6024 Mod 11 Diabetes.pdf

○ 100 U most common ● Humalog Mix 75/25 and Novolog Mix 70/30 (analogs); Humulin or Novolin 70/30 ● (insulin NPH + regular premixed insulin) ● Which therapies are expected to have the greatest A1c-lowering effect? ○ GLP1-RA ○ Least? ■ DPP4-I ● What is the difference between Ozempic and Rybelsus, si...

○ 100 U most common ● Humalog Mix 75/25 and Novolog Mix 70/30 (analogs); Humulin or Novolin 70/30 ● (insulin NPH + regular premixed insulin) ● Which therapies are expected to have the greatest A1c-lowering effect? ○ GLP1-RA ○ Least? ■ DPP4-I ● What is the difference between Ozempic and Rybelsus, since both are semaglutide? ○ Rybelsus is the oral version for T2DM; Ozempic is injectable ● Which non-insulin T2DM therapies are injected by the patient? ○ Dulaglutide ○ Liraglutide ○ Semaglutide ○ Exenatide ○ Lixisenatide ● ● ● ● ● ● ● ○ Tirzepatide Which T2DM therapies can be combined? ○ GLP1-RA + basal insulin ○ Metformin + insulin Which drugs are currently approved for pediatric patients with Type 2 DM? ○ Peds should really be managed by endo unless they don’t have access to one ○ Ages > 10 yrs ■ GLP1-RA (Liraglutide, dulaglutide) ■ SGLT2I (empagliflozin) Which patients need to monitor their BG more frequently? ○ When starting or adjusting dose; changing diet/exercise ○ 4-10x/day for T1DM & T2DM with very intensive insulin therapies Why do patients with CGM still need a monitoring device with test strips to check their BG with a fingerstick glucose? ○ Suspicion CGM may be inaccurate ○ Waiting for CGM to warm up ○ In clinical setting where BG levels are changing rapidly Which type of glucose-lowering medication is usually used for treatment of T2DM for a patient who is pregnant? -insulin (NPH, Lispro, Aspart, Detemir) -insulin resistance increased during 2nd & 3rd trimesters & decreases immediately postpartum What are principles of treating acute hyperglycemia related to DM in the hospitalized patient? ○ Regular or rapid insulin 1 unit for every 50 mg/dl over goal ○ Fasting goal: <140 ○ Random goal: <180 ○ Best to have basal or sliding scale insulin ○ Critical pts should be on insulin gtt w/ BG checks Q hr ■ Never lower BG <110 in critical pts ○ DKA or HHS ■ Fluids first, then IV insulin ■ Correct acidosis ■ Replace K+ Which drugs are typically held? ○ Oral agents–metformin/SGLT2-I ● How is hypoglycemia treated ○ Levels: ■ 1st (54–70) ■ 2nd (<54) ■ 3rd (severe w AMS findings) ○ Conscious patient—rule of 15 ○ Unconscious patient–assess ABCs, IV dextrose, D10 infusion, thiamine IV, glucagon IV or IM, steroids w no response to regular tx Pharmacotherapy for obesity ● What are the pharmacotherapeutic options? ○ Phentermine-Topiramate (Qsymia)--has an anti seizure med in it ■ Teratogenic ■ Paresthesia ■ Dry mouth, constipation ■ Tachy; HTN ■ Neuropsych effects ■ Metabolic acidosis ○ Phentermine (Adipex-P) ■ Tachy; HTN ■ Dry mouth, HA, insomnia, restlessness ○ Bupropion-Naltrexone (Contrave)--avoid for pts on opioids bc naltrexone is an antagonist ■ BBW: suicidality ■ Dry mouth, N/V/D/C, HA ■ Neuropsych effects ○ Orlistat (Xenical/Alli) ■ GI: oily spotting, gas with discharge, fecal urgency, incontinence ■ Increased risk of kidney stones ○ Liraglutide (Saxenda) ■ N/V/D; pancreatitis, gallbladder dz; gastroparesis; dehydration; tachycardia ■ BBW: medullary thyroid cancer/multiple endocrine neoplasia type 2 ■ Suicidal ideation ○ Semaglutide (Wegovy) ■ Same as above ● Which obesity medication is available over the counter? ○ Orlistat ● Which medication is only approved for short-term use? ○ Phentermine→ max 12 wks→ schedule IV med for abuse