Questions and Answers
What is the fasting glucose level that indicates diabetes mellitus (DM)?
An A1c level of 5.6 is considered pre-diabetes.
False
What medication should always be first-line for diabetes treatment?
Metformin
Insulin dosing must be coordinated with ______ intake in DM1.
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Which type of insulin is known to control postprandial rise in blood glucose?
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Thiazide or calcium channel blockers (CCB) cannot be used in diabetic patients with hypertension.
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What is the initial recommended A1c target for adjusting insulin dosage?
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The 'Rule of 15' suggests consuming ______ grams of sugar to address hypoglycemia.
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What should be monitored every three months in diabetic patients?
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Match the following insulin types with their characteristics:
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Study Notes
Diagnostic Criteria and Pre-DM
- Fasting glucose ≥ 126, random glucose ≥ 200, or symptoms of DM with A1c ≥ 6.5
- Pre-DM: A1c 5.7-6.4, requires lifestyle modification
Insulin Therapy
- Individualized therapy based on hypoglycemia symptoms, liver/renal distinction, price, A1c lowering ability, and prescribing experience
- Insulin dosing must be coordinated with carbohydrate intake in DM1
- Increase in carbs requires increase in insulin, while missed meal/low carbs requires decrease in insulin
DM with HTN
- ACE or ARB (first choice) can reduce the risk of DM nephropathy
- Thiazide or CCB can also be used
Insulin Types
- Short-acting:
- Lispro (Humalog): controls postprandial rise in blood glucose
- Aspart (Novolog)
- Glulisine (Apidra)
- Regular: slowest of short-acting, can be given IV and inhaled Afrezza
- Intermediate/Long-acting:
- NPH (Humulin N, Novolin N): provides glycemic control between meals and at bedtime, suitable for mixing with short-acting insulins
- Detemir (Levemir): long-acting
- Glargine (Lantus): long-acting, 100 and 300 units available
Hypoglycemia Management
- Conscious patient: use orange juice, ½ can of REAL soda, or glucose tabs
- Rule of 15: 15g of sugar and test in 15 minutes, repeat until blood glucose increases
- After increase, eat fat/protein snack or meal
- Glucose-centric algorithm for glycemic control: refer to sheet
Metformin and Insulin Algorithm
- Metformin should always be first, incorporate lifestyle, and recheck A1c every three months
- Algorithm for adding/intensifying insulin: basal insulin (long-acting), then prandial insulin if not controlled
- A1c ≥ 8%: TDD 0.2-0.3 U/kg, titrate every 2-5 days until under control
Oral Meds for DM2
- Sulfonylureas: stimulate pancreas, hypoglycemia risk, weight gain, and renal toxicity
- Other classes of oral meds for DM2: refer to table
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Description
This quiz covers the diagnostic criteria for diabetes, its therapy and management, including individualized treatment plans and insulin dosing coordination with carbohydrate intake.
