Goals
Per 2020 ADA guidelines:
Goal A1C = ___
<7%
How often should patients with diabetes get an eye exam?
~At diagnosis
~Annually
What are the MOA's and monitoring parameters of Metformin?
~MOA: Increase sensitivity in liver, muscle, and fat cells; decrease intestinal glucose absorption
~Monitor: SCr, electrolytes, LFTs, HCT/HGB, B12 and lactic acidosis
When would you initiate insulin therapy?
~T1DM
~Patient’s A1C >11%
Name 3 microvascular complications with diabetes
1) Retinopathy
2) Nephropathy
3) Neuropathy
Per 2020 ADA guidelines:
Goal FPG = ____
80-130 mg/dL
Name one exam that patients with diabetes should do daily and why (to prevent what?)
~Check feet
~Why? Diabetic Foot Infection (DFI)
Name two GLP1-RA with CV protective properties
1) Liraglutide
2) Semaglutide
Calculate a TDD, basal dose, and bolus dose of insulin for a patient who weighs 112 kg
TDD: 56 units
Basal: 28 units
Bolus: ~9 units
Name 4 macrovascular complications with diabetes
1) Cerebrovascular disease
2) Cardiovascular disease
3) Peripheral arterial disease
4) Impaired wound healing
Per 2020 ADA guidelines:
2-Hour Post Prandial PG = ____
<180 mg/dL
Patients diagnosed with diabetes need a dilated and comprehensive eye exam at diagnosis, then _____ if retinopathy is present or ______if not.
Name two classes of drugs that should be avoided in patients who are obese and trying to lose weight
1) SFU
2) Meglitinides
For a patient who requires a TDD of 60 units, calculate the ISF and explain what that number means
ISF = 1800/60 = 30
(1 unit of rapid acting insulin will decrease BG by ~30 mg/dL)
What are 4 examples of when a patient should call their doctor regarding their diabetes while they are sick?
1) Glucose remains >300 mg/dL for more than 6 hours or <70 mg/dL after repeated treatment
2) Vomiting and diarrhea for more than 6 hours
3) Dehydrated
4) Confusion, sleepiness, seizures
Patient presents with BP of 165/100 mmHG and Alb/Cr=40.
Per 2020 ADA guidelines, would you start this patient on HTN therapy? If so, give specific recommendation including drug(s) or drug classes.
ACE-I or ARB
+
CCB or diuretic
MNT: In T2DM what would patients need to decrease portions of and what are the goals for exercise?
Decrease portions of: sources of high sugar (carbs and starchy foods); saturated fats and trans fats; sodium
Exercise goals: 30-60 minutes five days per week
When should provider’s avoid prescribing SGLT-2 inhibitors for therapy?
~ eGFR < 30 ml/min
~ Lack of hygiene
~ Hx of urinary incontinence or frequent UTIs
~ Amputations risk (foot ulcers, PAD, osteoporosis)
~ Risk of DKA (acute illness, eating disorders, ETOH)
For a patient who requires a TDD of 70 units, calculate the Insulin:Carb ratio and explain what the number means
I:C Ratio = 500/70 = 7
(needs 1 additional unit of insulin for every 10 grams of carbohydrate consumed)
What are 3 appropriate food/drink options to manage a hypoglycemic event?
~4 glucose tablets
~1 tube of glucose gel
~8 oz of milk
~4 oz of juice
~4 oz regular soda
~2 sugar packets
~15 skittles
Per 2020 ADA guidelines, what is the goal BP for a 55 year old white male with a BP of 130/80 and currently not on any HTN treatment.
Total cholesterol is 200 mg/dL and HDL is 50 mg/dL. Patient is a current smoker and has a PMH of T2DM.
<130/80
(ASCVD risk score >15)
Name 3 immunizations indicated for patients with diabetes.
1) PPSV23
2) Influenza
3) Hepatitis B
Which oral anti-diabetic drugs should be discontinued when a patient has insulin initiated? And why?
1) SFU
2) Meglitinides
Why? Hypoglycemia
Patient KE is currently on insulin therapy and needs help with figuring out her mealtime dose.
Her total daily dose of insulin is 50 units.
Her pre-meal blood glucose is at 350 mg/dL and expected carb intake is 40 grams.
What is her mealtime dose of insulin?
Name 2 contraindications of TZDs
1) Class 3 or 4 HF
2) Liver failure