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What is the range for prediabetes for A1C? (__ to ___%)
5.7 to 6.4%
What is the A1C that meets the criteria for Diabetes?
6.5%
You should recommend to your diabetic patient to exercise for 150 minutes/week with no more than ____ consecutive days without physical activity
What is the A1C goal for most patients?
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What is the fast blood glucose goal for diabetic patients?
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What is the 2-hour post-prandial blood glucose goal for diabetic patients?
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Your patient has been taking a medication to help lower their A1C for the past few weeks. Today, the patient's A1C is >1.5% of their goal A1C. What should be considered for this patient?
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What Diabetic medication should your T2DM patient be started on based on their comorbidities?
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What is the first line diabetic medication for lower A1C by decreasing the hepatic production and intestinal absorption of glucose?
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What patient should NOT take Metformin?
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What medication needs to be stopped before or at the time of iodinated contrast imaging procedure (based on eGFR)?
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What is the target daily (max) dose of metformin?
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What patient education can you offer your patient that is starting on Metformin?
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The most common AE for metformin is diarrhea.
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If your patient is maxed of the dose of metformin, but still not at goal, you should add additional agents based on patient specific factors such as cardiorenal risks, weight loss promotion, and cost.
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What medication works in the proximal convoluted tubule by decreasing the reabsorption of filtered glucose (thus increasing excreted glucose in the urine)?
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A patient has been taking their medication for diabetes. They present c/o genital itchiness and burning. They are diagnosed with a genital yeast infection and UTI. What medication are they likely taking?
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There are specific drug warnings for the SGLT-2 inhibitors (FLOZINS). Match the drug with their specific caution/warning.
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A disadvantage to the use of SGLT2i (flozins) is the possibility of Fournier’s gangrene due to recurrent genital mycotic infections.
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What diabetic medication is an agonist to incretins and stimulates insulin release while simultaneously inhibiting glucagon release to lower blood glucose levels?
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A patient is wanting to start a medication in addition to their metformin to help lower their A1C, weight, and cardiovascular risks. They report a history of medullary thyroid cancer in their family. What class of medications can this patient NOT take?
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What medication can help with lowering blood pressure?
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You and your classmates are discussing black box warnings. You know there is a BBW for thyroid C-cell tumors, but are unsure which medication it is for. Which medication does this BBW go with?
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What are adverse effects that are seen with GLP-1 RA (-tides)?
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What monitoring is recommended for GLP-1 RA (-tides)?
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Mounjaro, GIP-GLP-1/RA COMBO, has additional actions of suppression of glucagon secretion during hyperglycemia and increasing fatty acid and glucose uptake by adipose cells. There is increased weight loss and 1-2% A1C lowering with this medication, but what patient should not use this?
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When taking mounjaro, the patient will need backup contraception for 4 weeks after each dose increase if they use oral contraceptive methods.
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What medication works by inhibiting the break down of incretins and therefore indirectly increasing insulin secretion and decreasing glucagon secretion?
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You are telling your patient that the medication that they are starting can cause Nasopharyngitis, URI and reversible Arthralgias, otherwise, it is very well tolerated with very low risk of hypoglycemic events. What medication is being described?
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DPP-4 Inhibitors can be used in patients with renal insufficiency, but should be dosed lower.
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What PPAR-gamma agonist is less commonly used for A1C lowering due to AE of edema, weight gain, and new onset or worsening of heart failure?
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What drug stimulates pancreatic beta cell insulin secretion to help in the lowering of A1C, but is less commonly used today due to AE of hypoglycemia and weight gain?
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What medication can be used for post-prandial control and is best taken with first bite of the meal in order to slow carbohydrate absorption?
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Study Notes
Diabetes Management
- The range for prediabetes A1C is not specified, but A1C ≥ 6.5% meets the criteria for Diabetes.
- The A1C goal for most patients is not specified.
Exercise and Diabetes
- Diabetic patients should exercise for 150 minutes/week with no more than 2 consecutive days without physical activity.
Medication and Diabetes
- If a patient's A1C is > 1.5% of their goal A1C, consideration should be given to adjusting their medication.
- Metformin is the first-line diabetic medication to lower A1C by decreasing hepatic production and intestinal absorption of glucose.
- Patients with severe kidney disease, congestive heart failure, or acute liver disease should not take Metformin.
- Metformin should be stopped before or at the time of iodinated contrast imaging procedure based on eGFR.
- The target daily (max) dose of metformin is 2,000 mg.
- Patient education for Metformin includes staying hydrated, taking with food, and monitoring for diarrhea.
- If a patient is maxed out on the dose of metformin but still not at goal, additional agents should be added based on patient-specific factors.
SGLT-2 Inhibitors (FLOZINS)
- SGLT-2 inhibitors work in the proximal convoluted tubule by decreasing the reabsorption of filtered glucose.
- A disadvantage to the use of SGLT2i is the possibility of Fournier’s gangrene due to recurrent genital mycotic infections.
GLP-1 Receptor Agonists
- GLP-1 receptor agonists stimulate insulin release while simultaneously inhibiting glucagon release to lower blood glucose levels.
- Adverse effects of GLP-1 RA include pancreatitis and thyroid C-cell tumors.
- Mounjaro, a GLP-1 RA, has additional actions of suppressing glucagon secretion during hyperglycemia and increasing fatty acid and glucose uptake by adipose cells.
- Patients with a history of medullary thyroid cancer in their family cannot take GLP-1 RA.
DPP-4 Inhibitors
- DPP-4 inhibitors work by inhibiting the breakdown of incretins and therefore indirectly increasing insulin secretion and decreasing glucagon secretion.
- DPP-4 inhibitors can be used in patients with renal insufficiency, but should be dosed lower.
Other Medications
- Sulfonylureas stimulate pancreatic beta-cell insulin secretion to help in the lowering of A1C.
- Pioglitazone is a PPAR-gamma agonist that is less commonly used for A1C lowering due to AE of edema, weight gain, and new onset or worsening of heart failure.
- Acarbose can be used for post-prandial control and is best taken with the first bite of the meal to slow carbohydrate absorption.
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Description
Test your knowledge on the range for prediabetes in terms of A1C levels. Determine the correct percentage range for diagnosing prediabetes based on A1C tests.
