Nur 731Dm/ Pharm/ Ogt

Front 1

DM Criteria?

Back 1

Casual plasma glucose>/= 200 mg/dl and sympt of DM
polyuria, polydipsia, ketoacidosis, or unexplained wt loss
OR fasting plasma glucose >/= 126mg/dl
OR results of a 2 hr 75 g OGTT>/= 200
(last 2 should be confirmed with a repeast test on a different day)

Front 2

Fasting Plasma Glucose or Preprandial Glucose Goal?
Normal?

Back 2

70-130
Normal <100

Front 3

Postprandial 2 hrs goal?
Normal?

Back 3

<180
Normal <140

Front 4

Bedtime Glucose goal?
Normal?

Back 4

90-150
Normal <120

Front 5

A1C goal?
normal?

Back 5

7%
Normal 6%

Front 6

How many times a uear should A1C be done?

Back 6

2-4 times a yr

Front 7

Most pts with type 1 DM should monitor BS?

Back 7

3 times a day

Front 8

Best time to measure?

Back 8

2-3 times postprandially
fasting and preprandial
for 2-4 days consecutively

Front 9

When should 1 hr postprandial be monitored?

Back 9

alpha glucosidase inhib
during preg

Front 10

Mild to moderate hypoglycemia?

Back 10

51-70 and <90 mg/dl at HS
Mild to moderate hypoglycemia

Front 11

Mild to moderate hypoglycemia
tx?

Back 11

15-20 g carb
(1/2 c juice or
reg soft drink
3-4 glucose tabs
8-10 hard candies)

Front 12

</=50 tx?

Back 12

20-30 g carb and recheck BG in 15 min
follow with additional carb or snack if next meal is more than 1 hr away

Front 13

Sever hypo?

Back 13

altered consciousness, unable to take carb orally or requiring the assistance of another person, tx with glucagon and or IV glucose

Front 14

Physical act for DM?

Back 14

min of 150-175 mi of moderate intensity/wk
target of 60-90 min 6-7 days per wk
resist. training qod to increase lean body mass

Front 15

How ofter should serum creat be measured?

Back 15

at min annually to est. GFR

Front 16

If GFR<60?

Back 16

eval for complications of kid dx
anemia
hyperparathyroidism
vit d def

Front 17

Screen for micro/macro albuminuria by checking urine?

Back 17

a/c ratio
type 1 within 5 yrs then yrly
type 2 at diag annually til 70

Front 18

How do you screen for micro/macro albuminuria by checking urine?

Back 18

spot or timed urine

Front 19

With which result do you A/C anually?

Back 19

under 30 timed or spot

Front 20

What can cause a false + A/C test?

Back 20

preg
UTI
excessive execr
menses
severe hypoglycemia

Front 21

If A/C 30-300, how do you confirm presence of micro alb?

Back 21

at least 2-3 positive collections done within 3-6 months and r/o other reasons
Consider a consult w/ nephro

Front 22

Once A/C of 30-300 confirmed, what do you do ?

Back 22

BP goal 130/80
Refer to a DE
ACE I (check K and Cr 1-2 wks after ACE)
Repeat A/C at least q 6 mo, consider more freq when change in meds are made

Front 23

If ratio >300 OR protienuria by + dipstick?

Back 23

gaol of 125/75
consult with nephro
consider reducing protien in the diet

Front 24

After how long do you check lipids

Back 24

6 wks

Front 25

When do you
start MNT
Physical activity
& consider Metformin?

Back 25

KIAS
K- No ketones in the urine
I-no acute or concurrent illness
A-A1C</= 7.5%
S-mild or no sympts

Front 26

With KIAS, What do you do?
K- No ketones in the urine
I-no acute or concurrent illness
A-A1C</= 7.5%
S-mild or no sympts

Back 26

start MNT
Physical activity
& consider Metformin?

Front 27

If target not met within ___, then?

Back 27

If target not met with 6 WEEKS, then START ORAL ANTIHYPERGLYCEMIC

Front 28

When do you automatically start oral antihyperglycemics?

Back 28

FPG > 150
Random >250
AND/OR
A1C>7.5%
Does not meet the criteria for mild or severe

Front 29

When do you start Insulin immediately?

Back 29

HWH SKID
h-severe Hyperglycemia
w-sever wt loss
h-HHNK
s-severe/sig sympts
k-ketones 2+
i-concurrent illness/ surgery
d-DKA

Front 30

How do you approach antihyerglycemic meds?

Back 30

titrate dose over 1-6 months
reinforce MNT and Physical activity

Front 31

When do you add a 2 nd antihyperglycemic

Back 31

titrate dose over 1-6 months
reinforce MNT and Physical activity
IF A1c>7 OR fasting plasma glucose >130 mg/dl OR 2 hr postprandial glucose>180 mg/dl
add 2nd oral antihyperglycemia OR GLP 1 agonist OR insulin

Front 32

Metformim is best used in which pts?

Back 32

•*Overweight/obese*
•Renal/liver function normal

Front 33

Metformin's Contraindicated in which pts?

Back 33

•Creatinine > 1.4 (women)
•Creatinine > 1.5 (men)
•IV contrast•Dehydration
•Alcohol excess
•> 80 years age (unless creatinine clearance allows)

Front 34

Thiazolidinediones (TZDs) are best used in which pts?

Back 34

•*Overweight/obese, signs of insulin resistance
•Liver function normal: need to follow LFT monitoring schedule
•Can be used in renal impairment but may increase fluid retention
•Consider risk for bone loss and fracture Note: Full effect of initiation or titration of therapy may take 2-4 months to be seen

Front 35

Clases of the Insulin Secretagogue?

Back 35

sulfonylurea or short-acting secretagogue)•sulfonylurea or short-acting secretagogue) are best used for which pts?

Front 36

Repaglinide or nateglinide are useful for patients with?

Back 36

postprandial hyperglycemia or with hypoglycemia on sulfonylurea

Front 37

Sulfonylureas are contraindicated in pts with ?

Back 37

in severe liver or renal disease

Front 38

α-Glucosidase Inhibitor are best used with which pts?

Back 38

•Milder presentation
•Use if postprandial hyperglycemia is the predominant hyperglycemic pattern
•No GI symptoms

Front 39

Alpha α-Glucosidase Inhibitor's Contraindicated with which pts?

Back 39

•Chronic intestinal disorders
•Acarbose in cirrhosis
•Acarbose and miglitol in renal impairment(creatinine > 2.0)

Front 40

When do you use (dipeptidyl peptidase IV Inhibitors) DPP-4 Inhibitors?

Back 40

•Use if postprandial hyperglycemia is the predominant hyperglycemic pattern
•Weight neutral
•Reduce in renal dx

Front 41

When are Dipeptidyl Peptidase IV Inhibitors Contraindicated?

Back 41

Not known at this time

Front 42

Bile Acid Sequestrant (colesevelam) used as?

Back 42

•Adjunct to other treatment modalities
•Modest effect on A1C. Also lowers LDL-C
Note: Reduces gastric absorption of some drugs. If known interaction or unknown interaction with narrow therapeutic index drug, administer 1 hour prior or 4 hours after colesevelam

Front 43

Bile Acid Sequestrant(colesevelam) Contraindicate?

Back 43

•Bowel obstruction
•Serum triglyceride > 500mg/dl
•Hx of hypertriglyceridemia-induced pancreatitis

Front 44

How do you titrate antihyper meds?

Back 44

Titrate Dose over 1 –6 months &Reinforce MNT and Physical Activity

Front 45

2 Hour Postprandial Glucose > 180 mg/dl what do you do?

Back 45

•Administered subcutaneously twice daily
•Use if postprandial hyperglycemia predominates
•To avoid hypoglycemia if using with a sulfonylurea, consider initially decreasing sulfonylurea dose. Use may be associated with weight loss

Front 46

GLP-1 agonist Contraindicated?

Back 46

•Gastroparesis requiring treatment with metoclopramide
•History of pancreatitis