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DIabetes t1d
| Question | Answer |
|---|---|
| what is the cause to type 1 diabetes? | autoimmune destruction of beta cells which insulin cannot be produced |
| what can high ketone levels cause? | DKA |
| How can you differentiate between type 1 and type 2? | test for islet autoantibodies and C-peptide |
| why would you wanna test for C-peptide in a person with T1D? | C-peptide level is very low or absent in T1D |
| what is the FDA approved medication to delay the onset of symptomatic disease in patients with T1D? | Teplizumab (Tzield) |
| In what pt population can metformin help? | BMI >35, age 25-59, and women with history of gestational diabetes |
| what are the risks of having diabetes during pregnancy? | can cause an infant to be larger than normal (macrosomia) and increases the risk (in both mom and baby) of developing obesity and diabetes later in life |
| what medication is preferred for gestational diabetes | insulin |
| how are women tested for gestational diabetes | at 24-28 week gestation using oral glucose tolerance test |
| what medications are not recommended but sometimes used for gestational diabetes | meformin and glyburide |
| what is the initial presentation with someone who may have T1D? | DKA |
| what is considered clear clinical diagnosis of diabetes? | classic symptoms of hyperglycemia plus a random BG >200 |
| each additional 1% increase in the A1C increases the eAG by how much | 28 points |
| a carbohydrate serving is 15 grams, and what does that look like? | one small piece of fruit, 1 slice of bread of 1/3 cup of cooked rice/pasta |
| what is the 1-hr PPG target in diabetes in a person who is NOT pregnant? | no targedt goal |
| what is the 2-hr PPG glycemic target in a diabetic person who is NOT pregnant | <180 |
| what is the FPG diagnostic level for a diabetic patient | >126 mg/dL |
| what are the natural prodcuts that can help to decrease BG | cinnamon, alpha lipoic acid, chromium, magnesium, and ginseng |
| what are the vaccines recommended for diabetes | hep b, flu, penumococcal |
| what are the treatment options for neuropathy? | gabapentin, pregabalin, SNRI (duloxetime), TCA or sodium channel blockers |
| what is the BP goal for someone with diabetes? | <130/80 |
| for a patient with type 2 diabetes when do you start 2 drugs at baseline? | if their A1c is 8.5-10% |
| when can insulin be initially started on a person who has type 2 diabetes? | pt with severe hyperglycemia (A1C >10% or BG >300) evidence of catabolism (weight loss) or hyperglycemic symptoms |
| what are the GLP1 that have cardiorenal benefits? | dulaglutide, liraglutide, SC semaglutide |
| what are the SGLT2 drugs that have cardiorenal benefits? | cangliflozin, dapagliflozin, empagliflozin, and ertugliflozn |
| does Byetta have the risk of thyroid C-cell carcinoma? | no |
| Ozempic, Trulicity, and Mounjaro have an increased risk of what? | diabetic retinopathy complications |
| which GLP med has an increase heart rate side effect? | Tirzapetide |
| by how much do the GLP-1 decrease A1c by? | 0.5-1.5% |
| what blood glucose level do the GLP-1 decrease? | postprandial BG |
| brand name for exenatide? | byetta |
| which med is on the NIOSH list | exenatide |
| what is a counseling point for rybelsus | take >30 minutes before first food/drink |
| where is the SGLt2 protein expressed | proximal renal tubule |
| brand name for ertugliflozin | steglatro |
| what are the warnings with SGLT-2 | ketoacidosis, genital infections, necrotizing fascittis, hypotension, AKI |
| which 2 SGLT-2 have an increased risk of leg and foot amputations and risk of fractures | canagliflozin and bexagliflozin |
| brand name for bexagliflozin | Brenzavvy |
| what electrolytes do SGLT2 increase? | mg/PO4 |
| which SGLT2 has an increased risk of hyperkalemia | canagliflozin |
| are SGLT2 recommended for patients receiving dialysis? | no |
| when should you NOT start metformin | if eGFR 30-45 |
| what is the boxed warning with metformin | lactic acidosis - increased risk with renal impairment, contrast dye, excessive alcohol, topiramate, and hypoxia |
| which drug can cause an increase risk of lactic acidosis if given with metformin? | topiramate |
| how soon can you restart metformin after imaging studies | 48 hours after |
| which sulfonylurea do you have to take 30 mins before a meal | Glipizide IR |
| taking sulfonylurea may increase the risk of what | hemolytic anemia with G6PD deficiency |
| what is a good counseling points for those taking repaglinide or nateglinide | skip dose if meal is skipped |
| which 2 DPP4-s has a risk for heart failure? | saxagliptin and alogliptin |
| what is the warning with using alogliptin besides heart failure? | hepatotoxicity |
| which medication do you want to avoid in patients with a history of bladder cancer? | pioglitazone |
| which medication can stimulate ovulation | actos |
| MOA of pioglitazone | PPAR gamma agonist that increases peripheral insulin sensitivity |
| what are the warnings to using actos | fractures, increased ovulation, increased risk of bladder cancer, edema, hepatic failure |
| what is the drug interaction between gemfibrozil and actos | gemfibrozil is an inhibitors therefore it will increase actos levels |
| what is the most common side effect of welchol | constipation |
| what dopamine agnost is CI in patients with syncopal migraines due to it causing hypotension and orthostatis | bromocriptine |
| Why is bromocriptine CI in patients who are postpartum and/or breastfeeding? | inhibits lactation |
| what is pramlintide | an amylin analog (SC injection) |
| what is the significant risk with using pramlintide | hypoglycemia risk. must reduce mealtime insulin dose by 50% when starting |
| which rapid acting insulin is CI in any lung disease | Afrezza |
| what type of test does Afrezza require? | requires lung monitoring with pulmonary function tests (FEV1) |
| what type of insulin is preferred for IV infusions? | regular insulin |
| IV regular insulin should be prepared in what type of container | a non-PVC container |
| which type of insulin is recommended when patients require >200 units of insulin per day? | humulin R U-500 |
| which insulin is dosed BID and causes more hypoglycemia? | NPH (Humulin N) |
| which insulin is an option when >20 units/day of insulin glargine are needed? | TOUJEO |
| when does Toujeo reach its max effect | by the 5th day |
| which insulin would be useful when glargine causes nocturnal hypoglycemia | insulin degludec (Tresiba) |
| when should you must reduce insulin by 50% | must reduce mealtime insulin by 50% when starting pramlintide to avoid severe hypoglycemia |
| hypoglycemia is defined as what | BG <70 |
| how to treat hypoglycemia if conscious | 15-20 grams of glucose or simple carbs |
| what if a person is unconscious from being hypoglycemic, what do you do ? | treat with dextrose (if there is IV access) or with glucagon |
| can alcohol cause hypoglycemia | yes especially if taken on an empty stomach. it can cause hypoglycemia when used with insulin or sulfonylurea |
| which medications lower BG? | BB, quinolones, tramadol, linezolid, octreotide, pentamidine, quinidien |
| what are some medications that can increase BG | thiazide & loop diuretics, tacrolimus/cyclosporine, protease inhibitors, statins, olanzapine, steroids, beta-agonists |
Created by:
KaHerre12