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what medication has risk for bladder cancer? ✔ Ans - pioglitazone Glucagon Emergency Kit ✔ Ans - Injection requires mixing glucagon powder 1mg / 1mL vial + syringe 1mg Dose 0.03mg/kg or < 6yrs or < 25 kgs (0.5mg) ≥ 6yrs or > 25kgs (1mg) All ages approved SubQ or IM admin Expires in 2 years at room temp. Types of glucagon resue meds ✔ Ans - Baqsimi Gvoke Dasiglucagon (Zegalogue) ACE ✔ Ans - Angiotensin Converting Enzyme Inhibitor Types of ACE inhibitors ✔ Ans - catopril (Capoten) lisinopril (Zestril) quinapril HCL (accupril) ramipril (altace) ARB ✔ Ans - Angiotensin Receptor Blocker
Types of ARBs ✔ Ans - Losartan (Cozaar) Valsartan (Diovan) Irbersartan (Avapro) How to calculate ASCVD risk ✔ Ans - Adults who are 40 to 75 years of age and are being evaluated for cardiovascular disease prevention should undergo 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation and have a clinician-patient risk discussion before starting on pharmacological therapy, such as antihypertensive therapy, a statin, or aspirin. ADA Diabetes and statin recs ✔ Ans - For people with diabetes aged 40-75 years at increased cardiovascular risk, including those with one or more atherosclerotic risk factors, high-intensity statin therapy is recommended to reduce LDL cholesterol by 50% Goal used to by LDL <100, NOW < To achieve that goal, advises "adding ezetimibe or a PCSK inhibitor to maximally tolerated statin therapy." Target BP for diabetes ✔ Ans - 130/ Aspirin recs ✔ Ans - Aspirin should be used infrequently in the routine primary prevention of ASCVD because of lack of net benefit. Can cause increased basal and stimulated release of insulin Statin therapy is first-line treatment for primary prevention of ASCVD in patients with ✔ Ans - -elevated low-density lipoprotein cholesterol levels (≥190 mg/dL) -those with diabetes mellitus, who are 40 to 75 years of age
A large randomized trial in patients who recently had acute coronary syndromes showed that ezetimibe modestly reduced cardiovascular risk over 7 years of follow-up when added to their regimen of moderate-intensity statin therapy PCSK9 inhibitors ✔ Ans - non-statin drug that lower LDL-C by 50% to 60% by binding to PCSK9, inhibiting labeling of LDL receptors for degradation, thus prolonging LDL receptor activity at the cell membrane. Several trials showed that PCSK9 inhibitors reduce cardiovascular risk in patients with stable atherosclerotic cardiovascular disease or recent acute coronary syndromes who are already on moderate- or high-intensity statin therapy. Statin ✔ Ans - HMG-CoA reductase inhibitor Fish oil ✔ Ans - omega-3 fatty acids ✔ Ans - polyunsaturated fatty acids commonly found in fish oils that are beneficial to cardiovascular health only icosapent ethyl can be linked to CVD risk reduction based on REDUCE-it trial Gemfibrozil and statins ✔ Ans - Gemfibrozil inhibits glucuronidation of statins, resulting in statin accumulation and increased risk of rhabdomyolysis. Should not be rx together glucuronidation ✔ Ans - process in which a hydrophilic glucose derivative is attached to a highly lipophilic drug to make it more hydrophilic rhabdomyolysis ✔ Ans - dissolution of striated muscle (caused by trauma, extreme exertion, or drug toxicity; in severe cases renal failure can result)
lipophilic ✔ Ans - Having an affinity for or an attraction to fat and oils (oil-loving). Hydrophilic ✔ Ans - Attracted to water Why are ACE and ARBs recommended for diabetes? ✔ Ans - because of their ability to preserve kidney function Hydrochlorothiazide ✔ Ans - is first line medication to treat HTN, however for people with insulin resistance needs to be limited <25 mg to avoid worsening insulin resistance peripheral arterial disease and symptoms ✔ Ans - blockage of arteries carrying blood to the legs, arms, kidneys and other organs Swelling and redness when the feet hang down are signs of poor circulation and peripheral artery dx 5-10% wt loss affect on lipids ✔ Ans - positive affect on TGL and HDL no positive affect on LDL and total cholesterol methlydopia ✔ Ans - antihypertensives Can statins be used in pregnancy? ✔ Ans - No, category X Catagory X drugs are? ✔ Ans - Contraindicated, risks outweigh the benefits. How to check accuracy of a BG meter IN OFFICE ✔ Ans - BG meter results should be compared to a fasting laboratory value, not another glucose meter. Only FBG levels should be compared because postmeal values will differ between the capillary blood (as measured on the meter) and the venous blood (as measured in the lab). test must be done at the same time
Obese BMI: 15# 5 phases of normal fuel homeostasis ✔ Ans - 1. Insulin inhibits breakdown of glycogen and TGL reservoirs. Excess glucose is stored in hepatic, muscle, adipose, and other tissue.
- Preabsorptive state: blood glucose originates from glycogen breakdown and hepatic gluconeogenesis. Plasma insulin levels decrease, and glucagon levels begin to rise. Energy storage ends and energy production begins. CHO and lipid stores are mobilized. Hepatic glycogen breakdown provides maintenance of plasma glucose and ensures an adequate supply of glucose for the brain and other tissues. Adipocyte TGL begin to break down and FFA are released into circulation,. and used by the liver and skeletal muscle as a primary energy source and as a substitute for gluconeogenesis. The brain cont to use glucose provided mainly be gluconeogenesis, because of its inability to use FFA as fuel.
- Counterregulatory hormone secretion is stimulated
Islet cell antibodies ✔ Ans - nonspecific markers of autoimmune disease of the pancreas can distinguish between T1 and T EXAMPLES: CMS (Centers for Medicare and Medicaid Services) reimbursement for DSME ✔ Ans - 10 program hours for initial 2 hours of annual CDC dental recs for DM ✔ Ans - visit q 6 months and more often if they have periodontal dx
How long do TZDs take to work? ✔ Ans - 8-12 weeks ADA Standards of medical care: Confirming BP ✔ Ans - if sys >/=140 OR dias >/=90, BP should be confirmed on a separate day. If repeat significant for high blood pressure, dx of HTN is confirmed. Should have prompt initiation of pharmacologic agents and lifestyle therapy Cellulitis ✔ Ans - diffuse inflammation of the deeper layers of the skin, dermis, and subcutaneous tissue that occurs as a result of diabetic cutaneous infection Most commonly affects the face and limbs Can go unnoticed in pts with neuropathy Necrotizing fasciitis ✔ Ans - fulminant infection of the skin and fascia that is caused by a mixture of aerobic and anaerobic organisms. The infection results in extensive tissue destruction, thrombosis of blood vessels and sepsis onychomyosis ✔ Ans - fungal infection of the nail zygomycosis ✔ Ans - fungal infection that starts in the naxal passage but may spread to the orbits and the brain Infections that happen more commonly in DM ✔ Ans - Cellulitis, necrotizing fasciitis, onychomycosis Sources of monounsaturated fats ✔ Ans - olive oil, canola oil, peanut oil, avocados avocados, almonds, pecans, and peanuts
Goal is to focus on moderate intensity exercises and increasing duration and frequency over time What are the four critical times to assess, adjust, provide, and refer individuals to DSMES ✔ Ans - 1) diagnosis
- annually
- when new complicating factors influence self-management
- when traditions of care occur (change in living situations, medical care team, insurance coverage resulting in treatment change as well age-related changes affecting cognition, self care, etc.) Emergency insulin use ✔ Ans - if no power, it is acceptable to use unrefrigerated and/or expired insulin A woman with T1DM notes that her BG prior to 1 hr step aerobic class is 278. She has not taken any insulin since her last mealtime bolus. What is the most appropriate action? ✔ Ans - Check for urine ketone, and continue only if ketones are negative. Worsening of hypoglycemia and ketosis can occur in the presence of absolute insulin deficiency. As a rule of thumb, ketone levels should be checked with a BG of >250. If ketones are present in moderate to large amounts, then the elevated glucose amounts are a result if insulin deficiency and corrective action should be taken immediately. In the absence of moderate to large ketones, this value should not propose a medical threat. Acceptions to group coverage for medicare ✔ Ans - No group session is available w/i 2 months of the date ordered The individual has severe vision, language, or hearing limitations or other conditions identified by the treating provider How to treat hypoglycemia for someone taking acarbose? ✔ Ans - Low fat or skim milk
Acarbose inhibits the enzyme alpha-glucosidase, which is responsible for breaking down complex carbohydrates in the proximal portion of the small intestine. Lactose is not affected by acarbose, so milk is absorbed at normal rate What medications improve insulin sensitivity in skeletal muscle? ✔ Ans - TZDs Which medications delay absorption of glucose in the GI tract? ✔ Ans - alpha-glucosidase inhibitors Which medications increase insulin secretion from the islet cells in the pancreas? ✔ Ans - SUs and meglintides Which medications are likley to cause hypoglycemia? ✔ Ans
- SU, meglintinides, insulin QI process ✔ Ans - a systematic review of process and outcome data to measure the effectiveness of the education and support and looks for ways to improve any identified gaps in service or service quality A 32 year old woman with PCOS and newly dx T2DM begins pioglitazone plus metformin. Initial medication counseling should include.. ✔ Ans - Use of contraception Metformin can restore normal glucose which enable PCOS women to get pregger Classes of heart failure ✔ Ans - Class I-- no limitation of physical activity, no pulmonary edema Class II-- slight limitation of physical activity, comfortable at rest; physical activity causes symptoms Class III-- marked limitation of physical activity Class IV-- symptoms at rest, poor prognosis
rate decline. For those on dialysis, higher protein may be required Normal BP ✔ Ans - 120/ Elevated BP ✔ Ans - 120-129/< HTN Stage 1 ✔ Ans - 130-139/80- HTN stage 2 ✔ Ans - 140/ HTN crisis ✔ Ans - 180/ Most common autoimmune disease for T1DM ✔ Ans - Thyroid dx with an incidence of about 17% Why can vision change depending on BG? ✔ Ans - Osmotic changes in the lens GDM stats ✔ Ans - 7% of all pregnancies in the US Approx 50% have no risk factors or symptoms Glycemic goals for pregnant woman with preexisting diabetes ✔ Ans - Same for those without diabetes FBG < 1-hr post meal < 2-hr < A1C <6% T2DM pregnancy activity recs ✔ Ans - 30 min of moderate intensity activity most days, if not every day. Exercise should be avoided with BG > insulin requirements during pregnancy ✔ Ans - Needs are increased in late gestation
Insulin resistance tends to increase in GDM, causing requirements to be similar to T2DM Insulin requirements do not decline until after pregnancy Dawn phenomenon ✔ Ans - an increase in blood glucose in the early morning, most likely due to increased glucose production in the liver after an overnight fast Dawn phenomenon treatment ✔ Ans - Increase basal insulin OR Change time of injection of evening intermediate-acting insulin from dinnertime to bedtime Symogi effect ✔ Ans - rebound hypoglycemia ✔ Ans - low blood sugar caused by a sudden dropping in intestinal carbohydrate load, leaving the body with inadequate time to drop insulin secretion How long is 70/30 good at room temp ✔ Ans - 10-14 days Alterable risk factors for retinopathy ✔ Ans - Glucose control is #1 followed by BP management Which medication is approved for pediatric and at what age? ✔ Ans - IR Metformin > What medication decreases risk of hospitalization for those with heart failure? ✔ Ans - Empagaflozin DRI for CHO in pregnant women ✔ Ans - 175 g/day (normal
Which medications increase insulin sensitivity? ✔ Ans - TZD, metformin
problem solving through interp of BG patterns Insulin adjustments DSME education algorithm ✔ Ans - Action steps at dx for DSME ✔ Ans - review meds emphasis risk reduction develop personal strategies to address psychosocial issues Action step at dx for provider ✔ Ans - When to start a high intensity statin ✔ Ans - Clinical ASCVD LDL > ASCVD >20% Diabetes age 40-75 with multiple ASCVD risk factors PA recommended for those with peripheral neuropathy ✔ Ans
- non-wt baring activities (swimming, seated) Moderate walking high impact, wt baring exercises like aerobics are not recommended recs for pneumonia vaccine ✔ Ans - All adults at 65+ DM are at increased risk, more so if they have CVD, pulmonary, or renal dx 1 dose of PPSV23 is rec between ages 19-64 w/ 2nd dose at 65+ (must be at least 5 years between doses Common complications with GDM ✔ Ans - Macrosomia, neonatal hyperglycemia, shoulder dystocia
**Not fetal malformation though. This is more common with those with hyperglycemia in 1st 8 weeks of permanency. Retinopathy in pregnancy ✔ Ans - Should hold off pregnancy with untreated retinopathy Regression is common after delivery Rapid normalization of BG can cause HTN and worsen retinopathy??
