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Flashcards in Diabetes General Deck (12)
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1

List 4 Common etiologies of Drug-induced hyperglycemia

1. Atypical antipsychotics
- increase hunger
- e.g. olanzapine, aripiprazole

2. Systemic Corticosteroids
- decrease glucose uptake --> insulin resistance

3. Immunosuppressants
- e.g. cyclosporine, tacrolimus, sirolimus

4. Niacin
- insulin resistance, hepatic gluconeogenesis

2

What are the 3 classes of "less common" etiologies causing drug-induced hyperglycemia?

1. Thiazides
2. Statins
3. B-blockers

3

Who should you screen for prediabetes?

Screen pt at risk q 3yrs:
- pt >/= 45yo
- RF: gestational DM, BMI > 25 (>23 in Asian)

4

How do you manage prediabetes?

[A1C 5.7-6.4 or FBG 100-125; on two separate measures]

1. emphasize lifestyle
- eat real food
- wt. loss

2. consider METFORMIN if lifestyle is not enough after 3-6mo

5

How often should you monitor blood sugar for patients who are on non-insulin analogues?

- avoid over monitoring STABLE T2DM w/LOW RISK FOR HYPOGLYCEMIA

** focus daily self-monitoring on:
- newly diagnosed pt
- during acute illness or pregnancy
- after changing meds
- with weight change
- when A1c gets out of desired range

6

What else do you need to be monitoring in diabetic patients in addition to BS/A1C?

- eGFR
- LFTs
- H&H
- Vit B12

7

What are the benefits of lowering A1C?

<7% can further decrease risk of *microvascular* disease (e.g. retinopathy, neuropathy, nephropathy)

- usually younger pt who does not have CVD or hypoglycemia

8

What should be the pharm focus for decreasing macrovascular events related to diabetes?

Focus on BP, lipids, ASA if needed.

- ACEI/ARB
- ASA
- Statin

9

Why do we not need ALL patients A1C to be < 7%?

Some patients may require less intensive glycemic control based on comorbidities.

Lowering A1C TOO FAST or intensive use of DM drugs may increase mortality in older pt w/long-standing DM2 and high CV risk.

10

When are ACEI/ARB indicated in DM pt?

- HTN --> improves CV and renal outcomes

- pt w/macroalbuminuria* to slow kidney disease

- pt w/microalbuminuria* AND normal BP --> does NOT reduce risk of progression to ESRD

11

When is ASA indicated in DM patient?

1. Secondary* prophylaxis against CV events

2. Primary* prophylaxis against CV events --> DM doesn't always trump GI bleeding risk


The typical DM pt who would benefit from ASA:
- most men >50y or women >60y WITH at least 1 CV RF

12

When are Statins indicated in a DM patient?

Use statin for most DM pt at diagnosis*