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Naplex
Diabetes
| Question | Answer |
|---|---|
| Definition of DM | - Decrease insulin secretion - Reduce insulin sensitive |
| Where insulin is produced | - Beta cell in pancreas (moving glucose from blood into body cells for energy: muscle for immediate use, liver as glycogen, fat) |
| Where glucagon is produced | alpha cell in pancrease. It has opposite role vs insulin |
| T1D | Autoimmune destruction of beta cell (body goes into starvation mode, metabolize fat into ketone. --> Diabetic ketoacidosis DKA |
| T1D vs T2D | C-peptide level í very low or absence (undetectable) in T1D |
| What diseases T1D pt need to screen? | - Autoimmune disorder: thyroid, celiac disease |
| What FDA approved med to delay the onset of symptomatic disease in T1D | Teplizumab (Tzield) |
| Metformin is preferred in prediabetes if | BMI > = 35, 25-59 yrs, hx of gastational diabetes |
| When to test GMD (gestational diabetes mellitus) in pregnancy women | - W 24-28 - Oral glucose tolerant test (OGTT): measure Plasma glucose 2 hrs post drinking high sugar liquid |
| Symptoms of DM (3P) | - Polyuria (excessive uritation) - Polydipsia (thirsty) - Polyphagia (hunger / increase appetite) |
| DM diagnosis: pre-diabetes | - A1C: 5.7 - 6.4% - FPG (mg/dL): 100-125 - OGTT 2hr (mg/mL): 140-199 |
| DM diagnosis: diabetes | - A1C: >= 6.6% - FPG (mg/dL): >= 126 - Random PG (mg/dL): >= 200 (incl classic symptoms 3P) - OGTT 2hr (mg/mL): >= 200 |
| Glycemic goals: non-pregnant | - A1C: < 7% - Preprandial (mg/dL): 80-130 - 2hr PPG: < 180 |
| Glycemic goals - Pregnant | - Preprandial (mg/dL): 95 - 1hr PPG: < 140 - 2hr PPG: < 120 |
| Frequently for testing A1C | - 3mo (if not meet goal) - 6 mo |
| Coverting A1C of 6% to estimated average glocose | - 126 mg/mL - 1% = 28 mg/mL |
| Natural product for DM | - Cinnamon - Alpha lipoic acid - Chromium - Mg, ginger |
| MD complication - Microvascular diseases | - Retinophathy - Diabetic kidney disease (nephropathy) - Peripheral neuropathy - Auto neuropathy (ED, gastroparesis, lost bladder control) |
| MD complication - Macrovascular diseases | - CAD (incl MI) - Stroke - PAD |
| Foot care for DM | - Daily - Moisturize (not btw toes), shock & shoes - Each visit - Annual compressive foot exam - Annual by podiatrist: 10-g monofilament test to assess sensation |
| Vaccination for DM | - Annual flu, covid-19 - Pneumococcal, RSV - Hep B (frequently blood glucose monitoring) |
| Meds for DM neurophathy | - Gabapentin, pregabatin - SNRI (duloxetine), TCA, sodium channel blocker |
| Cholesterol control - HIGH intensive statin | - Comorbid ASCVD, LDL goal <55 mg/dL - 40-75 yrs w > 1 ASCVD risk, LDL goal < 70 mg/dL |
| Cholesterol control - MODERATE intensive statin | - 40-75 yrs w /o ASCVD - 20 - 39 yrs w ASCVD risk |
| treatment delay CKD progression for DM pt | - ACE, ARB - SGLT2 - GLP-1 agonist - Finerenone: to maximize tolerant of ACE , ARB) |
| eGFR level to allow starting SGLT2 | >=20 at initiation. However, if pt has been on, ctn until until dialysis or tranplant |
| New diagnose T2D w A1C 8.5-10%, what med | - combination of 2 meds at baseline |
| Insulin should be started at baseline for new diagnosis of T2D if | - A1C > 10% or BG > 300mg/dL - Evidence of catabolism - Hyperglycemia symptoms |
| Duplicate therapy if | - DPP4 w GLP-1 agonist |
| Increasing hypoglycemia | - Sulfonylurea with insulin. SHOULD NOT use together - Meglitinide w insulin. Avoid concurrent use |
| GLP-1 agonist MOA | - Analog of incretin hormone GLP1: increase glucose-dependent insulin secretion, reduce glucagon secretion, slow gastric empty, improve satiety (no) and cause weight loss |
| List of all GLP-1 agonists | - SEMAglutide - DULA glutide - LIRA glutide - EXENA tide |
| SEMAglutide: route, brand name and dose | - Ozempic SC wkly. Staring 0.25mg for 4wks, then increase to 0.5mg. Max dose: 2mg weekly - Wegovy weight loss. SC wkly, PO daily w 4 oz WATER empty sto. 1.5*30d - 4*30d - 9*30d - 25 mgQD - Rylebsus: 3mg * 30 days, increase to 7mg. Max 14 mg QD |
| DULA glutide: route, brand name and dose | - Trulicity SC weekly - Starting dose: 0.75mg - Max dose: 4.5 mg - Available in single-dose pen •0.75mg/0.5mL. • 1.5mg/0.5mL. • 3mg/0.5mL. • 4.5mg/0.5mL. |
| LIRA glutide: route, brand name and dose | - Victoza SC daily 0.6mg * 1 wk, then 1.2mg, max 1.8 mg - Saxenda: 0.6mg* 1wk, 1.2mg*1wk, 1.8mg*1wk, 2.4mg*1wk, 3.0mg * 1 wk |
| EXENA tide: route, brand name and dose | - Exenatide (Byetta): SC 5mcg BID*1mo, max 10mcg, NOT if CrCl < 30 - Exenatide ER (Bydureon BCise): SC 2mg wk, NOT if CrCl < 45 |
| Dual GLP-1 and GIP agonist (twincretin): Tirzepatide | - Mounjaro: SC 2.5mg wkly * 4 wks, then 5mg. max 15 - Zepbound |
| GLP-1 agonist BW | - Thydoid C-cell carcinoma (except Byetta): NOT use if h/x medullary thyroid cercinoma (MTC) or Multiple Endocrine Neoplasia type 2 (MEN2) |
| What GLP-1 agonist is on NIOSH list | Exenatide (Byette, Bydureon) |
| What GLP-1 agonist DON'T have PEN NEEDLES provided | Victoza, Sexanda and Byetta (need a prescription to get them) - (BUT NOT for Bydureon) |
| GLP-1 agonist common SEs | - Weight loss, NAUSEA, vomitting, diarrhea, injection side reaction. Tirzepatide increase HR |
| GLP-1 agonist warining: | Pancreatitis (Risk: gallstone, high TG, alcoholism, AKI, gallbladder disease) |
| GLP-1 agonist caution | - Servere GI disease incl gastroparesis - Pulmonary aspiration (delay gastric empty during general anesthesia, deep sedation) |
| Bydureon BCise SEs | same other GLP-1, plus server injection side reaction (abcess, cellulitis, necrosis |
| GLP-1 agonist DDI | - REDUCE absorption of other drugs due to delay gastric empty - Caution with Narrow Therapeutic Index meds or requires threshold concentration eg ABx, Oral contraception - Tirzepatid - OC: Use non OC 4 wks after initiation or dose increase |
| 32 female Zepbound increasing from 7.5mg to 10 mg, what to counsel? | - Use additional protection on top of OC 4 wks |
| GLP-1 agonist injection sites | - Abdomen - Arm - Thigh - Upper buttock Pinch, pen at 90 degree, hold 5-10 seconds, disposal needle in a sharp container, NOT store PEN w NEEDLE attached |
| SGLT2 inhibitors MoA | REDUCE glucose re-absorption and increase glucose secretion at proximal renal tube |
| List of SGLT2 inhibitors | - EMPA-gliflozin - DAPA-gliflozin - CANA-gliflozin - BEXA-gliflozin - ERTU-gliflozin |
| EMPA-gliflozin: route, brand name and dose | - Jardiance: PO 10 mg QD in the morning (avoid nocturia 2/2 increasing glucose excretion in urine → osmotic diuresis - Max 25mg |
| DAPA-gliflozin: route, brand name and dose | - Farxiga: PO 5 mg QD in the morning - Max 10 mg |
| CANA-gliflozin: route, brand name and dose | - Invokana: PO 100mg QD prior 1st meal - Max 300mg - eGFR 30-59: Max 100mg |
| SGLT2 inhibitor common SEs | - increase URINATION, increase thirst, increase Mg/PO4 |
| SGLT2 inhibitor warning | - Keto-acidosis (Increase risk: acute illness, surgery, dehydration, ketogenic diet. D/C 3-4 prior surgery to reduce risk) - Hypotention, AKI - Genital mycotic infection, UTI - Leg/foot amputation, fracture (cana, bexa) |
| A pt is on SGLT2 inhibitor and will be scheduled for surgery, what is the next step | D/C SGLT2 3-4 days prior surgery to reduce Risk of keto-acidosis |
| Euglycemic diabetic ketoacidosis | Nhiễm toan ceton do đái tháo đường với đường huyết bình thường |
| SGLT2 inhibitors DDI | concurrent use w NSAIDs, RAAS, diuretics: hypotension, AKI |
| Metformin MoA | - Reduce hepatic glucose production - Increase insulin sensitive - Reduced intestinal absorption of glucose - Can be used for pre-diabetes (25-59 yrs, BMI >= 35) |
| Metformin brand, route | - Glucophase, Glumetza, Fortamet, Riomet - IR: 500, 850, 1000mg - ER: 500, 750, 1000mg - Riomet 500mg/5mL - Max: 2,000-2,550/d - W meal - GI upset (dose titreation) |
| Metformin BW | Lactice acidosis. Risk increase w contrast dye, renal impairment, excessive alcohol, hypoxia (thiếu оху), select med (topiramate) |
| Metformin CI | - eGFR < 30 - Acute or chronic metabolic acidosis |
| Metformin warning | - Not start if eGFR 30-45 - Vit B12 deficiency (peripheral neuropathy, cognitive impairment |
| Metformin SEs | - Diarrhea, NAUSEA, flatulence, cramping (transient, resolved over time) - Weight neutral - Lingering metallic taste |
| A T2D pt who is on Metformin will be scheduled for CT scan with lodinated contrast, what will be the next step | D/C metformin prior procedure, restart 48hrs after if eGFR is stable |
| Insulin secretagogues | - Sulfonylurea - Meglitinides |
| Sulfonylurea meds | - Glipizide (Glucotrol XL) - Glimepiride (Amaryl) - Glyburide (micronized: Glynase) |
| Sulfonylurea meds CI | - Sulfa allergy |
| Sulfonylurea warning | - Hypoglycemia (increase risk w short acting med e.g glypizide) - NOT in BEER list |
| Sulfonylurea SEs | - Weight gain, NAUSEA - Reduce efficacy after long term use (pancretic beta cell function declines) |
| Sulfonylurea takes 30 min prior meal | - Glypizide IR - Others: w breakfast or 1st meal - Hold dose if NPO |
| Ghost table (empty shell) in the stool | - Metformin ER - Glucotrol XL (OROS formulation) |
| Meglitinide meds | - Repa--glinide (Prandin) - Nate--glinide (Starlix) - Hypoglycemia - Weight gain - URTIs - Skip dose if skip meal |
| Repalinide DDI | - Gemfibrozil and clopidogrel: increase repaglinide level. CI repa and gemfi - Alcohol concurrence w insulin or insulin secretagogues: hypoglycemia |
| Pt is on insulin secretagogues w SH of alsohol, what risk he is facing | Hypoglycemia |
| DPP4 MoA (Dipeptidyl Peptidase) | - Prevent breaking down incretin hormone incl GLP-1 & GIP. Leading to increase insulin depedent insilin secretion, reduce glucagon secretion - gliptin |
| GLP- 1 inhibitor vs DPP4 inhibitor in term of name | - GLP-1 inhibitor: - GLUTIDE (most, except Exenatide) - DPP4 inhibitor: - GLIPTIN |
| List all DPP4 inhibitors | - SITA - gliptin - LINA - gliptin - SAXA - gliptin - ALO - gliptin All DPP4 is PO QD |
| SITA - gliptin: brand name, dose | - Januvia, Zituvio - 100mg - eGFR 30 - 45: 50 mg - eGFR < 30: 25 mg |
| LINA - gliptin: brand name, dose | - Tradjenta - 5mg - No renal dose adjustment |
| SAXA - gliptin: brand name, dose | - Onglyza - 2.5 - 5 mg - eGFR < 45: 2.5. mg |
| ALO - gliptin: brand name, dose | - 25 mg - CrCl 30-59: 12.5 mg - CrCl < 30: 6.25mg |
| What DPP4 inhibitor w/o renal dose adjustment | - LINA - gliptin / Tradjenta (5mg) |
| DPP4 inhibitors warning | - Pancreatitis - Servere arthralgia (join pain) - Acute renal failure - HF: Saxa & alo (but warning to the CLASS) - Hepatoxicity: Alo |
| DPP4 inhibitor common SEs | - Headaches, nasopharyngitis, URTIs, rash |
| DPP4 inhibitors DDI | - Lina & Saxa: major substrate of 3A4 & P-gp - Caution w 3A4 inhibitors (Itraconazole, clarithromycin) & inducers (rifampin, carbamazepine) |
| Thiazolidinediones (TZD: - GLITAZONE) MoA | Pio - GLITAZONE: PPAR gamma agonist: increase peripheral insulin sensitive - ACTOS - Initial dose: 15-30 mg daily - Max: 45mg |
| Actos (Pio - glitazone) BW | - HF (NOT use if NYHA class III/IV) |
| Actos (Pio - glitazone) warning | - Edema - Fracture - hepatic failure - Stimulate ovulation (un-intentional pregnant) - Bladder cancer |
| Actos (Pio - glitazone) SEs | - Peripheral edema - Weight gain - URTIs - Myalgia |
| Actos DDI | - Major substrate of 2C8 - caution w inducers (rifampin), inhibitors (gemfibrozil) |
| T2D meds w HF warning | - Actos - DPP4 inhibitors (esp Sexa & Alo) |
| T2D meds w PANCREATITIS warning | - DPP4 inhibitors - GLP-1 inhibitors |
| T2D meds w high risk of hypoglycemia | - Insulin - Insulin secretagogues (Sulfonylureas, meglitinide) |
| Alpha-glucosidase inhibitors | - Acarbose - Miglitol - Take w 1st bite of each meal - SEs: flatulence, diarrhea |
| Bile acid binding resins | - Colesevelam (Welchol) - Also indicated for dyslipidemia - Constipation - Separated from other meds |
| Dopamine agonist | - Bromocriptine - NOT concurrent w metoclopramide or other dopamine agonist |
| Amylin analog | - Pramlintide (Symlin): SC - Control postprandial glucose (slow gastric empty) - ok for T1D and T2D - Skip meal, skip dose - Hypoglycemia risk, reduce meal time insulin 50% at initiation - SEs: N/V, anoxeria (chán ăn), weight loss |
| T2D with SE of weight loss | - GLP-1 / GIP inhibitors - SGLT 2 inhibitors - Pramlintide (Symlin) |
| T2D with SE of weight gain | - Insulin - Sulfonylurea - TZD |
| Basal insulin | - Glargine, degludec: fasting glucose - NPH - w P Protamine |
| Rapid acting: Aspart, Lispro, Glulisine | - Aspart (Novolog, Novolog Flex Pen, Fiasp) - Lispro (Humalog, Humalog KwiPen, Admelog, Lyumjev) - Glulisine: Apidra, Apidra solostar - Clear & colorness - Onset 15 mins - Inhale: Afrezza |
| Short acting: Regular | - Novolin R, Novolin R ReliOn - Humulin R - Clear & colorness - Rx & OTC - Onset: 30 mins |
| Insulin warning | - Hypoglycemia - HypoKALEMIA |
| Insulin common SEs | - Weight gain - Lipoatrophy (lost fat) - Lipohypertrophy (accumulate fat) |
| Mix insulin, draw: | - Clear fist (Rapid or Regular 1st) - Cloudy later (NPH later) |
| Insulin: DON'T SHAKE | - Turn suspension (NPH, protamine mix) up and down slowly; or roll btw hand |
| NPH Insulin | - Novolin N, Novolin N ReliOn - Humulin N - Cloudy - Rx and OTC |
| Long acting insulin: Glargine | - Glargine: Lantus 100U/mL, Toujeo 300U/mL, Basaglar 100 U/mL - Clear & colorness - NOT MIX |
| Untra long action insulin: Degludec | - Tresiba 100U/mL - Tresiba flex touch 100U/mL or 200U/mL |
| Premixed insulin | - BID, sometine TID if mix contain rapid acting - % of NPH or protamin listed 1st - Cloudy - Rx and OTC |
| Insulin dose adjustment if initiate Pramlintide (Symlin) SC | - 50% dose reduction (hypoglycemia risk) |
| Insulin dose adjustment if concurrent w DAAs (Hep C treatment) | - 50% dose reduction (hypoglycemia risk) |
| What med if concurrent use w insulin, reduce 50% dose of insulin | - Pramlintide (SC with meal) - DAAs for hep C |
| OTC insulin | - Short/regular, NPH and pre-mix 70/30 of NPH w Regular |
| T2D: Dose of basal insulin once initiation | - 10 U SD QD or 0.1-0.2 U/kg/d |
| T2D: Dose of prandial insulin once adding to basal | 4 U or 10% of basal |
| T1D: initiate insulin dose | - 0.5 U /kg/d (TBW), 50% basal + 50% prandial |
| Adjust basal insulin dose based on | fasting insulin level |
| Adjust mealtime insulin dose based on | - Postprandial level - If preprandial low or high: adj mealtime of the previous dose |
| Insulin to Carb Ratio (ICR) | - Gram of carb covered by 1 unit insulin - Formula: 450 (or 500) divide for total insulin dose - 450: Regular insulin - 500: Rapid insulin (Aspart, Lispro, Glulisine) |
| Correction factor | - Formula: 1500 (or 1800) divide total daily insulin - 1500: regular - 1800: Rapid insulin (Aspart, Lispro, Glulisine) |
| Correction dose | - Formula: (reading BG - target BG) / correction factor |
| Insulin conversion - exception | - NPH BID to Glargin: 80% total NPH - Toujeo to other Glargine: 80% Toujeo 80% of NPH BID or Toujeo |
| Vial insulin | - 10 mL (Most common) - 20 mL (Humulin R U-500) - Toujeo: 1.5mL and 3mL |
| Insulin w BUD 10 days | - Humalog mix 50/50, 75/25 pen (rapid: Lispro) - Humulin 70/30 pen (Regular / Short) |
| Insulin w BUD 14 days | - Humulin N pen (NPH) - Novolog mix 70/30 pen (Aspart Protamin / Aspart) |
| Insulin w BUD 28 days | - Humalog mix 75/25 vial - Humalin R U-500 pen - Novolog Mox 70/30 vial - Novolin R U-100, N, 70/30 pens - Lantus, Basagar, Semglee vial and pen - |
| Insulin w BUD 31 days | Humulin R U-100, N, 70/30 vial |
| Insulin w BUD 40 days | - Humulin R U-500 vial |
| Insulin w BUD 42 days | - Novolin R U-100, N and 70/30 vial |
| Insulin w BUD 56 days | - Toujeo pen - Tresiba pen |
| Pen needle for insulin | - Needle 4-5 mm: NOT pinch - Needle 8mm (most pt): NEED pinch - Gauge: 28-32 |
| Re-suspended NPH or protamin insulin | - Vial: roll btw hands - Pen: invert up and down 4-5 times |
| Prime the pen? | - 2U for each injection |
| Counsel insulin inj | - Pen: 90 degree - Syringe: 90 degree (45 degree if thin) - Count 5-10 seconds - Prick side of fingertips (less painful) w a lancet |
| Hypoglycemia symptoms | BG < 70 mg/mL: dizziness, shakiness, anxiety/irritability, confusion, tremors, palpitation, tachycardia, diaphoresis (sweating), hunger, nausea, headache, ataxia, blur vision - Servere: seizure, coma, death |
| Hypoglycemia treatment - conscious pt | - 15 gram of carb - 8 oz Skim Milk - 4 oz juice - 4 oz regular soda - 1 tablespoon sugar, honey, corn syrup - 3-4 glucose tabs - 1 serving glucose gel |
| Hypoglycemia treatment - UN-conscious pt | - Glucagon 1mg SC (GlucaGen, Gvoke) - Disaglucagon (Zegalogue) - Glucagon nasal spray (Bagsimi) - Place the pt lateral recumbent position - tư thế nằm nghiêng (on their side): protect airway and prevent choking |
| Drugs induced HIGH BG (STOPS CAN GO) | - Thiazide & Loop - Tacrolimus, cyclosporine - Protease inhibitors - Quinolone (hyper & hypo) - Antispychotics (olanzapine, quentiapine) - Statin - Steroid (systemic) - Cough syrup - Niacin - Others: Azole, beta agonist, Octreotide |
| STOPS CAN GO | S = Steroids T = Tacrolimus/Cyclosporine O = Octreotide P = Protease inhibitors S = Statins C = Cough syrup A = Antipsychotics + Azoles N = Niacin G = Quinolones (glucose increase or decrease) O = Other (Thiazides, Loops, ß-agonists) |
| Drugs induced LOW BG "Be Quick To Lower Old People's Sugar" | - Beta blocker (Hypo / hyper) - Quinolone (Hypo / hyper) - Tramadol - Others: Linezolid, Octreotide (Hypo / hyper), Pentamidine, Quinine |
| "Be Quick To Lower Old People's Sugar" | Be = Beta blockers (can mask hypoglycemia; may cause hypo/hyper) Quick = Quinolones (hypo or hyper) To = Tramadol Lower = Linezolid Old = Octreotide (hypo or hyper) People's = Pentamidine Sugar = Quinine |
| in-patient glucose goal | - Non-Critical ill: 100 - 180 mg/mL - Critical ill: 140-180 mg/mL - Oral intake adequate: basal, bolus and correction dose - Rapid acting (Aspart, Lispro, Glulisine) - Regular / short acting |
| DKA | - T1D - BG >= 200 mg/mL - Fruity smell - Abdominal pain - N/V - Metabolic acidosis (pH < 7.3; bicarbonate HCO3 < 18mEq/L, anion gap > 12 |
| HHS | - T2D - Confusion, dilirium - BG >= 600; Serum osmolity > 320 - Extreme dehydration - pH >= 7.3, HCO3 > = 15 - No Ketone - Servere HHS: decrease sodium |
| DKA & HHS treatment | - Fluid for all pt: NS, and Dextrose when BG < 250mg/mL - REGULAR insulin infusion: DKA 0.1U/kg + 0.1U/kg/h continous; HHS 0.05U/kg/h continous |
| What hyperglycemia if REGULAR insulin dose is 0.1U/kg bolus, then 0.1U/kg/h continous infusion | DKA |
| What hyperglycemia if REGULAR insulin dose is 0.05U/kg/h continous infusion | HHS |
| What hyperglycemia if having REGULAR insulin bolus of 0.1U/kg | DKA |
| What hyperglycemis if having no REGULAR insulin bolus | HHS |
| DKA vs HHS in term of REGULAR insulin dose for infusion continuous | - DKA: 0.1 U / kg / h (Plus bolus dose) - HHS: 0.05 U /kg / h |
| What meds to avoid if obesity / weight gain | - Insulin - Sulfonylurea - Meglitinide - TZDs |
| What meds to avoid if renal insufficient (eGFR or CrCl < 30 | - Metformin - Exenatide - Glyburide - Insulin may start at lower dose |
| What meds to avoid if sulfa allergy, servere | - Sulfonylurea (or use w caution) |
| What meds to avoid if peripheral neurophathy, PAD, foot ulcer | - Canagliflozin - Bexagliflozin (leg & foot amputation) |
| What meds to avoid if Osteopenia / Osteoporosis | - Canagliflozin, Bexagliflozin (decrease BMD, fracture) - TZD (fracture) |
| What meds to avoid if pancreatitis | - DPP4 inhibitor - GLP-1 agonist - GLP-1 / GIP agonist |
| What meds to avoid if lactic acidosis | - Metformin - Increase risk of renal impairment, alcoholism |
| What meds to avoid if ketoacidosis | SGLT2 inhibitor (can occur when BG < 250mh/mL) |
| What meds to avoid if hypotension / dehydration | SGLT2 inhibitor |
| What meds to avoid if HYPO kalemia | Insulin |
| What meds to avoid if HYPO glycemia | - Insulin - Sulfonylurea - Meglitinide - Pranlintide (Symlin) |
| What meds to avoid if HF | - TZD - Alogliptin, Saxagliptin (DPP4) |
| What meds to avoid if genital infection, UTI | SGLT2 inhibitor |
| What meds to avoid if gatroperasis, GI disorder | - GLP-1 agonist - GLP1/GIP agonist - Pramlintide (Symlin) |
| What meds to avoid if thyroid cancer (MTC, MEN2) | - GLP-1 agonist - GLP1 / GIP agonist |
| What DM med inj can be shaked | - Brydueon BCise: shake vigorously (look the window to check for drug particles to shake again |
| Thiazolidinediones TZDs - MoA | • Increase Peripheral glucose uptake/utilization • Activates PPARy |
| Metformin titrate dose | - W1: 500mg AM - W2: 500mg AM + 500mg PM - W3: 1000mg AM + 500mg PM - W4: 1000mg AM + 1000mg PM |
| pt w hx of CKD, adherent to metformin and Januvia, but BG is not at goal, Adding GLP1 or SGLT2 | SGLT2 (NOT GLP1 because duplicate therapy w Januvia |
| Insulin for sliding scale | - Aspart - Lispro - Glulisine - R U-100 |
| Treat hypoglycemia caused by Alpha-glucosidase inhibitors (acarbose, miglitol)) | • Use glucose (or dextrose) to treat • Avoid sucrose-based foods (eg, fruit juice) |
| True or false: polycystic ovary syndrome (PCOS) is non-modified risk for T2D | TRUE |
| Humulin 70/30, 50 units in the morning and 40 units at night. If switch to a regimen of lispro and glargine. How many units of glargine? | - NPH BID: apply 80% rule |
| What is interchangable biosimilar to Lantus? | - Semglee - Rezvoglar |
| What Toujeo comes w 1.5 mL and what w 3mL? | - Toujeo ------ SoloStar is U300 and 1.5mL - Toujeo MAX SoloStar is U300 and 3 mL |
| What is used to treat hypoglycemia if pt taking Alpha-glycosidase (Acarbose, Miglitol)? | - Glucose tablet of gel - DON'T treat w sucrose (in fruit juice, table sugar or candy, sugar cube) |
| What are medications increase insulin production? | - Sulfonylureas - Meglitinides - GLP-1 agonists - DPP-4 inhibitors |
| In DKA situation, when to initiate potassium replacement? | - Serum K: < 3.3 mEq/L: Hold insuline, start potassium replacement - Serum K: 3.3-5.2 mEq/L, Start insulin and give potassium (typically 20-30 mEq K/ L of IV fluid). |
| What are the oral agents that are thought to be relatively safe in patients with non-dialysis CKD ? | - Short-acting sulfonylureas (e.g., glipizide) and repaglinide. - The dose for glipizide is 2.5 to 10 mg per day. |
| Glucophage generic | Metformin |
| DiaBeta generic | glyburide (alternative to insulin for pregnancy DM) |
| 1st line T2D | Metformin |
| Glucotrol generic | glipizide |
| Fortamet generic | Metformin |
| Wat is the maximum daily dose of Glucophage? | - 2550mg/day - Glucophage XR: Max dose: 2000 mg QD - Glumetza: Max dose: 2000 mg QD - Fortamet: Max dose: 2500 mg |
| in DM pt, ACE or ARB is preferred if | - Albuminuria - CAD |
| When to start insulin in DM pt | - Cardiovascular disease (CVD) - >40 years of age and have LDL>70 mg/dL. |
| Nesina | Alogliptin (DPP4) |
| Albiglutide (Tanzeum): GLP -1 agonist | |
| Ertugliflozin (Steglatro) | |
| GLP-1 agonists effects | 1. Increase Insulin production 2. Stop liver from making too much glucose 3. Reduce appetite - weight loss 4. Suppressing glucagon secretion and slowing gastric motility 5. Slow down food and glucose absorption |
| What can cause a high anion gap metabolic acidosis? | - Diabetic ketoacidosis - Salicylate toxicity - Lactic acidosis - Renal failure (acute and chronic) - Starvation |
| What factors help type 2 diabetic patients who has with albuminuria increased? | - Blood glucose control - Blood pressure control - Use ACEi or ARBs |
| - FPG ≥126 mg/dL (7.0 mmol/L) - plasma glucose ≥200 mg/dL (11.1 mmol/L) | |
| What diabetes medications improve insulin sensitivity and the ovulation rate in PCOS (polycystic ovary syndrome)? | - Metformin (Glucophage) - Pioglitazone (Actos) |
| Miglitol (Glyset) | |
| What DM meds should be used with caution in patients with advanced heart failure? | - Thiazolidinediones - Metformin (increased risk of lactic acidosis secondary to hypoferfusion) |
| DM risk | - BMI ≥23.0 kg/m2 for Asian Americans - Belonging to certain racial/ethnic groups (e.g., Native Americans) - AND MORE |
| What meds have to be skipped if skip meal | Meglintide: - Miglitol (Glyset) - Repaglinide (Prandin) |
| What sulfonylureas is/are most likely to cause hypoglycemia? | - DiaBeta: Glyburide micronase - Glynase: Glyburide micronized (longest acting) |
| Insulin detemir (Levemir) may be given twice daily | |
| rosiglitazone SEs | - Increased insulin sensitivity - Fluid retention |
| Kazano | - Alogliptin / metformin 12.5 / 1000 (DPP4 / Met) |
| Glucovance | Glucophage and glyburide |
| Cycloset generic | Bromocriptine |
| Cycloset (Bromocriptine) SEs | - Somnolence - Orthostatic hypotension - High BG, high prolactin levels, symtoms of parkinson disease |
| What are bugs responsible for superficial diabetic foot infections? | - Aerobic gram-positive cocci - Staphylococcus aureus |
| Macrosomia | Large fetus |
| What are the safe and effective alternative to insulinfor women with gestational diabetes mellitus who simply refuse to take insulin. | - Metformin - Glyburide (less preferred than metformin) |
| Levimer BUD | - 42 Ds (out fridge) |
| Aspirin (75-162 mg/day) is recommended for ASCVD primary or secondary prevention? | - SECONDARY prevention (eg. post MI) - Primary prevention / diabetes at increased cardiovascular risk (10yr risk >10%): men >50yrs, women >60yrs w 1+ risk factor smoking, HP, obesity, albuminuria, dyslipidemia, or family hx CAD family history of CAD). |
| Should ASA 81 mg initiated for a 61 yrs femal DM pt who smoke | YES, primary prevention for high risk (ASCVD > 10%) |
| Baseline liver function tests should be obtained prior to initiating of what DM meds | - ACTOS / TZD - Medfornin (MoA: Insuline sensitive) |
| DUETACT | Pioglitazone hydrochloride and Glimepiride |
| What medications has indications for both T1D and T2D? | SYMLIN (pramlintide) |
| SYMLIN (pramlintide) contraindicated in - | - Patients with HbA1c >9% - Patients allergic to metacresol - Patients with gastroparesis - Patients on Acarbose - recurrent severe hypoglycemia within 6 months - hypoglycemia unawareness |
| The primary adverse reaction that leads to the discontinuation of pramlintide therapy is | Significant nausea |
| BUD at room for Pramlintide | 30 days |
| Pramlintide T1D dose | Initiate dose at 15 mcg immediately before |
| Pramlintide T2D dose | Initiate dose at 60 mcg immediately before |
| Risk factors for lactic acidosis with metformin: | - Renal insufficiency - Radioactive contrast dye - Hepatitis - CHF - COPD - Excessive alcohol intake |
| Insulin treat gestational diabetes to reduces the risk of | Macrosomia (large fetus) complication in the fetus. |
| Metaglip | Glipizide / Metformin |
| diabetic medications require LFT monitoring | Glucophage Actos (Pioglitazone) Avandia (Rosiglitazone) |
| Symlin causes weight gain | FALSE, it cause weight lost |
| Actos Plus Met | Glucophage / Actos |
| Jentadueto | Metformin / Linaglitin (NOT bold) |
| Janumet | Metformin / sitagliptin |
| Xigduo XR | Metformin / Dapagliflozin |
| Synjardy | Metformin / empagliflozin |
| Segluromet | Metformin / ertugliflozin |
| Trijardy XR | Metformin / empagliflozin/linagliptin |
| Oseni | Alogliptin / pioglitazone |
| Glyxambi | Linagliptin / empaglifiozin |
| Qtem | Saxagliptin/dapagliflozin |
| Steglujan | Sitagliptin/ertugliflozin |
| Xultophy | Liraglutide / insulin degludec |
| Soliqua | Lixisenatide / insulin glargine |
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dao.vo11017