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69 Cards in this Set
- Front
- Back
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What are the 4 criteria that diagnoses DM?
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symptoms of diabetes +
random plasma glucose >200 fasting plasma glucose >126 2 hr glucose during OGTT >200 A1C >6.5% |
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What are the criteria for the diagnoses of pre-diabetes?
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FPG 100-126
2 hr OGTTT 140-200 A1C 5.7-6.4% |
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How do you treat diabetic ketoacidosis?
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intensive fluid replacement
immediate insulin potassium replacement treat underlying illness |
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What meds are used in T1 DM with microalbuminuria?
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ACEI
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What meds are used in T2 DM with microalbuminuria?
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ACEI or ARB
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What meds are used in T2 DM with macroalbuminuria?
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ARB
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What is the ADA goal A1C?
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<7%
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What are the ADA recommended goals for fasting BS and 2 hr post prandial BS?
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Fasting 70-130
2 hr postprandial <140 (use these if pt has CV ds) |
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Which drug lowers A1C the most?
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Insulin 1.5-3.5%
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What drug for parkinsons disease may also be used to lower A1C?
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bromocriptine
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How does metformin work?
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decreases hepatic glucose production
increases insulin mediated peripheral glucose uptake |
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What is the most common side affect of metformin
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diarrhea and abdominal discomfort
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Metformin is contraindicated in pts with what condition?
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impaired renal function
(Cr >1.5, CrCl >30 ml/min) |
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How do sulfonylureas work?
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increase endogenous insulin secretion
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What is a key side effect of sulfonylureas?
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hypoglycemia
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What are the 1st gen. sulfonylureas?
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chlorpropamide
tolazamide acetohexamide tolbtuamide |
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What are the 2nd gen. sulfonylureas?
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glyburide
glimepiride glipizide |
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Which sulfonylurea is worse for kidneys?
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glyburide
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How do thiazolidinediones work?
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decrease insulin resistance by making muscle and adipose cells more sensitive to insulin
suppress hepatic glucose production |
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What are common side effects of thiazolidinediones?
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weight gain
edema |
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Thiazolidinediones are contraindicated in patients with what condition?
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abnormal liver function
CHF |
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Which diabetes drug class improves HDL and TG levels?
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thiazolidinediones
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What are the thiazolidinediones?
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pioglitazone
rosiglitazone |
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Which diabetic drug may increase the risk of MI?
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rosiglitazone
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How do meglitinides work?
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stimulate insulin secretion in the presence of glucose
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When are meglitinides taken?
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only when you eat
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What are side effects of meglitinides?
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hypoglycemia
weight gain |
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What class of diabetic drugs are safer in kidney disfunction than sulfonylureas?
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meglitinides
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What are the meglitinides?
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repaglinide
nateglinide |
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How do alpha glucosidease inhibitors work?
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block enzyme that digest starches in small intestine
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What are common side effects of alpha glucosidase inhibitors?
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flatulence
abdominal discomfort |
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Alpha glucosidase inhibitors are contraindicated in pts with what conditions?
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inflammatory bowel disease
cirrhosis |
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What are the alpha glucosidase inhibitors?
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acarbose
miglitol |
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What peptide is co-secreted with insulin?
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amylin
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What does amylin do in the body?
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decreases glucagon secretion post prandialy
suppression of hepatic glucose production slows gastric emptying promotes satiety |
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What drug is an amlynomimetic?
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pramlintide
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What 3 actions does pramlintide have?
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inhibits high postprandial glucagon secretion
slows gastric emptying promotes satiety/reduces caloric intake |
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When is pramlintide used for DM 1 and 2 patients?
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as adjunct if glycemic control cant be achieved with insulin
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What are adverse reactions to pramlintide?
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hypoglycemia
N/V |
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How much should insulin dosage be reduced if the dose of pramlintide is doubled?
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decrease insulin dose by 50%
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How is pramlintide dosed in T2 DM?
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initial dose of 60 mcg prior to major meals
reduce preprandial insulin by 50% increase pramlintide to 120 mcg if no nausea for 3-7 days |
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How is pramlintide dosed in T1 DM?
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initial dose of 15 mcg prior to major meals
reduce preprandial insulin by 50% increase pramlintide by 15 mcg when nausea has not occurred for 3 days |
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Pramlintide should be avoided in what pts?
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A1C >9%
poor compliance with insulin recurrent severe hypoglycemia in last 6 months gastroparesis diagnoses using GI motility drugs pediatric pts |
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What drug is a incretin mimetic?
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exenatide
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What does incretin do?
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gut hormone that enhances insulin secretion in response to food
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What does GLP-1 do?
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enhances glucose dependent insulin secretion
promotes satiety decreased postprandial glucagon secretion decreased glucagon regulates gastric emptying |
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When is exenatide used in diabetic pts?
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T2 DM pts who are taking metformin, a sulfonylurea, a glitazone, and not achieving glycemic control
(not for pts taking insulin) |
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What are side effects of exenatide?
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nausea
hypoglycemia jittery dizziness HA dyspepsia |
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What drugs cant be used in pts with gastroparesis?
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exenatide
pramlintide |
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How is exenatide dosed and given?
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5mcg or 10mcg pens
BID within 1 hr of AM and PM meals 6 or more hrs apart |
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What is the GLP-1 analog?
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liraglutide
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Liraglutide should be avoided in patients with a history of what?
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thyroid cancer
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What are the DPP4 inhibitors?
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sitagliptin
saxagliptin |
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DPP4 increases levels of what?
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incretin (GLP 1)
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What diabetic drugs may cause acute pancreatitis?
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sitagliptin
exenatide |
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DPP4 inhibitors should be given at a lower dose for what reasons?
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renal impairment
if drug interaction with CYP3A4 |
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What are the rapid acting insulins?
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aspart (novolog)
glulisine (apidra) lispro (humalog) |
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What type of insulin is regular insulin?
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short acting
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What is the intermediate acting insulin?
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NPH (Humulin-N, Novolin-N)
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What are the long acting insulins?
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glargine (lantus)
detemir (levemir) |
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How should insulin be dosed on initiation?
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Start with NPH or long acting insulin:
10 units at bedtime or 0.2 u/kg increase by 2 units every 3 days based on FBS target of 70-130 |
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How should rapid acting insulin be dosed on initiation?
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begin with 4 units
increase by 2 units every 3 days until in range of preprandial BS |
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What insulins cant be mixed in the same syringe as other insulins?
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glargine
detemir |
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What insulin can be mixed in the same syringe as other insulins?
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NPH
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How many injections should a T1 DM pt receive daily?
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4 (1 basal and 3 bolus)
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What amount of long acting and short acting insulins are needed to cover the bodys needs in T1 DM?
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1/2 - 2/3 long acting to cover basal needs
other 1/2 - 1/3 short acting |
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How can you estimate the units of insulin needed by a pt?
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0.6 X kg
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What is the general rule to calculate the amount of short acting insulin needed for a certain carb intake?
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1 unit of SA insulin covers 10-15 grams of carbs
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What is the rule of 15 when treating hypoglycemia?
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15g of carbs, wait 15 min, check BS,
repeat if needed |
