Diagnosis/monitoring parameters
Signs of Hypoglycemia
Tachycardia
Shakiness
Hypertension
Diaphoresis
Decreased plasma glucose
What glucose-lowering medication class has ASCVD and Heart Failure benefits?
Sodium-Glucose Cotransporter 2 (SGLT-2) Inhibitors
How is insulin given?
Subcutaneously (under the skin)
How are lipids being managed in patients with diabetes?
All patients age 40-75 years with diabetes
HMG-CoA reductase inhibitors (statin)
What is the A1C goal for most diabetic patients?
< 7%
Hypoglycemia is an adverse effect of which of the following?
a. metformin
b. glyburide
c. semaglutide
b. glyburide
Insulin is the preferred therapy for what type of diabetes?
What vaccines are recommended for patients who have a history or have diabetes?
Hepatitis B vaccine
Pneumococcal vaccine
Influenza vaccine
COVID-19 vaccine
Glycemic goal for patients with diabetes
Preprandial 80-130 mg/dL
Postprandial <180 mg/dL
Mrs. Picazo is a 45-year-old patient who is newly diagnosed with type 2 diabetes. The doctor initiated 4 different diabetic medications. She comes to the clinic and reports difficulty urinating and a burning sensation upon urinating. She wants to know if any of the medications she is taking caused this. Which medication is most likely the culprit?
a. metformin
b. pioglitazone
c. semaglutide
d. empagliflozin
c. glipizide
d. empagliflozin
Mrs. Finlay visited the clinic today and her glucometer records show that her morning fasting blood glucose is elevated, which insulin dose would you adjust?
a. Bolus insulin before breakfast
b. evening basal insulin
c. Bolus insulin before dinner
d. Bolus insulin before lunch
b. evening basal insulin
Do any of the glucose-lowering agents improve cardiovascular risk? Give examples of those medications, if any.
Yes
SGLT-2 inhibitors
GLP-1 Receptor Agonists
What is recommended for patients who are at risk of level 2 or 3 hypoglycemia?
Glucagon
Onglyza is recommended for patients at risk of heart failure
a. true
b. false
b. false
Saxagliptin (dipeptidyl peptidase-4 inhibitors) may increase the risk of heart failure
How is basal insulin dose initiated in Type 2 diabetes?
Fixed dose: start 10 units once a day
Weight-based: 0.1 to 0.2 units/kg/day
What agent was approved by the U.S. Food and Drug Administration (FDA) for diabetes prevention?
none
How is Hypoglycemia classified?
Level 1: glucose < 70 mg/dL, but > 54 mg/dL
Level 2: glucose < 54 mg/dL
Level 3: "severe event characterized by altered mental and/or physical status requiring assistance for treatment of hypoglycemia"
Mrs. Smith has a past medical history of Type 2 Diabetes and CHF. She is on Metformin 1000 mg twice a day. Vitals are as follows: BP 90/58, HR 65, BMI 28. Which of the following would be the most appropriate treatment to add to metformin?
a. Onglyza
b. Farxiga
c. Ozempic
d. Actos
c. Ozempic
When do we consider insulin over GLP-1 receptor agonist or initiation of insulin?
unusual weight loss
symptoms of hyperglycemia (polyuria, polydipsia, polyphagia)
HbA1c >10%
Blood glucose levels 300 mg/dL or more
Microvascular complications of diabetes
Neuropathy
Nephropathy
Retinopathy