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T2DM
Principles
| Question | Answer |
|---|---|
| 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
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