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Diabetes

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munsele's version from 2016-07-08 17:12

Section 1

Question Answer
Microvascular complicationsRetinopathy, Nephropathy, Peripheral neuropathy, autonomic neuropathy (ED, gastroparesis, loss of bladder control/UTIs)
Macrovascular complicationsCAD, Cerebrovascular disease, PAD
Criteria for diagnosis of DMClassic sx of hypoglycemia or hyperglycemic crisis AND random glucose of 200 OR fasting >126, OR 2h OGTT >200, or A1c >6.5
Risk factors for DMFirst degree relative, high risk ethnicity, BMI >25, Physical inactivity, hypertension, CVD hx, HDL <135 or TG >250, women with PCOS, women delivering babies >9lbs
Gestational DM goalspreprandial <95, 1h post meal <140, 2h <120
Meds that lower BGNon selective BBLs, Quinolones
Meds that raise BGAtypical antipsychotics, Cyclosporine/tac/sirolimus, Protease inhibitors, quinolone, systemic steroids
Goal waist circumference<35 for women, <40 for men
Goal grams of fiber per 1000kcal14 grams
Number of carbs in one serving 15g
ASA primary prevention appropriate whenType 1 and type 2 patients with high CVD risk (>10%), men >50 or women >60 with one additional major risk factor
ASA secondary prevention Use 75-162mg/day (plavix if ASA allergy)
Nephropathy screeningAnnual urine test to measure albumin excretion
When to start ACE/ARB for renal protectionwhen albumin is >30mg/24h
how often should they inspect their feet?daily, do not put lotion between toes when moisturizing
What vaccines should diabetics receiveHep B, Flu, Pneumococcal, Tetanus
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Section 2

Question Answer
A1c goals<7 from ADA, <6.5 from AACE
Fasting goals80-130 from ADA, <110 from AACE
PP glucose goals<180 from ADA, <140 from AACE
Glucose associated with A1c of 10240
Glucose associated with A1c of 7154
Agents causing weight lossSGLT2, GLP-1, pramlinitide
Agents causing weight gainInsulin, SUs, meglitinides, TZDs
When to restart metformin following contrast dyeWait 48 hours and confirm renal fxn is normal
Metformin effect on B12can decrease absorption eating to megaloblastic anemia
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Section 3

Question Answer
RepaglinidePrandin
NateglinideStarlix
Dosing for PrandinA1c <8: 0.5mg TID, A1c >8: 1-2mg TID
Meglitinides Class SEHypoglycemia, upper resp tract infections
TZD MOAperoxisome proliferator-activated receptor gamma agonists
How long until TZD effectiveSeveral weeks!
TZD CIHeart failure stage lll/lV (warning to avoid in bladder cancer as risk is increased)
TZD SEperipheral edema, upper resp infections
Alpha glucosidase inhibitors Acarbose (Precose) and Miglitol (Glyset)
SGLT2 SEGenital mycotic infections, serious UTIs, hypoglycemia, wt loss
SGLT2 DIDigoxin (increases Dig)
DPP4 SEnasopharyngitis, upper resp infections, UTIs
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Section 4

Question Answer
Meds with renal dosingDPP4s, SGLT2s, alpha glucosidase inhibitors, GLP-1 agonists
DulaglutideTrulicity
AbiglutideTanzeum
Liraglutide Victoza
GLP boxed warning and other warningFor all but Byetta, thyroid C cell carcinomas in rats, pancreatitis
Trulicity stability at room temp14 days
Tandem adminrock side to side 5 times
Bydureon use after mixingRight away or will clump. Allow to be at room temp for 15min
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Section 5

Question Answer
PramlintideAmylin
Which type of diabetics can Pramlintide be used inType 1 and 2
Pramlintide dose adj with insulinDecrease insulin dose by 50%
Pramlintide SEN/V, anorexia, hypoglycemia, HA, wt loss
Colesnvelam Welchol
Welchol usageMOA unknown other than bile acid resin, decreases A1c by 0.5%
BromocriptineCycloset
Bromocriptine MOAdopamine agonist; effect on glucose control-thought to decrease insulin resistance and glucose pdtn
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Section 6

Question Answer
AspartNovolog
Regular InsulinHumulin R, Humulin N, ReliOn
Glulisine Apidra
LisproHumalog
NPH insulinsHumulin N, NovolinN, ReliOn
Insulin DetemirLevemir
Insulin GlargineLantus and Toujeo
Insulin DegludecTresiba
TDD of insulin dosing0.6 units/kg/day
Dividing dose among basal bolus using NPH2/3 of the dose goes to NPH
Basal insulin starting dose 0.1units/kg/day or 10units
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Section 7

Question Answer
Insulin to carb ratio500/TDD insulin -for rapid acting, use 450 for regular
Correction factor for rapid acting 1800/TDD insulin
Correction factor for regular insulin1500/ TDD insulin
Afrezza stability at room temp3 days once opened
Levemir stability at room temp42 days
Tresiba stability at room temp 56 days
Goal BG when hospitalized140-180
BBL mask what sx of hypoglycemiashakiness, palpitations, and anxiety
memorize

Section 8