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multiple syndromes characterized by an elevation of blood glucose caused by a deficiency of insulin
diabetes mellitus
Type I DM
insulin-dependent DM
Type II DM
non-insulin-dependent DM (90%)
autoimmune destruction of the pancreatic islet B cell resulting in a loss of insulin secretion causes Type ___ DM
I
B-cell dysfunction, peripheral cell insulin resistance, abnormal intestinal glucose absorption, and obesity assoc w/ Type ___ DM
II
DM that usually develops before 20 y/o
Type I
risk factors for Type II DM
- FamHx
- Obese
- physical inactivity
- race (native , hispanic, asians, and african americans, and pacific islanders)
- Hx of glucose intolerance
- HTN
- HDL < 35
- TG > 250
- polycystic ovary syndrome
complication of DM
Acute
- diabetic ketoacidosis (type I)
- hyperosmolar nonketotic syndrome (type II)

Chronic
- microvascular (retinopathy, neuropathy, nephropathy)
- macrovascular (cardiac events, HTN)
metabolic syndrome characterized by:
- abdominal obesity
- atherogenic dyslipidemia (+TG, +LDL, -HDL)
- HTN
- insulin resistance
NML fasting plasma glucose
< 100 mg/dL
NML oral glucose tolerance test (2 hr)
< 140 mg/dL
Diagnose diabetes by any of following:
- classical s/sx (polyuria, polydipsia, unexplained wt loss) and random plasma glucose >200 mg/dL
- fasting plasma glucose >126 mg/dL
- oral glucose tolerance (2 hr) >200 mg/dL
* confirm on subsequent test
Tx of Type I DM
- Insulin
- diet
- exercise
- pt ed
Tx of Type II DM
- control blood glucose
- diet
- exercise
- oral hypoglycemic agents
- insulin
- pt ed
plasma glucose goals for diabetics
- preprandial 90-130 mg/dL
- peak postprandial <180 mg/dL
- HGb A1C <7%
standards of care for diabetics
- HbA1C <7%
- LDL <100 mg/dL
- HDL >40 mg/dL (male); >50 mg/dL (female)
- annual eye and foot exams
- albumin:creatinine ratio <30
- BP < 130/80 mmHg
- ASA 75-162 mg/d if > 40 y/o
- annual HIB vaccine
- pneumococcal vaccine at dx and rpt once when > 64 y/o
insulin lispro (humalog)
insulin aspart (novolog) (BCF)
insulin glulisine (apidra)
ultra-short acting insulin
regular insulin (humulin/novolin [BCF])
short acting insulin
only insulin that can be given IV or IM
regular insulin
isophane insulin suspension (NPH)
intermediate-acting
insulin glargin (lantus) [BCF]
long-acting insulin
onset, peak, and duration of ultra-short acting insulins
15 mins, 1-2 hrs, 4 hrs
onset, peak, and duration of short-acting insulin
.5-1 hr, 2-4 hrs, 8 hrs
onset, peak, and duration of intermediate insulin
2 hrs, 8 hrs, and 24 hrs
onset, peak, and duration of long-acting insulin
NA, NA, 24 hrs
insulins used for basal control
intermediate (NPH) or long-acting (Lantus)
insulins used for prandial control
ultra-short (Novolog) or short-acting(regular insulin)
how many units in 1cc of U-100 insulin?
100 units
how often should pt test blood sugar (book answer)
before each meal, 2 hrs after each meal, bed time, and occasionally at 3 a.m.
what is std insulin dose?
0.5U/kg/d divided by basal and preprandial requirements
blood glucose of < 50 mg/dL = ___ hypoglycemia
mild
blood glucose of < 20 mg/dL = ___ hypoglycemia
severe
which antidiabetic agents stimulate release of insulin from pancreas B cells?
sulfonylureas
SEs of sulfonylureas incl
hypoglycemia and weight gain
CIs for sulfonylureas
hepatic and renal insufficiency, and pregnancy (glyburide is only cat B), sulfa allergies
how long before a meal should 2nd gen sulfonylureas be taken?
30 min
which sulfonylurea drug is not recommended if CrCl <50ml/min?
glyburide
which sulfonylurea drug is not recommended if CrCl is <10ml/min?
glipizide
which sulfonylurea drug is generally prescribed to the elderly?
glipizide
which sulfonylurea-like drugs are not sulfa drugs?
meglitinides (secretogogues)
which antidiabetic drug is prescribed to obese pts?
metformin (glucophage) [BCF]
what is the absolute CI for metformin?
serum Cr > 1.5 mg/dL
which antidiabetic drugs acts as an insulin sensitizer eo enhance the action of insulin in the liver and skeletal muscle?
thiazolidinediones (gliltazones)
what are the CIs for thiazolidinediones?
- class III/IV HF
- liver dysfunction (hepatotoxicity)
what must baseline LFT be for starting thiazolidinedieones?
<2.5 ULN
what must be present for thiazolidinediones to work?
insulin must be on board
what is a lipid SE of thiazolidinediones?
raises LDL-C
which class of drugs affect absorption of glucose?
a-glucosidase inhibitors
pioglitazone (actos)
thiazolidinediones (glitazones)
rosiglitazone (avandia) [BCF]
thiazolidinediones (glitazones)
acarbose (precose)
a-glucosidase inhibitor
miglitol (glyset)
a-glucosidase inhibitor
MOA for a-glucosidase inhibitors
reversibly inhibits enzymes in the mucosa of the sm int from breaking down polysaccharides into absorbable sugars (delays the digestion of carbs resulting in a smaller rise in blood conc postprandial)
CIs for a-glucosidase inhibitors
inflammatory bowel dz; colonic ulcers; intestinal obstructions
ARs of a-glucosidase inhibitors
abd pn; diarrhea; flatulence
(less carbs = less GI probs)
what must be monitored when using rosiglitazone/metformin [BCF] combi drug?
renal and liver function (baseline LFTs and rpt q 2 mos x 1yr)
Tx for Type II DM and HbA1C 7%
therapeutic lifestyle changes
Tx for Type II DM and HbA1C 7-8%
single oral agent
Tx for Type II DM and HbA1C 9-10%
two or more oral agents needed
which agent reduces FPG by ~50-70% and HbA1C by ~1-2%?
Sulfonylureas and Metformin
which agent reduces FPG by ~60% and HbA1C by ~1.7%?
Meglitinides
which agent reduces FPG by ~50% and HbA1C by ~1%?
Glitazones
which agent reduces FPG by ~10-20%, PPG by ~25-50%, and HbA1C by ~0.5-1%?
a-glucosidase inhibitors
which antidiabetic agent do you administer w/ first bite of food?
a-glucosidase inhibitors
what is algorithm for txing obese pts w/ type II DM?
- metformin or a-glucosidase inhibitor
- add SU, meglitinide, or glitazone
- add insulin
what is algorithm for txing non-obese pts w/ type II DM?
- SU or meglitinide
- add meformin or glitazone
- add insulin
what is algorithm for txing elderly w/ type II DM?
- SU or meglitinide or a-glucosidase inhibitor
- add or sub insulin
* no metformin because of renal function
what is only acceptable antidiabetic drug for prenancies?
insulin (must have NML HbA1C prior to conception)
when is the most important time to control glucose during prenancy/
the first two months
which antidiabetic drugs may be teratogenic or cause fetal hyperinsulinemia or hypoglycemia?
oral antidiabetic agents
pregnant women screened for GDM at ___ wks
24-28 (esp high risk)
what is MC acute complication of type I DM?
diabetic ketoacidosis
s/sx of DKA
- hyperglycemia (>250)
- ketosis (fruity breath)
- acidosis (pH <7.3)
Tx for DKA
- fluids
- IV insulin (reg)
- electrolytes (esp K, even if it looks high)
- sodium bicarbs if severe acidosis
what syndrome occurs mainly in type II diabetics who are elderly, and physically impaired w/ limited access to water?
hyperosmolar nonketotic syndrome (HNKS) - hyperglycemic hyperosmolar state
s/sx for HNKS
similar to DKA w/o acidosis, and w/ higher blood glucose (>600mg/dL)
Tx for HNKS
- IV fluids
- insulin
- K replacement
Stds of care for diabetics (monitoring)
- HbA1C <7%
- LDL <100mg/dL (<70mg/dL if CVD)
- TG <150mg/dL
- HDL >40mg/dL males; >50mg/dL females
- annual eye and foot exam w/ monofilament
- microalbuminuria <30ug/mg creatinine
- BP <130/80mmHg
- aspirin 75-162mg/d if >40y/o
- annual influenza vaccine @ dx, rpt @ 64y/o