amandakzinn's version from 2015-11-15 22:29

Section 1

Question Answer
insulin testing begin waht age?45. if normal repeat every 3 years
diagnosis A1C>6.5%
FPG diagnosis>= 126 mg/dl no caloric intake at least 8 hrs
2 hr PG>= 200 using glucose load 75 g glucose
random plasma glucoseclassic symptoms random draw >=200
A1Cmeeting goals two times yearly....not goal quarterly
urine albumin to urine creatinine ratioat least once a year.....ACEI when 30 or above
eye examevery 2 years if no evidence retinopathy
neuropathymoniflament least once a year
foot examannually
A1C goalless than 7% most people some people less than 8%
fasting blood glucose goal80-130
post prandial peak <180 1-2 hours after beg meal
phsycial activity at least 150 mins/week spread over 3 days. children at least 60 mins physical each day.
smoking cessation
dual combo meds when A1C>= 9
combo insulin injectible therapy blood glucose or A1Cabove 300 or 10-12%
if noninsulin agent over 3 months max dose no acheive a1c target then add 2nd agent each added reduce by about 1%
how to dose mixed insulin0.5-1 units/kg/day. give 2/3 dose morning breakfast and 1/3 dinner
basal/bolus0.5-1 units/kg/day. give 50% basal and 50% bolus
sliding scaleadditional 1 unit per 30mg/dL above target added to bolus normal dose
carb count1 unit insulin to cover 15-20 grams of carbs
test for gestational what weeks24-48 weeks
one step approach for gestational testing75 gram. glucose when fasting, 1 hr, 2 hr. fasting 92 or higher,,,,,1 hr 180....2 hr 153
two step approach50 g 1 hr if over 140 then do 100g ......95, 180, 155, 140 fasting thru 3 hours post
gestation DM after birth test after6 weeks

Section 2

Question Answer
insulin lispro humalog. mealtime
insulin aspartnovolog. mealtime
short acting insulinhumulin or novolin R.
intermediate insulinhumulin or novolin N
long acting insulinlevemir and lantus
onset rapid5-15 mins
duration rapid5 hrs
short acting onset30-60 min
short acting duration5-8 hrs
intermediate acting onset2-4 hrs
intermediate duration10-16
long acting onset2-4 hrs
long acting duration20-24 hrs
metformin avoid usewomen cr >1.4 and men >1.5, history acidosis, heavy alcohol users
metformin counselingtake with food or milk, GI side effects get better with time
metformin inital dose500 twice daily. max dose 2550
sulfonylureas and renalglipizide CI under 10, glyburide <50, glimepiride <20 start 1mg. monitor crcl
glipizide dose 5 mg up to 40mg IR or 20ER
metformin monitoringcr
sulfonyl counseling30 min before meal. dont take if no eat. glucose tabs carry- take 3 to 4 if hypo.
SGLT2 inhibs no use incanagliflozin (invokana), dapaflizon........crcl under 30, frequent UTI, kidney disease,
SLGT2 inhibs counselingdiff doc let em know your on, weight loss, drink a lot of water, increased risk UTI,
invokana dose100 QD
GLP-1 agonist (victoza) counselingdecrease meal size by half---GI side effects decrease cont use. hypoglycemia
pramlintide counseling=3x day before meal.
victoza dose0.6 mg one week every day then 1.2 mg day