Goals
Per 2020 ADA guidelines:
Goal A1C = ___
<7%
How often should patients with diabetes get an eye exam?
- DMT2: At diagnosis & annually
- DMT1: Within 5 years after Dx of DM.
Mention 1 MOA and 1 monitoring parameters of Metformin?
~MOA: Prevents gluconeogenesis/glycolysis, increases GLP-1 secretion, inhibits lipid and cholesterol synthesis; also, decrease intestinal glucose absorption
~Monitor: SCr, B12. Also, Lactate if concern for lactic acidosis.
When would you initiate insulin therapy?
~T1DM
~T2DM: Catabolic, symptomatic hyperglycemia or A1C >10% or glycemia > 300 mg/dL
Name 2 microvascular complications with diabetes
1) Retinopathy
2) Nephropathy
3) Neuropathy
Per 2020 ADA guidelines:
For elderly (76 yo) with HF, CKD stage 4 and COPD, what is the HbA1c % goal = _____
< 7.5 to 8.5, life expectancy < 10 years.
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
Complications of insulin use:
- Hypoglycemia, weight gain, lipohyperthrophy, infection in injection site...
Name 2 macrovascular complications with diabetes
1) Cerebrovascular disease
2) Cardiovascular disease
3) Peripheral arterial disease
4) Impaired wound healing
Per 2020 ADA guidelines:
BP goal for diabetic patient = ____
<130/80 mmHg, if can be safely achieved and avoid symptomatic hypotension
Recommended screening for Albuminuria in patients with DMT2: ______
At least annually. If > 30 mg/g Cr or eGFR < 60 ml/min/1.73 m2, should be monitored twice annually.
Name two classes of drugs that should be avoided in patients who are obese and trying to lose weight
1) SFU/Meglitinides
2) Insulin (unless symptomatic from hyperglycemia)
Mention type of basal insulin formulation
- Glargine: Lantus or Toujeo (~36 hrs)
- Detemir: Levemir
- Degludec: Tresiba (up to 42 hours).
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
Recommended minimum time of moderate intensity physical activity per week:
At least 150 min/week of moderate exertion (walking, stain climbing). Increased as tolerated.
When should provider’s avoid prescribing SGLT-2 inhibitors for therapy?
~ Hx of urinary incontinence or frequent UTIs
~ Amputations risk (foot ulcers, PAD, osteoporosis)
~ Risk of DKA (acute illness, eating disorders, ETOH)
Mechanism of action by which Sulfonylureas increase insulin secretion?
Blockage of ATP-sensitive K channels of Beta cells in pancreas, facilitating depolarization and release of insulin.
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 recommended Pre-prandial capillary plasma glucose goal: _______.
(Not pregnant, young, and otherwise healthy individuals)
80-130 mg/dL
Name 3 immunizations indicated for patients with diabetes.
1) PPSV23
2) Influenza
3) Hepatitis B
Which oral anti-diabetic drugs should be discontinued if patient has HF NYHA III-IV? And why?
1) Thiazolidinediones. Because of concern for fluid retention and worsening HF.
Calculate a TDD, basal dose, and bolus dose of insulin naive patient who weighs 90 kg:
TDD: 30 units
Basal: 15 units
Bolus: ~5 units before each meal
Name 1 contraindications of GLP-1 Receptor agonists
1- Personal or family of Medullary Thyroid Carcinoma Thyroid C-cell tumor) or MEN type 2