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Endocrine: DM management
DM management
42
Anatomy
Graduate
09/03/2011

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Cards

Term
___, __, and __ __ __ have a hyperglycemic effect.
Definition
- Epinephrine
- glucocorticoids
- oral contraceptive pills
Term
__, ___, and ___ ___ ___ REDUCE secretion of insulin.
Definition
- Phenytoin
- Clonidine
- calcium channel blockers
Term
Type II DM pts have w/o tmt have consistently elevated glucose levels. These pts ___ does not rise like normal after a meal, and their ___ is constantly elevated and does not decrease after a meal.
Definition
- insulin
- glucgaon
Term
What is the mechanism of Metformin?
Definition
- decreases hepatic gluconeogenesis
- decreases GI absorption of glucose
- increases glucose uptake by skeletal muscles
Term
Metformin is/is not dependent on beta cell function.
Definition
is NOT
Term
What is the mechanism of SU?
Definition
increase insulin release from beta cells
Term
START WITH METFORMIN> (STILL FASTING IS HIGH)> ADD SU> (STILL FASTING IS HIGH)> ADD TZD
Definition
Term
What is the action of TZDs?
Definition
increase insulin sensitivity in muscle, liver, and fat

decrease insulin resistance
Term
What oral agent can increase the amount of beta cells in the pancreas?
Definition
TZD
Term
If T2DM pt is on double/triple therapy, when do you add Glargine (long acting insulin)?
Definition
when FPG is > 120
Term
When should a SU be discontinued?
Definition
when bolus meal time insulin is started
Term
Metformin does not work as well on lean people as it does on overweight people.
Definition
Term
When would you start a newly diagnosed T2DM pt on insulin immediately instead of oral meds?
Definition
HbA1c > 10%
Term
What is the key physicochemical property that distinguishes the onset and duration of action of insulin preparations?
Definition
SOLUBILITY

(long actings are insoluble)
Term
Exenatide (Byetta) is __ __ __ analoge. It __ secretion of insulin, ___ secretion of glucagon, and has an ___ effect. It can be given as an adjunct to metformin or SU or a combination for T2DM. It is given as __ __ __.
Definition
- glucagon-like polypeptide analoge
- increases secretion of insulin
- inhibits secretion of glucagon
- anorectic effect
- twice daily injections
Term
Sitagliptin (Januvia) is a __ __ ___. ___ normally degrades GLP-1 and GIP. GLP and GIP increase insulin release, decrease glucagon release, and delay gastric emptying. This is a __ __ __ agent.
Definition
- Dipeptidyl Peptidase Inhibitor
- once daily oral
Term
What drug besides insulin can be used for TIDM and TIIDM?
Definition
Pramlintide (Symlin)
Term
Pramilintide is a __ __ __ that ___ release of __ and __ ___ and decreases __ __ glucose levels. It is given as an adjunct to insulin, but NOT mixed with insulin. It is good for TIDM or TIIDM in pts that require lots of insulin. It has a anorectic effect since it __ __ __. Thus it can result in weight loss. This is __ __ __ and not mixed with __.
Definition
- synthetic amalyin analoge
- suppresses release of glucagon and hepatic gluconeogenesis
- decreases post prandiol glucose levels
- delays gastric emptying
- injected before meals
- not mixed with insulin
Term
__ __ therapy is often used in patients with Type I DM. This is a combo of __ and ___ insulins.
Definition
- Split-mixed therapy
- combo of regular(short) and intermediate (NPH or Lente)
Term
What interaction may propranolol have with glipizide?
Definition
Propanolol (beta blocker) can mask the symptoms of hypoglycemia
Term
What interaction may metformin have with morphine?
Definition
Metformin and morphine compete for renal tubular transport for elimination. So a pt on metformin and morphine, will have increased blood concentration of morphine.
Term
Do a random plasma glucose on a patient. It is 167. Whats the diagnsosis?
Definition
Pre-Diabetic
Term
With the monofilament test, you test 10 sites. If pt cannot perceive the monofilament at __ or more sites, they are considered to have neuropathy.
Definition
4
Term
To call someone hypertensive, have to have __ separate readings.
Definition
3
Term
FIGURE OUT WITH WHAT AIC WHAT GLUCOSE RANGE IS. LOOK THIS UP IN OLD PPTS.
Definition
Term
With Metformin, you can expect a __ reduction in HbA1c.
Definition
1-2%
Term
When you put a patient on a statin, __ function needs to be monitored every ___.
Definition
liver
every month
Term
Triglycerides should be less than ___.
Definition
150
Term
Her HbA1c is 7.4

What would you do now? ADD ANOTHER MEDICINE TO LOWER HBAIC MORE.
Definition
Probably not sulfonylurea b/c her fasting is good and these meds effect fasting. Also SU contribute to weight gain, TZDs also contribute to weight gain.
Term
LOOK AT DRUG NAMES OF INSULINS AND OTHER ORALS AND KNOW GENERIC AND TRADE NAMES.
Definition
Term
How many units of insulin does a patient whose blood sugar is 200 before a meal need? He plans on eating 200 g CHO.
Definition
1 unit of insulin lowers blood sugar by 50.

1 unit of insulin covers 15 g CHO.

55/15= 3.6 units for meal

correction dose to lower bs by 75. So 75/50= 1.5 units

3.6 +1.5= 5.1 units of insulin
Term
2 drugs that may preserve beta cell function?
Definition
TZDs
incretins
Term
When to start insulin?
Definition
- 3 oral meds and A1c still not at goal
- 2 oral meds and A1c far from goal
- any patient with moderate to severe renal impairment (creatinine > 1.5, GFR> 150).
Term
Start with 10 units hs
Record fasting sugar readings for next 3 mornings
Add those up and divide by 3--if average is >110, add 3 units (now at 13)
Record next 3 mornings, add up and divide by 3, if >110, add 3 units and so on...
Do this until average is between 80-110 and then hold at that dose
If average gets <80, substr
Definition
Term
I usually tell patients to titrate until their average is 80-110 OR they get to 40 units--whichever comes first
It takes right at 1 month to get to 40 units
Most people end up at 30-50 units
Usually don’t go more than 60-70 units for basal
Numbers will come down slowly so there is a lower risk of hypoglycemia
Definition
Term
Order your next A1c after patient has been on insulin for 3 months
Want fastings <110 and A1c < 7 %
Most patients will reach this goal and will remain on oral meds & basal insulin regimen for a long time
If A1c is high, postprandial sugars are probably to blame
Now time to initiate mealtime insulin
Definition
Term
Drop the ___ ___ and ___ when you add meal time insulin.
Definition
- non-insulin injectables
- SU
Term
Pre-Mixed Insulin Regimen:
Definition
Combine a rapid-acting insulin with an intermediate-acting protamine suspension into one injection (usually give bid before breakfast and supper)
Provide mealtime coverage with the rapid and a basal-like supplementation with the intermediate
Intended to simplify dosing and permit less shots per day (2 vs 4)
Term
Basal-Bolus Insulin Regimen:
Definition
Uses basal insulin and rapid-acting insulin in separate injections (rapid is given tid before all meals and basal is given qhs)
Patient can achieve tighter control with this method
Requires a more compliant and educated patient
Term
Therapeutic lifestyle modifications (TLC)
Low carb diet + exercise + weight loss
Metformin 500 mg 1 tab po bid with meals Metformin 1000 mg I tab po bid with meals
Actos (pioglitazone) 15 mg I tab po qd 30 mg qd
Victoza (liraglutide) 0.6 mg SQ qd1.2 mg1.8 mg
Lantus or Levemir (basal insulin)
Definition
Term
Pre-Diabetes:
Definition
- Fasting: 100-125
- OGTT: 140-199
- A1C: 5.7-6.4
Term
Normal A1c:
Definition
5.6 or below
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