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Diabetes – BCPS (General Info, Oral Agents) – Qs & As
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Diabetes – BCPS (General Info, Oral Agents) – Qs & AsType I DM ✔️Ans - Absolute insulin deficiency caused by beta cell
destruction; immune mediated; 95% have genetic marker of human
leukocyte antigen DR3 and/or DR4
Type 2 DM ✔️Ans - 90-95% of all diabetes; insulin resistance with
progressive insulin secretory defect (insulin deficiency); 50% of adults
have diabetes related complications when diagnosed;
Type 2 DM Risk Factors ✔️Ans - Overweight (BMI 25-29) or Obese (BMI
> 30), AA, hispanic, Native American; physically inactive; hx of gestational
DM opr birth of child > 9 lbs; having pre-diabetes / HTN / high TG (more
than 250) / low HDL (less than 35) / hx of PCOS / hx of cardiovascular dz
DM - diagnosis ✔️Ans - Fasting glucose > 126 on 2 different days OR Sx
of DM with random glucose > 200 OR A1C 6.5% or greater OR 2 hour OGTT
of 200 or more
Gestational Diabetes ✔️Ans - If no risk factors, screen at 24-28 weeks;
screen at first visit if even 1 risk factor (if normal repeat at 24-28 weeks).
Women with hx of Gestational Diabetes should be screened 6-12 weeks
postpartum
Gestational Diabetes Diagnosis ✔️Ans - 75 gram OGTT: 1 hour = 180; 2
hour = 153
Diabetes Type 2- Screening ✔️Ans - Test all adults age 45 and older;
consider testing earlier if risk factors
PRE-Diabetes ✔️Ans - A1C 5.7-6.4%. Recommend weight loss of 7%,
increase in physical activity to at least 150 minutes/week. Use metformin
in those at very high risk of diabetes
DM Type 2 - pathophys ✔️Ans - 1. Relative insulin deficiency
2. Insulin resistance
3. Increased hepatic glucose production
4. Increased gastric emptying rate
, 5. Neuroendocrine dysfunction - decreased amylin secretion and impaired
incretin effect
Treatment Goals ✔️Ans - 1. Eliminate symptoms
2. Prevent short term complications such as hypoglycemia and ketoacidosis
3. Prevent long-term complications
4. Attain glycemic gols (patient specific)
SMBG and A1C goal ✔️Ans - ADA: A1C < 7%, preprandial 90-130,
postprandial < 180
ACE/AACE: A1C < 6.5%, preprandial < 110, postprandial < 140
Diet ✔️Ans - Carbs = 60-70% of calories
Protein = 15-20% of calories
Fat = 10-20% of calories
Injectables (non-insulin) ✔️Ans - Amylin analog (Type 1 & 2)
Incretin mimetics (Type 2 only)
Sulfonylureas ✔️Ans - Lowers A1C 1-2%
Reduces both fasting and postpradial
50% of max dose = 80% of drug efficacy
Sulfonylureas - AE ✔️Ans - weight gain, hypoglycemia, rash, nausea,
photosensitivity, dyspepsia
Sulfonylureas - contraindications ✔️Ans - Diabetic Ketoacidosis, Type 1
DM, Severe liver or kidney dz, hypoglycemia unawareness
Metformin - brand names ✔️Ans - Glucophage, Glumetza, Fortamet,
Riomet
Metformin ✔️Ans - Inhibits hepatic glucose production, improves
peripheral insulin resistance, may decrease intestinal absorption of glucose
in small intestine. No hypoglycemia when used as monotherapy, positive
effects on lipids, weight neutral
Metformin - efficacy ✔️Ans - Reduces A1C 1-2%
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