Term
| Drugs that can cause Dysglycemia |
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Definition
| Atypical antipsychotics, BBs, Diazoxide, glucocorticoids, interferon alfa, INH, Niacin, Pentamidine, Protease inhibitors, Tacrolimus, Thiazide or loop diuretics |
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Term
| 3 ways to diagnose diabetes? |
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Definition
1) Casual plasma glucose > 11.1 mmol/L at any time of day in presence of symptoms ( polyuria, polydipsia, unexplained weight loss)
2) FPG > 7mmol/L (8 hour fast)
3) plasma glucose > 11.1 mmol/L 2 hours after a 75 g oral glucose load |
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Term
| Approach to patients T1DM ? |
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Definition
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Term
| Approach T2DM with A1C < 9% ? |
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Definition
| Lifestyle modifications first, if goal not met within 2 months (A1C < 6.5%) pharmacologic recommended |
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Term
| what are insulin doses based on? |
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Definition
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Term
| Self monitoring of blood glucose recommendations? |
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Definition
- pre and post parandial measurements
- minimum 3 measurements per day should be performed if on basal bolus regimens |
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Term
| Blood Glucose and exercise |
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Definition
| Exercise usually lowers blood glucose levels, but after extreme intensity it may actually increase BG (a stress response) |
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Term
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Definition
Insulin Aspart
Insulin glulisine
Insulin lispro |
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Term
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Definition
Insulin detemir
Insulin glargine |
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Term
Common Diabetic complications
Is intensive treatment or conventional treatment associated with better outcomes? |
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Definition
Retinopathy, nephropathy, neuropathy
INTENSIVE TREATMENT associated with better outcomes |
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Term
| Intermediate acting Human insulin |
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Definition
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Term
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Definition
| http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001363/ |
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Term
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Definition
| In T1DM, after new diagnosis patient may experience periods where requirement for insulin is decreased or transiently eliminated. |
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Term
| When should patients take regular insulin relative to a meal? |
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Definition
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Term
| When should a patient take rapid acting insulin relative to a meal? |
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Definition
| Shortly before, but definitely within 20 minutes of a meal |
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Term
Symptoms of mild hypoglycemia
How to treat mild hypoglycemia? |
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Definition
Sweating, tremors, tachycardia, hunger, nausea, weakness
Treat with oral source of sugar, 15 grams glucose: (3/4 cup of juice or regular soft drink).
This will increase blood glucose about 2mmol/L in 20 minutes |
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Term
| Severe hypoglycemia symptoms and treatment (conscious and unconscious) |
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Definition
Neuroglycopenic symptoms: confusion, altered behavior, difficulty speaking... can progress to seizure or coma
If patient is conscious - oral 20 g glucose tablet or equivalent. (Glucose get NOT preferred)
Unconcious patient - 1 mg of SC or IM glucagon, but it is not effective in malnourished or alcohol induced hypoglycemia. Use 50mL of IV dextrose 50% in water in those cases |
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Term
| Cause and result of localized fat hypertrophy |
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Definition
Cause - frequent use of same injection site
Result - unpredictable adsorption of insulin from that site |
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Term
| Allergic reactions from insulin? |
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Definition
| Urticaria, angioedema, rashes, local erythema are all RARE... switching to a different manufacturer may help. |
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Term
| T1DM patient taking non-human insulin develops immune mediated insulin resistance, what do you do? |
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Definition
| Switch to insulin NPH (concentrated 500 U/mL) |
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Term
| T2DM, monotherapy with what is recommended if patient A1C <9% but hyperglycemic for 2-3 months |
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Definition
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Term
| T2DM with A1C > 9% what to initiate? |
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Definition
| Metformin with another agent OR initiate insulin. If patient takes 2 oral agents and is still not at target within 6-12 months, consider adding bedtime insulin (preferred), or a 3rd agent |
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Term
| managing T2DM with symptomatic hyperglycemia and metabolic decompensation? |
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Definition
| Initiate Insulin with or without metformin |
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Term
Biguanide
role?
Important note concerning imaging contrast agents or pre-op |
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Definition
Biguanides - Metformin
- First line for new diagnosis of T2DM
- HELD pre-op or before given contrast agents because can cause renal failure and increase the risk for lactic acidosis |
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Term
Dipeptidyl Peptidase-4 inhibitors (DPP-4 inhibitors)
What are they?
How do they work?
Role? |
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Definition
Dipeptidyl Peptidase-4 inhibitors (DPP-4 inhibitors)
What are they - Saxagliptin & sitagliptin
How do they work: GLP-1 is released in response to food ingestion by endocrine leading to insulin secretion, glucagon suppression, slower gastric emptying, and satiety. DPP-4 is an enzyme that breaks down GLP-1. DPP-4 inhibitors prevent this.
Role - Should be used of sulfonylureas or insulin are inappropriate eg. high risk of hypoglycemia |
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Term
Sulfonylureas - Insulin secretagogues
What are they?
Action?
What are the first generation?
Side effects? which is worst for these effects?
Place in therapy? |
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Definition
Sulfonylureas - Insulin secretagogues
What are they - Chlorpropamide, gliclazide, glimepiride, glyburide, tolbutamide
Action - Stimulate basal and meal-stimulated insulin release (obviously only for T2DM).
First generation - tolbutamide, chlorpropamide very poor PK profile and are rarely used
Side effects - hypoglycemia and weight gain --> Glyburide is the worst
Place in therapy: Second line either as add on to metformin, or monotherapy when contraindicated to metformin. |
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Term
Meglitinides - secretagogues
What are they ?
How the they work vs sulfonylureas? |
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Definition
Meglitinides - secretagogues
What are they - Nateglinide, repaglinide
How the they work vs sulfonylureas - shorter actions therefore need to be dosed immediately before meals. Advantageous in that if a patient knows they are going to miss a meal, they can avoid taking these. |
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Term
Thiazolidinediones (TZDs)
What are they ?
How do they work?
Side effects? What condition would you want to avoid use in due to these side effects? |
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Definition
Thiazolidinediones (TZDs)
Pioglitazone & Rosiglitazone
Increase insulin sensitivity and so lowers both blood glucose and insulin level.
Low risk of hypoglycemia
Associated with weight gain due to fat deposition, fluid retention, and edema --> watch out for HF and ischemic heart disease |
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Term
effect of antihyperglycemic agents over time? Important of what medication, following this?
When should insulin be initiated in T2DM? |
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Definition
Oral antihyperglycemics lose their effectiveness over time, INSULIN becomes important as well in T2DM
Initiate insulin in T2DM:
- maximum tolerated dose of oral agent, yet A1C > 7%
- Initial diagnosis A1C >9%
- End organ damage (CKD) renders oral agents ineffective
- preconception and in pregnancy |
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Term
Insulin dosing (approximately_
T1DM?
T2DM? |
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Definition
Insulin dosing (approximately_
T1DM - approx 0.5 U/kg
T2DM - approx 1 U/kg |
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Term
Targets for glucose Control > 13 years old
A1C ?
FPG?
2 hour PPG? |
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Definition
Targets for glucose Control > 18 years old
A1C < 7%
FPG 4-7 mmol/L
2 hour PPG 5-10 mmol/L |
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Term
Targets for glucose Control: 6 - 12 years old
A1C ?
FPG?
2 hour PPG? |
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Definition
Targets for glucose Control: 6 - 12 years old
A1C < 8%
FPG 4 - 10 mmol/L
2 hour PPG - NOT RECOMMENDED |
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Term
Targets for glucose Control: 6 - 12 years old
A1C ?
FPG?
2 hour PPG? |
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Definition
Targets for glucose Control: 6 - 12 years old
A1C < 8%
FPG 4 - 10 mmol/L
2 hour PPG - NOT RECOMMENDED |
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Term
Targets for glucose Control: < 6 years old
A1C ?
FPG?
2 hour PPG? |
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Definition
Targets for glucose Control: < 6 years old
A1C < 8.5%
FPG: 4-12 mmol/L
2 hour PPG - NOT RECOMMENDED |
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Term
| Goal A1C in pre-pregnancy counseling? |
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Definition
| A1C < 7% ( same as usual) |
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Term
| When should women begin taking folic acid? |
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Definition
| If planning pregnancy, 3 months prior to conception, take during pregnancy, and until 6 months postpartum |
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Term
| T2DM woman wants to become pregnant, what should be done with her medications? |
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Definition
| Switch her medications from oral to Insulin to avoid possible teratogens |
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Term
| In a pregnant woman a 1h PG after a 50 gram glucose load. What is normal, what is indicative of GDM ? |
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Definition
1hPG < 7.8 mmol/L is normal
1hPG > 10.3 mmol --> GDM
1hPH 7.8 - 10.2 mmol/L Do further testing.... a 75g OGTT and measure FPG, 1hPG, and 2hPG.
If 2 or more of: FPG >5.3, 1hPG > 10.6 or 2hPH >8.9 --> GDM, if not, just impaired glucose tolerance of pregnancy (IGM) |
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Term
| First line in GDM? If T2DM, and cannot take insulin ? |
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Definition
| First line in GDM - Insulin with lifestyle modifications. Consider glyburide if cannot take insulin because glyburide does not cross the placenta. Metformin is another option/ |
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Term
Glycemic targets in pregnancy
A1C ?
FPG?
2 hour PPG? |
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Definition
Glycemic targets in pregnancy
A1C < 6%
FPG 3.8 - 5.2 mmol/L
2 hour PPG 5 - 6.6 mmol/L |
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Term
| Insulin monitoring in pregnant women? |
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Definition
| NORMAL. It does cross placenta, but is degraded in GI tract before becoming systemic. Important to monitor w vigilance after delivery, as requirements may change drastically |
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Term
Diabetic Ketoacidosis
Why do it happen?
Symptoms?
Management |
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Definition
Diabetic Ketoacidosis
Not enough calories from carbs so body breaks down fat. One byproduct of fat breakdown is ketones. Build up of ketones to the extent that it is being built faster than excreted is ketoacidosis.
Symptoms - hyperglycemia, volume depletion, ketones in urine, depressed consciousness, and depleted electrolytes.
Management - Replenish electrolytes & fluids, Insulin ( NOT if K+ is < 3.3 as this will drive K+ into cells lowering it further), bicarbonate. |
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Term
| Rapid acting human insulin |
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Definition
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Term
| Sulfonylurea contraindications? |
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Definition
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Term
Metformin - weight gain ?
Contraindications? |
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Definition
Metformin - NO weight gain!
Contraindications - hepatic or renal impairment, or previous lactic acidosis |
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Term
| what patients to avoid with TZDs - pioglitazione and rosiglitazone |
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Definition
Avoid in patients with HF, increase risk of pregnancy if no contraception used.
Rosiglitazone - pt. consent is required if have heart disease |
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