Flashcards in Diabetes General Deck (12)
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
- e.g. cyclosporine, tacrolimus, sirolimus
- insulin resistance, hepatic gluconeogenesis
What are the 3 classes of "less common" etiologies causing drug-induced hyperglycemia?
Who should you screen for prediabetes?
Screen pt at risk q 3yrs:
- pt >/= 45yo
- RF: gestational DM, BMI > 25 (>23 in Asian)
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
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
What else do you need to be monitoring in diabetic patients in addition to BS/A1C?
- Vit B12
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
What should be the pharm focus for decreasing macrovascular events related to diabetes?
Focus on BP, lipids, ASA if needed.
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.
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
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