Term
| What is entailed in 'intensive' insulin dosing? |
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Definition
| ~ 4 shots per day and SMBG frequently, basal AND mealtime insulin |
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Term
| What are the ACE blood glucose goals? |
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Definition
| a1c <= 6.5, fasting/preprandial <110, PPG <140, bedtime no goal given |
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Term
| What are the ADA blood glucose goals? |
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Definition
| a1c <= 7, fasting 70 - 130, PPG < 180, bedtime 110 - 150 |
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Term
| How does a1c equate to mean plasma glucose (mg/dL)? |
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Definition
| MPG = 100 + 35 (a1c - 5) //// this at least works for a1c's 6-12, itf outside this range you are in big trouble |
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Term
| What are the intitials IGT in diabetes? |
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Definition
| impaired glucose tolerance |
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Term
| What are the initials IFG in diabetes? |
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Definition
| impaired fasting gluscose |
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Term
| why is diabetes prevalent in severe psychiatric illness? |
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Definition
| most of these patients are treated with atypical antipsychotics which increase blood glucose and cause weight gain thus precipitaing DM over time. |
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Term
| What diabetic medication is abreviated AGI? |
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Definition
| alpha glucosidase inhibitor |
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Term
| What are the general point of diabetic lifestyle modifications? |
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Definition
| Medical Nutrition Therapy (MNT), Physical fitness program, weight loss |
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Term
| What should be the minimum wieght loss goal for those diagnosed with DM? |
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Definition
| 5 - 7% reduction in body weight (if overwieght) |
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Term
| What does ACE recommend as the screening proceedure for type 2 diabetes? |
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Definition
| fasting plasma glucose (FPG) or 2 hour OGTT (oral glucose tolerance test) |
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Term
| What are the 'high risk' populations that warrant early detection measures for diabetes be taken in those >= 30 years of age? |
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Definition
| PIG DOG SPEFCH DOBB - Previous Impaired Glucose, Darker skinned ethnics (AfAm, AsAm, AmIn, Latin/Hisp, Pac Isler), Overweight, Gestational diabetes history, Sedentary lifestyle, Psychos (severe psychiactric illness), Elevated TG and/or low HDL, Family hx of diabetes, Cardiovascular problems, Hypertension, Delivery Of Big Baby (> 9#) |
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Term
| What is the preferred 1st agent in patients with type 2 daibetes? |
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Definition
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Term
| What are the ACE pharmacological intervention options for therapy naive type 2 diabetics newly diagnosed with a1c range 6 - 7? |
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Definition
Initial therapy preferred: metformin, TZD, AGI, or DPP-4 inhibitor
alternative: glinides, SU (low dose), or prandial insulin |
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Term
| According to ACE what therapy escalation should take place if titrating maximal effective doses of initial therapy fails to achieve a1c < 6.5 for the patient that started at a 6 - 7 range a1c? |
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Definition
| intensify lifestyle modifications, intensify or combine Rx including incretin mimetic |
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Term
| What are the ACE pharmacological intervention options for therapy naive type 2 diabetics newly diagnosed with a1c range 7 - 8? |
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Definition
| combine therapies with preferred metformin, gilinides, AGI, TZD, SU, DPP-4 inhibitor + metformin, colesevelam + (metformin, SU, or insulin) / alternative: prandial insulin, premixed insulin preparations, basal insulin analog |
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Term
| Which dibetic medication drug class(es) is(are) contraindicated in NYHA CHF classes? |
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Definition
| TZDs, NYHA CHF class 3 and 4 |
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Term
| According to ACE what therapy escalation should take place if titrating maximal effective doses of combined therapy fails to achieve a1c < 6.5 for the patient that started at a 7 - 8 range a1c? |
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Definition
| intensify lifestyle modifications, intensify or sombine Rx, including incretin mimetic with SU, TZD, and/or metformin |
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Term
| What are the ACE pharmacological intervention options for therapy naive type 2 diabetics newly diagnosed with a1c range 8 - 9? |
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Definition
| combine therapies to address FPG and PPG: metformin, TZD, SU, glinides, DPP-4 inhibitor, basal insulin analog, prandial insulin, premixed insulin preparations, NPH, other approved combinations |
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Term
| According to ACE what therapy escalation should take place if titrating maximal effective doses of combined therapy fails to achieve a1c < 6.5 for the patient that started at a 8 - 9 range a1c? |
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Definition
| intensify lifestyle modifications, intensify or combine Rx including prandial insulin, incretin mimetic, or amylin analog (with prandial insulin) |
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Term
| What are the ACE pharmacological intervention options for therapy naive type 2 diabetics newly diagnosed with a1c range 9 - 10? |
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Definition
| combine therapies to address FPG and PPG: metformin, TZD, SU, glinides, basal insulin analog, prandial insulin, premixed insulin preparations, NPH, other approved combinations |
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Term
| According to ACE what therapy escalation should take place if titrating maximal effective doses of combined therapy fails to achieve a1c < 6.5 for the patient that started at a 9 - 10 range a1c? |
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Definition
| intensify lifestyle modifications, initiate or intensify insulin therapy or add incretin mimetic |
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Term
| What are the ACE pharmacological intervention options for therapy naive type 2 diabetics newly diagnosed with a1c range >10? |
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Definition
| basal insulin analog or NPH + prandial insulin, premixed insulin preparations |
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Term
| According to ACE what therapy escalation should take place if titrating maximal effective doses of combined therapy fails to achieve a1c < 6.5 for the patient that started at a >10 range a1c? |
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Definition
| intensify lifestyle modification |
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Term
| What are the ACE approved combination therapies to escalate upto when titrating current monotherapy to its limits for those treatment savvy patients who still maintain a a1c in the 6.5 - 7.5 range? |
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Definition
| met + (SU or glinide), met + (TZD or AGI), TZD + SU, DPP-4 + met +- SU, DPP-4 + TZD, colesevelam + (met, SU, or insulin), incretin mimetic + met and/or SU, incretin mimetic + ... |
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