Term
| ___, __, and __ __ __ have a hyperglycemic effect. |
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Definition
- Epinephrine
- glucocorticoids
- oral contraceptive pills |
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Term
| __, ___, and ___ ___ ___ REDUCE secretion of insulin. |
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Definition
- Phenytoin
- Clonidine
- calcium channel blockers |
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Term
| Type II DM pts have w/o tmt have consistently elevated glucose levels. These pts ___ does not rise like normal after a meal, and their ___ is constantly elevated and does not decrease after a meal. |
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Definition
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Term
| What is the mechanism of Metformin? |
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Definition
- decreases hepatic gluconeogenesis
- decreases GI absorption of glucose
- increases glucose uptake by skeletal muscles |
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Term
| Metformin is/is not dependent on beta cell function. |
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Definition
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Term
| What is the mechanism of SU? |
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Definition
| increase insulin release from beta cells |
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Term
| START WITH METFORMIN> (STILL FASTING IS HIGH)> ADD SU> (STILL FASTING IS HIGH)> ADD TZD |
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Definition
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Term
| What is the action of TZDs? |
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Definition
increase insulin sensitivity in muscle, liver, and fat
decrease insulin resistance |
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Term
| What oral agent can increase the amount of beta cells in the pancreas? |
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Definition
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Term
| If T2DM pt is on double/triple therapy, when do you add Glargine (long acting insulin)? |
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Definition
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Term
| When should a SU be discontinued? |
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Definition
| when bolus meal time insulin is started |
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Term
| Metformin does not work as well on lean people as it does on overweight people. |
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Definition
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Term
| When would you start a newly diagnosed T2DM pt on insulin immediately instead of oral meds? |
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Definition
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Term
| What is the key physicochemical property that distinguishes the onset and duration of action of insulin preparations? |
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Definition
SOLUBILITY
(long actings are insoluble) |
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Term
| Exenatide (Byetta) is __ __ __ analoge. It __ secretion of insulin, ___ secretion of glucagon, and has an ___ effect. It can be given as an adjunct to metformin or SU or a combination for T2DM. It is given as __ __ __. |
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Definition
- glucagon-like polypeptide analoge
- increases secretion of insulin
- inhibits secretion of glucagon
- anorectic effect
- twice daily injections |
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Term
| Sitagliptin (Januvia) is a __ __ ___. ___ normally degrades GLP-1 and GIP. GLP and GIP increase insulin release, decrease glucagon release, and delay gastric emptying. This is a __ __ __ agent. |
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Definition
- Dipeptidyl Peptidase Inhibitor
- once daily oral |
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Term
| What drug besides insulin can be used for TIDM and TIIDM? |
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Definition
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Term
| Pramilintide is a __ __ __ that ___ release of __ and __ ___ and decreases __ __ glucose levels. It is given as an adjunct to insulin, but NOT mixed with insulin. It is good for TIDM or TIIDM in pts that require lots of insulin. It has a anorectic effect since it __ __ __. Thus it can result in weight loss. This is __ __ __ and not mixed with __. |
|
Definition
- synthetic amalyin analoge
- suppresses release of glucagon and hepatic gluconeogenesis
- decreases post prandiol glucose levels
- delays gastric emptying
- injected before meals
- not mixed with insulin |
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Term
| __ __ therapy is often used in patients with Type I DM. This is a combo of __ and ___ insulins. |
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Definition
- Split-mixed therapy
- combo of regular(short) and intermediate (NPH or Lente) |
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Term
| What interaction may propranolol have with glipizide? |
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Definition
| Propanolol (beta blocker) can mask the symptoms of hypoglycemia |
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Term
| What interaction may metformin have with morphine? |
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Definition
| Metformin and morphine compete for renal tubular transport for elimination. So a pt on metformin and morphine, will have increased blood concentration of morphine. |
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Term
| Do a random plasma glucose on a patient. It is 167. Whats the diagnsosis? |
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Definition
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Term
| With the monofilament test, you test 10 sites. If pt cannot perceive the monofilament at __ or more sites, they are considered to have neuropathy. |
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Definition
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Term
| To call someone hypertensive, have to have __ separate readings. |
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Definition
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Term
| FIGURE OUT WITH WHAT AIC WHAT GLUCOSE RANGE IS. LOOK THIS UP IN OLD PPTS. |
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Definition
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Term
| With Metformin, you can expect a __ reduction in HbA1c. |
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Definition
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Term
| When you put a patient on a statin, __ function needs to be monitored every ___. |
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Definition
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Term
| Triglycerides should be less than ___. |
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Definition
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Term
Her HbA1c is 7.4
What would you do now? ADD ANOTHER MEDICINE TO LOWER HBAIC MORE. |
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Definition
| Probably not sulfonylurea b/c her fasting is good and these meds effect fasting. Also SU contribute to weight gain, TZDs also contribute to weight gain. |
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Term
| LOOK AT DRUG NAMES OF INSULINS AND OTHER ORALS AND KNOW GENERIC AND TRADE NAMES. |
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Definition
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Term
| How many units of insulin does a patient whose blood sugar is 200 before a meal need? He plans on eating 200 g CHO. |
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Definition
1 unit of insulin lowers blood sugar by 50.
1 unit of insulin covers 15 g CHO.
55/15= 3.6 units for meal
correction dose to lower bs by 75. So 75/50= 1.5 units
3.6 +1.5= 5.1 units of insulin |
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Term
| 2 drugs that may preserve beta cell function? |
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Definition
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Term
|
Definition
- 3 oral meds and A1c still not at goal
- 2 oral meds and A1c far from goal
- any patient with moderate to severe renal impairment (creatinine > 1.5, GFR> 150). |
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Term
Start with 10 units hs
Record fasting sugar readings for next 3 mornings
Add those up and divide by 3--if average is >110, add 3 units (now at 13)
Record next 3 mornings, add up and divide by 3, if >110, add 3 units and so on...
Do this until average is between 80-110 and then hold at that dose
If average gets <80, substr |
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Definition
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Term
I usually tell patients to titrate until their average is 80-110 OR they get to 40 units--whichever comes first
It takes right at 1 month to get to 40 units
Most people end up at 30-50 units
Usually don’t go more than 60-70 units for basal
Numbers will come down slowly so there is a lower risk of hypoglycemia |
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Definition
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Term
Order your next A1c after patient has been on insulin for 3 months
Want fastings <110 and A1c < 7 %
Most patients will reach this goal and will remain on oral meds & basal insulin regimen for a long time
If A1c is high, postprandial sugars are probably to blame
Now time to initiate mealtime insulin |
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Definition
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Term
| Drop the ___ ___ and ___ when you add meal time insulin. |
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Definition
- non-insulin injectables
- SU |
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Term
| Pre-Mixed Insulin Regimen: |
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Definition
Combine a rapid-acting insulin with an intermediate-acting protamine suspension into one injection (usually give bid before breakfast and supper)
Provide mealtime coverage with the rapid and a basal-like supplementation with the intermediate
Intended to simplify dosing and permit less shots per day (2 vs 4) |
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Term
| Basal-Bolus Insulin Regimen: |
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Definition
Uses basal insulin and rapid-acting insulin in separate injections (rapid is given tid before all meals and basal is given qhs)
Patient can achieve tighter control with this method
Requires a more compliant and educated patient |
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Term
Therapeutic lifestyle modifications (TLC)
Low carb diet + exercise + weight loss
Metformin 500 mg 1 tab po bid with meals Metformin 1000 mg I tab po bid with meals
Actos (pioglitazone) 15 mg I tab po qd 30 mg qd
Victoza (liraglutide) 0.6 mg SQ qd1.2 mg1.8 mg
Lantus or Levemir (basal insulin) |
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Definition
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Term
|
Definition
- Fasting: 100-125
- OGTT: 140-199
- A1C: 5.7-6.4 |
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Term
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Definition
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