Principles
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| 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
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| 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%
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| 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
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| What is the target weight loss in diabetic patients? | 7% of body weight
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| 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%
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| 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
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| What is the recommended treatment for hypoglycemia? | 15-20 g glucose, repeated in 15 minutes if hypoglycemia is still present, followed by a snack
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| What is the preferred first line treatment? | Metformin
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| When should you consider initiation dual hypoglycemic treatment? | A1c >= 9%
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| When should you consider initiating insulin? | A1c >= 10-12%
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| Metformin: brand name | Glucophage
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| Metformin: BBW | Lactic acidosis
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| Metformin: dosing | 500mg bid with meals titrated to 1000mg bid after 1-2 weeks
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| Metformin: dosing adjustments | GFR < 45 decrease dose to 500mg bid, GFR < 30 contraindicated
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| Metformin: class | biguanide
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| Metformin: MOA | Decreased hepatic glucose production, decreased intestinal absorption of glucose, improved insulin sensitivity
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| Metformin: AEs (4) | diarrhea, nausea, vomiting, flatulence
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| Glimepiride: brand name | Amaryl
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| Glimepiride: dosing | 1-2mg daily with biggest meal titrated to max of 8mg daily
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| Glimepiride: dosing adjustments | renal impairment start at 1mg daily and adjust carefully, use with caution in hepatic impairment
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| Glimepiride: class | sulfonylurea
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| Glimepiride: MOA | Stimulates insulin release from the pancreatic beta cells; reduces glucose output from the liver; insulin sensitivity is increased at peripheral target sites
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| Glimepiride: AEs (2) | hypoglycemia, nausea
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| Glipizide: brand name | glucotrol
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| Glipizide: dosing | 2.5-5mg daily before breakfast titrated to a max of 40mg daily
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| Glipizide: dosing adjustments | no renal adjustment, in hepatic impairment start with 2.5mg daily
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| Glipizide: class | sulfonylurea
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| Glipizide: MOA | Stimulates insulin release from the pancreatic beta cells; reduces glucose output from the liver; insulin sensitivity is increased at peripheral target sites
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| Glipizide: AEs (3) | nauses, diarrhea, hypoglycemia
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| Glyburide: brand name | Diabeta
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| Glyburide: dosing | 1.5-3mg with first meal titrated to max of 12mg daily
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| Glyburide: dosing adjustments | GFR < 60 use not recommended, no adjustments in hepatic impairment
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| Glyburide: class | sulfonylurea
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| Glyburide: MOA | Stimulates insulin release from the pancreatic beta cells; reduces glucose output from the liver; insulin sensitivity is increased at peripheral target sites
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| Glyburide: AEs (3) | nausea, heartburn, hypoglycemia
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