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T2DM

Principles

QuestionAnswer
What are the 4 methods to diagnose T2DM? 1. A1c >= 6.5% 2. OGTT with 75 g glucose >= 200 mg/dl 3. 8-hr FPG >= 126 mg/dl 4. Symptomatic with BG >= 200 mg/dl
What is the definition of pre-diabetes? 1. FPG 100-125 mg/dl 2. 2-hr OGTT 140-199 mg/dl 3. A1c 5.7-6.4%
What are the physical activity recommendations for diabetic patients? 150 minutes a week, spread over 3 days, without more than 2 consecutive days of inactivity
What is the target weight loss in diabetic patients? 7% of body weight
What is the A1c goal for non-pregnant adults? What are alternate goals for healthy and non-healthy patients? < 7.0%. 6.5% and 8.0%
What are the glycemic recommendations for non-pregnant diabetic patients? 1. Pre-prandial PG 80-130 mg/dl 2. Post-prandial PG < 180 mg/dl
What is the recommended treatment for hypoglycemia? 15-20 g glucose, repeated in 15 minutes if hypoglycemia is still present, followed by a snack
What is the preferred first line treatment? Metformin
When should you consider initiation dual hypoglycemic treatment? A1c >= 9%
When should you consider initiating insulin? A1c >= 10-12%
Metformin: brand name Glucophage
Metformin: BBW Lactic acidosis
Metformin: dosing 500mg bid with meals titrated to 1000mg bid after 1-2 weeks
Metformin: dosing adjustments GFR < 45 decrease dose to 500mg bid, GFR < 30 contraindicated
Metformin: class biguanide
Metformin: MOA Decreased hepatic glucose production, decreased intestinal absorption of glucose, improved insulin sensitivity
Metformin: AEs (4) diarrhea, nausea, vomiting, flatulence
Glimepiride: brand name Amaryl
Glimepiride: dosing 1-2mg daily with biggest meal titrated to max of 8mg daily
Glimepiride: dosing adjustments renal impairment start at 1mg daily and adjust carefully, use with caution in hepatic impairment
Glimepiride: class sulfonylurea
Glimepiride: MOA Stimulates insulin release from the pancreatic beta cells; reduces glucose output from the liver; insulin sensitivity is increased at peripheral target sites
Glimepiride: AEs (2) hypoglycemia, nausea
Glipizide: brand name glucotrol
Glipizide: dosing 2.5-5mg daily before breakfast titrated to a max of 40mg daily
Glipizide: dosing adjustments no renal adjustment, in hepatic impairment start with 2.5mg daily
Glipizide: class sulfonylurea
Glipizide: MOA Stimulates insulin release from the pancreatic beta cells; reduces glucose output from the liver; insulin sensitivity is increased at peripheral target sites
Glipizide: AEs (3) nauses, diarrhea, hypoglycemia
Glyburide: brand name Diabeta
Glyburide: dosing 1.5-3mg with first meal titrated to max of 12mg daily
Glyburide: dosing adjustments GFR < 60 use not recommended, no adjustments in hepatic impairment
Glyburide: class sulfonylurea
Glyburide: MOA Stimulates insulin release from the pancreatic beta cells; reduces glucose output from the liver; insulin sensitivity is increased at peripheral target sites
Glyburide: AEs (3) nausea, heartburn, hypoglycemia
Created by: kornblum