RX PREP DIABETES

Helpfulness: 0
Set Details Share
created 13 days ago by vodaosu88
1 view
updated 13 days ago by vodaosu88
show moreless
Page to share:
Embed this setcancel
COPY
code changes based on your size selection
Size:
X
Show:
1

What's the difference between type 1 diabetes and type 2 diabetes?

TYPE 1 DIABETES

  • Autoimmune destruction of beta cells
  • Loss of insulin production
  • Patients tend to be thinner, younger.

TYPE 2 DIABETES

  • Develops insulin resistance
  • Insulin production decreases over time
  • Patients tend to be fatter, older
2

What test is used to determine whether or not the patient is still producing insulin?

  • The C-peptide test
3

Describe gestational pregnancy?

  • when diabetes develops during pregnancy.
  • Those that develop gestational diabetes, both mother and child are at risk of developing DM2 later in their lives.
4

How to manage gestational pregnancy?

  1. lifestyle modifications: first line
  2. or add Insulin (preferred).
  3. Metformin and glyburide are also commonly used.
5

2 drugs used for gestational pregnancy?

  • Metformin
  • Glyburide
6

What's the goal for gestational pregnancy?

  • FPG <95 mg/dL (TQ)
  • 1 h post-meal <140 mg/dL
  • 2 h post-meal <120 mg/dL
7

What are the s/s of diabetes?

  • 3P’s (polyuria, polyphagia, polydipsia)
  • blurred vision
  • and fatigue.
8

Who should be screened for diabetes?

  1. > 45 Y/O (regardless of risk factors)
  2. BMI >25 (>23 if Asian American) + 1 risk factor
  3. Children/adolescents with obesity + 1 risk factor
  4. Pregnant women at weeks 24-28 (TQ)
9

What are the risk factors for diabetes?

  • First degree relative with diabetes
  • >25 BMI (or >23 if Asian)
  • HTN
  • Females with polycystic ovary syndrome
10

What are the criteria for Prediabetes diagnosis?

    1. FPG 100-125 mg/dL
    2. 2 h glucose after a 75 g OGTT 140-199 mg/dL
    3. A1C 5.7-6.4%
11

What are the criteria for Diabetes diagnosis?

  • Classic hyperglycemic symptoms/hyperglycemic crisis + random plasma glucose >200 mg/dL (TQ - this is the only one we use with 1 test. All others we must confirm with repeat testing!!!)
  • FPG >126 mg/dL
  • 2 h glucose after a 75 g OGTT >200 mg/dL
  • A1C >6.5%
12

What are some non-drug treatment for diabetes?

  • Smoking cessation
  • Weight loss
  • Nutrition
  • Physical activity
13

What are the goals for weight loss?

  • 3,500 kcal weekly reduction = 1 lb weight loss
  • Waist circumference <35 in for females and <40 in for males (TQ)
14

What are the goals for nutrition?

  • Carbs from vegetables, fruits, whole grains, legumes, and dairy
  • Increased consumption of omega-3 fatty acids and fiber
  • Limit saturated fat, cholesterol, trans fat, and sodium
  • 15 g = 1 serving of carbohydrates (TQ)
15

What are the goals for physical activity?

  • 150 min/week, mod-intensity
  • No more than 2 consecutive days off
  • Resistance training at least 2x/week
16

Name 4 MICROVASCULAR COMPLICATIONS of diabetes?

  1. Retinopathy (most common)
  2. Nephropathy
  3. Peripheral neuropathy
  4. Autonomic neuropathy
17

Name 3 MACROVASCULAR COMPLICATIONS of diabetes?

  1. CAD
  2. CVD
  3. PAD
18

What's the criteria to use

  • Antiplatelet therapy (ASA 75-162 mg/day)?
  1. Primary prevention for ASCVD risk if men/women >50 Y/O with >1 additional major risk factor
  2. Secondary prevention unless contraindicated (in this case, use clopidogrel 75 mg/day)
  3. Use in pregnancy to reduce the risk of preeclampsia. Initiate in the start of the first trimester, and continue until the baby is born.
19

According to diabetes guidelines, how to chose statin intensity?

  • Clinical ASCVD => High Intensity
  • All others => moderate intensity
20

In patients with ASCVD + LDL >70 mg/dL on a max tolerated statin,

what would be next?

card image
  • ADD ON ezetimibe or PCSK9i. (TQ)
21

What's the BP control for diabetic patients?

  • BP goal is <140/90 mmHg for most, but for certain individuals at high risk of CVD (DM, HTN, + ASCVD risk of >15%), <130/80 mmHg is fine.
  • If the patient has albuminuria, ACEI/ARB is first-line.
  • If the patient does not have albuminuria, any option is fine (thiazide, CCB, ACEI/ARB)
  • If the patient has resistant HTN, consider a mineralocorticoid receptor antagonist.
  • It is recommended to take >1 medication at bedtime
22

What vaccines are recommended for diabetic patients?

  • Aside from the other routine vaccinations, keep a closer eye on the following:
  • Hep B (19-59 Y/O unvaccinated adults)
  • Annual influenza injection (start as early as >6 months old)
  • Pneumococcal:

+ 2-65 Y/O = PPSV23

+ >65 Y/O = PCV13, then PPSV23 1 year later

23

What test should be done for neuropathy?

  • Have an annual comprehensive exam (10 g monofilament test + 1 additional test)
  • Visual examination,
24

What's the treatment for neuropathy?

  • duloxetine
  • Pregabalin
25

Besides test for neuropathy (foot care), what other tests, diabetic patients should pay attention to?

  • Diabetic kidney disease (nephropathy):
    • Annual urine test (to detect albuminuria - >30 mg/24 h)
    • Consider ACEI/ARB (see BP care)
  • Retinopathy
26

What are some glycemic targets for diabetic patients?

  1. A1C <7% (A1C - 2) x 30 = average blood glucose (TQ)
  2. Preprandial plasma glucose 80-130 mg/dL
  3. Peak postprandial plasma glucose <180 mg/dL
27

When should we meaure A1C?

(A1C - 2) x 30 = average blood glucose (TQ)

  • A1C should be measured Q3MO if not at goal or if therapy changes.
  • If the patient is at goal and stable, twice a year is fine. (Q6MO)
28

What's the first line treatment for TYPE 2 DIABETES?

First-line therapy = lifestyle modifications + metformin (unless contraindicated)

29

If the A1C >8.5%, what's the treatment

  • Start dual therapy.
30

If the A1C > 10 % (or BG >300 mg/dL), what's the treatment?

  • Start insulin
31

If your patient has ASCVD, what's the treatment?

Add a drug that is proven to reduce major CV events +/- CV mortality

    1. Liraglutide (Victoza, Saxenda)
    2. Empagliflozin (Jardiance)
    3. Canagliflozin (Invokana)
32

If your patient has no ASCVD or CKD,

Add an agent that can minimize hypoglycemia such as...

  1. DPP-4 inhibitors
  2. GLP-1 agonists
  3. SGLT2 inhibitors
  4. Thiazolidinediones
33

If your patient has no ASCVD or CKD,

Add an agent to promote weight loss such as...

  1. GLP-1 agonists
  2. SGLT2 inhibitors
34

If your patient has no ASCVD or CKD,

Add an agent that won’t empty the patient’s wallet such as....

  1. Sulfonylurea
  2. Thiazolidinediones
35

If your patient really has no luck with getting their blood sugar under control, ___

most triple drug therapy combinations are acceptable

36

What drug class are to be avoided in combo?

  1. Metformin + DPP4 inhibitors + GLP-1
  2. Metformin + basal insulin + sulfonylureas
37

Which anti-diabetic drugs

  • ↑ Insulin Secretion
  1. Insulin
  2. Sulfonylureas
  3. Meglitinides
38

Which anti-diabetic drugs

  • ↓Glucose from Liver
  1. Metformin
39

Which anti-diabetic drugs

  • ↓Glucagon to ↓Glucose Production
  1. GLP-1 agonists
  2. DPP-4 inhibitors
  3. Pramlintide
40

Which anti-diabetic drugs

  • Slow Gastric Emptying
  1. GLP-1 agonists
  2. Pramlintide
41

Which anti-diabetic drugs

  • ↑Glucose Excretion
  • SGLT2 inhibitors
42

Which anti-diabetic drugs

  • ↑Insulin Sensitivity
  • TZDs
  • Metformin
43

What's the MoA of BIGUANIDE (Metformin)?

  • Decreases production of glucose, absorption of glucose, and increases insulin sensitivity.
44

Based on the MoA, what drug class should be avoided with Biguanide (Metformin)?

card image

TZDs

  • Pioglitazone (Actos)
  • Rosiglitazone (Avandia)
45

What are the brands of Metformin?

  • Glucophage, Glucophage XR, Fortamet, Glumetza
46

What's the BBW of BIGUANIDE (Metformin)?

  • lactic acidosis
47

What's the contraindications of BIGUANIDE (Metformin)?

  • CrCl <30 mL/min (risk of lactic acidosis), metabolic acidosis
48

What are some warnings of BIGUANIDE (Metformin)?

  • Do not initiate if CrCl 30-45 mL/min
  • D/C in instances of hypoxia
  • Temporarily D/C when receiving IV iodinated contrast
49

What are ADRs of BIGUANIDE (METFORMIN)?

  • NVD, flatulence, abdominal cramping, long-term B12 deficiency
50

Which drug you may see the shell of medication in the stool?

Metformin ER formulation

51

What are agents of

  • MEGLITINIDES?
  • Repaglinide (Prandin)

+ metformin (PrandiMet)

  • Nateglinide (Starlix)
52

Which formulation contains metformin?

  1. Prandin
  2. PrandiMet
  3. Starlix

PrandiMet

= Repaglinide+ metformin

53

What is the MoA of MEGLITINIDES?

  • Stimulates insulin secretion from pancreatic beta cells
54

What's the counseling point meglitinides such as Repaglinide and Nateglinide?

  • Take the medication at most 30 min before meals
55

What are the ADRS of meglitinides such as Repaglinide and Nateglinide?

  • hypoglycemia, mild weight gain, upper respiratory tract infection.
56

What drugs should be avoided with meglitinides such as Repaglinide and Nateglinide?

card image
  • Do not use with sulfonylureas (TQ)
57

What drugs are SULFONYLUREAS?

  • Glipizide (Glucotrol, Glucotrol XL, Glipizide XL)

+ metformin

  • Glimepiride (Amaryl)
  • Glyburide (Glynase)
  • + metformin (Glucovance) - D/C’d in market, but name still used in practice
58

What is the MoA of SULFONYLUREAS?

  • Stimulates insulin secretion from pancreatic beta cells
59

Based on the MoA, what drug class should be avoided with SULFONYLUREAS?

  • Do not use with meglitinides (Repaglinide and Nateglinide) (TQ)
60

What's the counseling point for SULFONYLUREAS?

  • Take with meals (breakfast)
61

What are the ADRS for SULFONYLUREAS?

  • hypoglycemia, weight gain, nausea
62

What are some THIAZOLIDINEDIONES?

Pioglitazone (Actos)

  • + metformin (Actoplus Met, Actoplus Met XR)
  • + glimepiride (Duetact)

Rosiglitazone (Avandia)

63

What's the MoA for THIAZOLIDINEDIONES such as Pioglitazone and Rosiglitazone?

  • Increases insulin sensitivity
64

Based on the MoA, THIAZOLIDINEDIONES should be avoided with which drug class?

card image
  • Metformin
65

What's the BBW of THIAZOLIDINEDIONES such as Pioglitazone and Rosiglitazone?

  • may cause/exacerbate HF
66

What's the contraindication of THIAZOLIDINEDIONES such as Pioglitazone and Rosiglitazone?

  • NYHA Class III/IV HF
67

What are the ADRs of THIAZOLIDINEDIONES such as Pioglitazone and Rosiglitazone?

  • peripheral edema, weight gain, URTIs
68

What are some warnings for THIAZOLIDINEDIONES such as Pioglitazone and Rosiglitazone?

  • Pioglitazone + bladder cancer
  • Risk of macular edema
  • Fracture risk
  • Hepatic failure
  • Resumption of ovulation (TQ)
69

What are some drugs for

SGLT2 INHIBITORS?

  • Canagliflozin (Invokana)
  • Dapagliflozin (Farxiga)
  • Empagliflozin (Jardiance) - approved for ASCVD risk reduction
  • Ertugliflozin (Steglatro)
70

What's the brand name for

Canagliflozin?

  • Invokana
71

What's the brand name for

  • Canagliflozin + Metformin
  • Invokamet, Invokamet XR
72

What's the brand name for

  • Dapagliflozin?
  • Farxiga
73

What's the brand name for

  • Dapagliflozin + Metformin
  • Xigduo XR
74

What's the brand name for

  • Empagliflozin?
  • Jardiance
75

What's the brand name for

  • Empagliflozin + Metformin
  • Synjardy, Synjardy XR
76

What's the brand name for

  • Ertugliflozin
  • Steglatro
77

What's the brand name for

  • Ertugliflozin + Metformin
  • Segluromet
78

What are the MoA of

SGLT2 INHIBITORS?

  • Blocks glucose reabsorption in the PCT to increase excretion
79

Based on the MoA, what drug class should be avoided with SGLT2 inhibitors?

card image

None

It has its own MoA

80

What are the contraindications of SGLT2 INHIBITORS?

  • CrCl <30 mL/min, ESRD, dialysis patients
81

What are the ADRs of of SGLT2 INHIBITORS?

  • hypoglycemia, weight loss
82

What's the ADRs of SGLT2 inhibitors?

  • Genital mycotic infections, hypotension, UTIs, increased LDL, renal insufficiency, ketoacidosis
83

What's the ADRs specific of Canagliflozin (Invokana)?

  • BBW of leg/foot amputations, hyperkalemia
84

What's the ADRs specific of Dapagliflozin (Farxiga)?

  • bladder cancer
85

What are some DPP-4 INHIBITORS?

  • Sitagliptin (Januvia)
  • Saxagliptin (Onglyza)
  • Linagliptin (Tradjenta) - no renal dosing (TQ)
  • Alogliptin (Nesina)
86

What's the brand name for

  • Sitagliptin
  • Januvia
87

What's the brand name for

  • Sitagliptin + Metformin
  • Janumet, Janumet XR
88

What's the brand name for

  • Sitagliptin + Ertugliflozin
  • Steglujan
89

What's the brand name for

  • Saxagliptin
  • Onglyza
90

What's the brand name for

  • Saxagliptin + Metfomin
  • Kombiglyze XR
91

What's the brand name for

  • Saxagliptin + Dapagliflozin
  • Qtern
92

What's the brand name for

  • Linagliptin
  • Tradjenta -no renal dosing (TQ)
93

What's the brand name for

  • Linagliptin + Metformin
  • Jentadueto, Jentadueto XR
94

What's the brand name for

  • Linagliptin + Empagliflozin
  • Glyxambi
95

What's the brand name for

  • Alogliptin
  • Nesina
96

What's the brand name for

  • Alogliptin + Metformin
  • Kazano
97

What's the brand name for

  • Alogliptin + Pioglitazone
  • Oseni
98

What's the MoA of DPP-4 inhibitors?

  • ↓Glucagon to ↓Glucose Production
99

Based on the MoA, which drug class should be avoided with DPP-4 inhibitors?

card image
  1. GLP-1 agonists
  2. Pramlintide
100

What are the ADRs of DPP-4 INHIBITORS?

  • nasopharyngitis, URTIs, UTIs
101

What are the warnings of DPP-4 INHIBITORS?

  • Consider dosage reduction of insulin or secretagogues
  • Acute pancreatitis
  • Arthralgia
  • Saxagliptin and alogliptin = HF
102

What are some

ALPHA-GLUCOSIDASE INHIBITORS?

  • Acarbose (Precose)
  • Miglitol (Glyset)
103

What is the MoA of ALPHA-GLUCOSIDASE INHIBITORS?

  • Delays the absorption of glucose in the gut and inhibits the metabolism of sucrose to glucose + fructose
104

What is the ADRs of ALPHA-GLUCOSIDASE INHIBITORS?

  • GI ADRs (flatulence, diarrhea, abdominal pain)
105

If experience hypoglycemia with ALPHA-GLUCOSIDASE INHIBITORS, do what?

  • use glucose tablets/gel to treat hypoglycemia, NOT sucrose (candy, table sugar, soda)
106

What is BILE ACID BINDING RESIN agent?

What's the ADR?

  • Colesevelam (Welchol)
  • May cause constipation.
107

What are some GLP-1 AGONISTS?

  • Exenatide (Byetta)
  • Liraglutide (Victoza)
  • Dulaglutide (Trulicity)
  • Lixisenatide (Adlyxin)
  • Semaglutide (Ozempic)
108

What's the MoA of GLP-1 AGONISTS?

  • ↓Glucagon to ↓Glucose Production
  • Slow Gastric Emptying
109

Based on the MoA, which drug class should be avoided with GLP-1 AGONISTS? ?

card image
  • DPP-4 inhibitors
  • Pramlintide
110

What's the brand for

  • Exenatide

How is it dosed?

  • Byetta
  • BID
111

What's the brand for

  • Exenatide ER

How is it dosed?

  • Bydureon- weekly
112

What's the brand for

  • Liraglutide

How is it dosed?

  • Victoza daily
  • Approved for ASCVD risk reduction
113

What's the brand for

  • Liraglutide + Insulin degludec

How is it dosed?

  • Xultophy
114

What's the brand for

  • Dulaglutide

How is it dosed?

  • Trulicity - weekly
115

What's the brand for

  • Lixisenatide

How is it dosed?

  • Adlyxin - daily
116

What's the brand for

  • Lixisenatide + Insulin glargine

How is it dosed?

  • Soliqua
117

What's the brand for

  • Semaglutide

How is it dosed?

  • Ozempic - weekly
118

What are the BBW for

GLP-1 AGONISTS?

(all except Byetta and Adlyxin) =

  • thyroid C-cell carcinoma;
  • contraindicated if personal or
  • FMH of medullary thyroid carcinoma or
  • multiple endocrine neoplasia syndrome type 2
119

What are the ADRs for GLP-1 AGONISTS?

  • nausea
  • weight loss
120

When we can NOT inject GLP-1 AGONISTS?

  • Do NOT inject AFTER meals!
121

What are the warnings for GLP-1 AGONISTS?

  • Pancreatitis
  • GI disease, e.g. gastroparesis
  • Byetta and Bydureon not recommended if CrCl <30 mL/min
  • Consider lowering the dose of insulin/secretagogue
122

What's the MoA of Pramlintide (Symlin)?

AMYLINOMIMETIC:

  • Amylin is produced by pancreatic beta cells to control glucose and also slows gastric emptying
123

T/F. Pramlintide (Symlin) can ONLY be given for diabetes type 2?

FALSE.

  • Can be given for both types of diabetes! Given prior to major meals (>250 kcal or >30 g of carbs)
124

What's the BBW for Pramlintide (Symlin)?

  • increased risk of hypoglycemia with insulin.
  • Reduce mealtime insulin by 50% (TQ)
125

What are the ADRs for Pramlintide (Symlin)?

  • N/V, anorexia, hypoglycemia, headache, weight loss
126

T/F.

Insulin are high risk medications! Pens are generally easier to use than vials.

TRUE

  • Most are 100 units/mL (TQ)
127

Rapid-acting insulin is given up to ____

15 min before or immediately after meals

128

What are some rapid-acting insulin?

What are the brands?

  1. Aspart (Novolog, Novolog FlexPen, Fiasp, Fiasp FlexTouch)
  2. Glulisine (Apidra, Apidra SoloStar)
  3. Lispro (Humalog, Humalog KwikPen)
129

Which rapid-acting insulin is available as 200 units/ mL?

  • Lispro (Humalog, Humalog KwikPen) = TQ
130

What's the inhaled insulin? and what's the BBW for it?

  • Afrezza
  • BBW = do not use in patients with chronic lung diseases.
  • Be sure to monitor FEV1; it may drop FEV1 over time.
131

Which insulin is available without a prescription?

  1. Short-acting insulin: Regular insulin (Humulin R, Novolin R)
  2. Intermediate-acting (NPH) insulin: NPH insulin (Humulin N, Humulin N KwikPen, Novolin N, Novolin N ReliOn)
132

Which insulin is 5x as concentrated; used when a patient requires >200 units/day of insulin. (TQ)

Concentrated regular insulin (Humulin R-U500, Humulin R U-500 Kwikpen)

  • Not available OTC!!! Those using these vials must be prescribed the U-500 insulin syringe to prevent overdose!!
133

Name some Intermediate-acting (NPH) insulin and their appearance?

  • NPH insulin (Humulin N, Humulin N KwikPen, Novolin N, Novolin N ReliOn)
  • Has a cloudy appearance.
134

T/F. Intermediate-acting (NPH) insulin can NOT be mixed with other insulin

FALSE.

Can be mixed with rapid and short-acting insulins.

  • Just be sure to draw up clear insulin first before cloudy
135

What are some

  • Long-acting (basal) insulins
  • Insulin detemir (Levemir, Levemir FlexTouch)
  • Insulin glargine (Lantus, Lantus SoloStar, Basaglar KwikPen, Toujeo SoloStar, Toujeo Max SoloStar)
  • Insulin degludec (Tresiba FlexTouch)
136

What long-acting insulin is available as

  • 300 units/mL
  • Toujeo
137

What long-acting insulin is available as

  • 200 units/mL
  • Insulin degludec (Tresiba FlexTouch)
138

Novolog Mix 70/30, Humulog mix 75/25, Humalog mix 50/50

What are the mixed insulins?

  • -log = rapid-acting mixed with NPH
  • A/B → A = basal %; B = rapid-acting %
  • These are also available without a prescription!
139

Humulin 70/30, Novolin 70/30, Ryzodeg

What are the mixed insulins?

  • -lin = short-acting mixed with NPH
  • A/B → A = basal %; B = rapid-acting %
  • These are also available without a prescription!
140

How to calculate

TYPE 1 DIABETES INSULIN DOSING (TQ)?

  • Rapid acting + basal insulin preferred (TQ).
  • If you end up using NPH + regular insulin instead… make sure it’s ⅔ NPH and ⅓ regular.
141

How to calculate total daily dose (TDD) of insulin…

  1. 0.6 units/kg/day using TBW
  2. Divide TDD by 2 (50/50 basal/bolus)
  3. Divide the bolus dose by 3 (3 meals)
142

How to convert convert the insulin:carbohydrates ratio?

  • Rule 500 for rapid-acting insulin
  • Rule 450 for regular insulin
  • The equation is (450 or 500)/ TDD insulin = the # of carbs covered by 1 unit of _______ insulin.
143

How to calculate correction factor (aka how much 1 unit of insulin will decrease the glucose)?

  • Rule of 1,800 for rapid-acting insulin.
  • Rule of 1,500 for regular insulin
  • The equation is (1,800 or 1,500)/ TDD insulin = 1 unit of _______ insulin will drop the blood glucose by this much.
144

How to calculate correction dose?

  • [ (BG now - target BG)/ correction factor] = correction dose
145

What's the starting insulin dose for TYPE 2 DIABETES?

  • Initiate basal insulin when a patient fails to reach goal on multiple oral therapies
  • Starting dose = 0.1-0.2 units/kg/day OR 10 units/day
    • Titrate by 10-15% or 2-4 units 1-2x/week until FBG is at goal
  • If the A1C is still above goal at this time, consider the addition of rapid-acting mealtime insulin or a GLP-1 agonist
146

For insulin conversion, it's....

  • It’s usually 1:1 (unit per unit) for most insulins. There are few exceptions, however…
147

How to convert insulin

  • BID NPH → once daily insulin glargine (Lantus, Toujeo, Basaglar)
  • use 80% TDD NPH as the initial insulin glargine dose.
148

How to convert insulin

  • Daily Toujeo → daily Lantus or Basaglar
  • use 80% TDD Toujeo as the initial Lantus/Basaglar dose
149

What's the preferred site of administration for insulin?

  • The abdomen is the preferred injection site (avoid the belly button!) Other sites include the side of the upper thighs, outer arms, and upper buttocks.
150

Name drugs that can cause hyperglycemia?

  • 2nd gen atypical antipsychotics (e.g. olanzapine, clozapine, quetiapine)
  • CSA, TAC, SRL
  • Protease inhibitors
  • Systemic corticosteroids
  • Fluoroquinolones
  • Beta-blockers
  • Niacin
  • Statins
  • Thiazide and loop diuretics
  • Cough syrups (sugar content)
151

Name drugs that can cause hyPOglycemia?

  • Antidiabetic drugs (esp insulin, sulfonylureas, meglitinides, pramlintide)
  • Linezolid (Zyvox)
  • Lorcaserin
  • Octreotide (DM1)
  • Fluoroquinolones Beta-blockers
  • Pentamidine
  • Quinine
152

Which drug classes can cause both hyper and hypoglycemia?

  • Fluoroquinolones
  • Beta-blockers
153

What's the definition of hypoglycemia?

What are the S/S?

  • blood glucose <70 mg/dL
  • S/S = sweating, pallor, irritability, hunger, lack of coordination, sleepiness
154

What drug class can mask most s/s of HYPOGLYCEMIA EXCEPT hunger and sweating?

Beta-blockers

155

Beta-blockers can mask most s/s of HYPOGLYCEMIA EXCEPT ____

  • hunger and sweating
156

What's the management? for HYPOglycemia?

Rule of 15

  1. Consume 15-20 g of glucose or simple carbs
  2. Recheck blood glucose after 15 min
  3. Repeat if needed to restore normoglycemia
  4. Eat a small meal or snack to prevent recurrence
  • Glucagon (GlucaGen) is only used if the patient is unconscious
157

What's the goal blood sugar in hospital?

  • Maintain blood glucose between 140-180 mg/dL.
158

Describe DIABETIC KETOACIDOSIS (DKA)

  1. More common in ____
  2. BG >___
  3. ___ present (fruity breath due to____)
  4. Lab value___
card image
  1. DM1
  2. 250 mg/dL
  3. Ketones
  4. Anion gap metabolic acidosis (exception = SGLT2)
159

Describe HYPEROSMOLAR HYPERGLYCEMIC STATE (HHS)

  1. More common in ____
  2. BG >___
  3. ___ present (fruity breath due to____)
  4. Lab value___
card image
  • DM2
  • 600 mg/dL
  • NO ketones present
  • High serum osmolality
160

What are the treatment for DKA & HHS?

  1. FLUIDS (NS)
  2. Regular IV insulin (0.1 units/kg BOLUS, then 0.1 units/kg/h INFUSION)
  3. Potassium if needed
161

Room temperature stability of insulin + injectable medications:

THERE'S A HUGE SECTION ON THE NOTE FOR THIS...NOT QUITE SURE HOW TO COMMIT THAT TO MEMORIES