Diabetes Pharm Quiz - 10/22

difference between type 1 and type 2 DM

type 1 = immune mediated (beta cell destruction) and no insulin produced

• lean body, younger diagnosis, symptomatic

type 2 = progressive and insulin resistance 

• obese, older diagnosis, asymptomatic

diagnostic criteria for DM

A1c of 6.5 or higher

fasting blood glucose of 126 or higher

OGTT 2hr plasma glucose greater than 200mg

random plasma glucose greater than 200 AND classic symptoms of hyperglycemia 

diabetes complications

nephropathy

retinopathy

neuropathy

coronary artery disease

stroke - CVA

peripheral artery disease

hypoglycemia

diabetic foot infections

hypoglycemia and hyperglycemia S/S

hyperglycemia = 3 P

• polyuria

• polydipsia

• polyphagia

• lethargy

• nocturia

• blurred vision

• weight loss

hypoglycemia = MORE DANGEROUS

• dizziness

• shaky

• fatigue

• sweating

• anxious

• rapid heartbeat

• irritability

• headache

• pale skin

• seizure

products used to treat hypoglycemia

15-30 grams of glucose = ½ can soda, 1 cup milk, 1tbs honey/sugar/corn syrup

check blood glucose after 15 min

repeat if still low

eat a complex carb meal 

for level 2 or 3 give emergency glucose - injection OR nasal spray 

HbA1c test

glycosylated A1c → glucose is bound to hemoglobin

a measure of blood glucose over the past 3 months 

treatment goals for diabetes

A1c < 7%

fasting plasma glucose 70-130

2 hr post-prandial glucose <180

oral diabetic medications

insulin secretagogues = sulfonylureas and meglitinides

insulin sensitizers = metformin and TZD

alpha-glucosidase inhibitor

sodium glucose co-transporter 2 inhibitor**

DPP-4 inhibitors **

injectable diabetic medications

GLP1 agonists & GLP1/GIP agonists

amylinomimetic

insulin 

insulin types

*rapid acting - bolus 

short acting

intermediate acting 

*long acting - basal 

how to adjust insulin regimen after reviewing glucose logs

1. check for pattern of hypoglycemia = <70

2. correct fasting glucose = 70-130

3. correct other values = post-pradnial <180

4. ID the insulin to change for desireed effect = pre meal is from insulin prior

principles of correct insulin admin

match vial and syringe

same body part and rotate site