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