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Chapter 44 Diabetes Key Things to Remember

Terms in this set (76)

A1C and BG goals for adults ADA
A1C <7
Pre- prandial: 80-130
Post prandial: <180
A1C and BG goals for adults AACE
A1C: < (or equal to) 6%
Pre: <110
Post: <140
A1C and BG goals for pregnant women
Fasting < (or equal to) 95
1 hr. post meal < (or equal to) 140
2 hr. post meal < (or equal to) 120
What is the primary treatment for pregnant women with diabetes?
Treat first with lifestyle modification and then insulin is preferred treatment option

Metformin and glyburide can be used but insulin is the preferred option
What is the A1C goal for a pregnant woman?
A1C < 6%
What is the diagnosis criteria for pre-T2DM
Fasting 100-125
2 hr. plasma glucose of 140-199 after 75g OGTT
A1C 5.7-6.4%
What is the diagnostic criteria for T2DM
classic symptoms + random plasma glucose > (or equal to) 200
FPG >126 (no intake for 8 hours)
2 hr. plasma glucose > (or equal to) 200 after 75 g of OGTT
A1C > or equal to 6.5%
When should screening begin for T2DM?
start at age 45
unless BMI is >25 or >23 in Asian americans with atleast 1 risk factor

SHOULD BE repeated every 3 years
What lifestyle modifications can be done for diabetes patients?
150 min of exercise (moderate intensity) per week with no more than 2 consecutive days off

Resistance training at least 2 times per week
What vaccinations should diabetes patients receive?
Annual flu vaccination
Pneumococcal vaccine
hepatitis B vaccine
When should diabetes patients receive eye examinations
Type 2: at diagnosis
Type 1: 5 years within onset

If normal repeat every 2 years
When should diabetes patients receive monofilament examinations?
once annually
What drug treats diabetic retinopathy?
Lucentis (Ranibizumab)
Hyperglycemia symptoms
- Polydipsia (excessive thirst)
- Polyuria (excessive urination)
- Acetone breath
- Increased hunger (Polyphagia)
- Blurred/impaired vision
- Presence of ketones in the urine
What BG level is considered hypoglycemic?
<70 mg/dL
Symptoms of hypoglycemia
- confusion
- mild shakiness
- palpitations
- headache
- lack of coordination
-SWEATING
-Nervousness/Anxiety
Treatment of hypoglycemia
15g CHO from glucose tablets, fruit juice or sugar
wait 15 minutes <70mg give another 15g.
Eat snack of meal after getting back to normal

Rule of 15
pre-diabetic patients should be screened _____.
yearly
Risk Factors for diabetes
overweight, poor diet, little daily exercise, close relative with diabetes, ethnicity (Not Caucasian)
Women who have delivered babies over 9 lbs. or diagnosed with GDM, hypertension, (>140/90), high cholesterol (HDL <35, TG>250), PCOS, History of CVD, current smoker, A1C >5.7%
Microvascular complications with diabetes
-blindness (retinopathy)
-kidney disease (diabetic kidney disease)
-Neuropathy (peripheral and autonomic)
Macrovascular complications with diabetes
Cardiovascular disease
Cerebrovascular disease
peripheral artery disease
What type of disease is Type 1 Diabetes
autoimmune disease
body attacks beta cells and therefore loose ability to produce insulin
What test is used to determine if a patient is producing insulin?
C-peptide test
Metformin can be used in pre-diabetes treatment for patients who are ___________, __________, or ________.
BMI >35 kg/m3
<60 years
women with a history of Gestational Diabetes (GDM)
If a person classifies as being prediabetic, how often should they be monitored for diabetes?
annually
When should patients who are pregnant be screened for T2DM?
initial prenatal visit and 24-28 weeks gestation
____________Americans have a higher risk of diabetes at a lower BMI
Asian
When is a diagnosis confirmed for diabetes?
Must have two abnormal readings on two test (A1C, FPG, OGTT) or
two abnormal readings from the same test on two different occassions
Low carbohydrate diets are not recommended for patients taking __________ T2DM medication
SGLT2 due to increase risk of ketoacidosis
A carbohydrate serving is ________ grams which is one small piece of fruit, 1 slice of bread, 1/3 cup of cooked rice/pasta, or 1/2 cup of oatmeal
15 grams
What medications do the ADA recommend as first line for diabetic neuropathy
pregabalin duloxetine or gabapentin
what drugs are not recommended by the ADA for neuropathy due to safety and addiction concerns but are FDA approved for diabetic neuropathy
tapentadol, tramadol and opioids
How often should diabetic patients be screened for albumin excretion?
annually because it is an indicator of ESRD and disease progression
What drugs are used in diabetic patients who have a urinary albumin excretion of > or = 30mg/24 hours or urine albumin ratio of < or = 30 mg/g
ACE and ARB for kidney protection
If a diabetic patient has hypertension but no albuminuria what HTN medication should they be prescribed
ACE
ARB
CCB
Thiazide
If a diabetic patient has diabetes and albuminuria but not HTN what medication should be prescribed
ACE or ARB
If a diabetic patient has hypertension, diabetes and albuminuria what should they be prescribed
ACE inhibitor
ARB
plus thiazide or CCB if needed in addition
A1C eAG equation
(A1C -2) * 30
What are some drugs that can cause an increase in blood glucose?
Beta blockers
cough syrups
diuretics
immnosuppressants
niacin
protease inhibitors
quinolones
second-generation antipsychotics
statins
systemic steriods
___________ is the leading cause of morbidity and mortality in patients with diabetes
ASCVD
What T2DM medications have proven CVD benefit?
GLP-1 (liraglutide, semaglutide, or exenatide)
SGLT2 (empagliflozin or canagliflozin)

Brand Names
Victoza, Ozempic, Byetta
Jardiance and Invokana
Which T2DM drugs have proven HF and CKD benefit
Invokana and Jaridance
Which T2DM meds can be used to minimize hypoglycemia
DPP4 inhibitors
GLP-1 agonist
SGLT2 inhibitors
TZD
Which T2DM medications promote weight loss
GLP-1 agonist and SGLT2 inhibitors
What T2DM are the most affordable
SU or TZD
IF A1C > _____ start dual therapy
8.5%
If A1C > ______ start insulin therapy
10%
What is an example of 15 grams of carbohydrates?
4 oz. of juice
8 oz. of milk
4 oz. of regular soda
1 tablespoon of sugar or honey
3-4 Glucose Tablets
When should a Glucagon (GlucaGen) be used?
if patient is unconscious or not conscious enough to self-treat
What is the target blood glucose levels for inpatient?
140-180 mg/dL
What is the hyperglycemic crisis seen in T1DM mostly
DKA
What are the recognizing factors of DKA?
- BG > 250 mg/dL
- Ketones (urine and serum, or picked up as "fruity breath"
- Anion gap metabolic acidosis (arterial pH <7.35, anion gap >12)
What is the hyperglycemic crises seen in T2DM mostly?
Hyperosmolar Hyperglycemic State
HHS
What are the recognizing factors of HHS?
- BG: >600 mg/dL
- high erum osmolality >320 mOsm/L
- Extreme dehyrdration
- Altered consciousness (confusion, dizziness, seizures)
- pH >7.3, bicarbonate >15 mEq/L
How do you treat HHS?
Start with NS when BG gets below 200 start D5W1/2NS

Use regular insulin infusion (0.1 unit/kg bolus then 0.1 units/kg/hr continous)

Monitor potassium levels (potassium will shift into cells) can cause hypokalemia

Treat acidosis (only if pH <6.9)
give sodium bicarbonate if needed
Which diabetes medications have the biggest decrease in A1C
Insulin
metformin
sulfonylureas
TZDs
GLP-1s
Which diabetes medications have the greatest risk of hypoglycemia?
insulin
sulfonylureas
meglitinides
pramlintide
Which diabetes medications have cardiovascular benefits?
Empagliflozin
Canagliflozin
Liraglutide
Semaglutide
Exenatide
Which diabetes medications are most likely to cause weight gain?
Insulin
SUs
Meglitinides
TZDs
Which diabetes medications are most likely to cause weight loss?
SGLT2 inhibitors
GLP-1 agonists
prmlintide
Which diabetes medications are the most affordable?
SU
Metformin
TZDs
Which diabetes medications have injection formulations
insulin
GLP-1 agonist
pramlintide
Do not use ______ if eGFR or CrCl is <30
Meformin
SGLT2 inhibitors
exenatide
glyburide
Do not use ____ if you have heart failure
TZDs
alogliptin
saxagliptin
Do not use _______ if you have peripheral neuropathy PAD or diabetic foot ulcers
Canagliflozin
Do not use _____ if yo uhave gastreoparesis or other GI disorders
GLP-1 agonist
pramlintide
Do not use ____ if you have a sulfa allergy
Sulfonylureas
Major risk with Metformin
Lactic acidosis
Vit B 12 def
Major risk with TZDs and alogliptin
Hepatotoxcicity
Major risk with SGLT-2 inhibitors
Hypotension/dehydration
UTI/genitial infection
Major risk with Canagliflozin
hyperkalemia
Major risk with insulin
hypokalemia
Pancreatitis can occur with ______ and _______ (DM meds)
DPP-4 inhibitors
GLP-1 agonists
When BG is > 250 mg/dL _______ can occur with SGLT2 inhibitors
ketoacidosis
Major risk of pioglitazone and dapagliflozin
bladder cancer
Major risk with GLP-1 agonists
thyroid cancer
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