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administration of Victoza (liraglutide)?
SC once daily
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ADA recommendations on screening adults for T2DM
q3yrs
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urine collection for microalbumin
first thing a.m. specimen
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concerning microalbumin level in T2DM
GT 20 mg/L
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microalbumin should be checked how often in T2DM
at diagnosis and then annually
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routine monitoring when on TZD
ALT
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TZDs work how?
increase insulin sensitivity
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pts on metformin should receive what monitoring to reduce risk of lactic acidosis
creatinine
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uncommon but serious risk of metformin in pts with renal dz, heart dz, and liver dz
lactic acidosis
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Somogyi effect ; treatment
high dose of insulin at bedtime induces hypoglycemia that induces increased glucagon and cortisol production that then induces hyperglycemia in a.m. ; tx by reducing dose of long-acting insulin at bedtime
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where does 80% of insulin mediated glucose uptake take place
muscle
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2 hr GTT result that is dx of T2DM
GT 200
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HDL and triglyceride levels that warrant screening for T2DM in children/ados
HDL LT 35 or triglycerides GT 250
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body shape associated with T2DM
apple-shape because abd fat is associated with insulin resistance
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what dz is often associated with T2DM because insulin resistance is associated with decreased renal uric acid clearance?
gout
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what 2 classes of DM drugs are incretin mimetics?
DPP-4 inhibitors like Januvia (sitagliptin) and GLP-1 agonists like Byetta (exenatide) and Victoza (liraglutide)
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administration of exenatide (Byetta) IR and ER
IR at SC mealtimes ; ER SC once weekly
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how do GLP-1 agonists like Byetta and Victoza work?
incretin mimetics they increase insulin secretion and inhibit glucagon
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What non-insulin DM drugs are administered SC?
the GLP-1 agonists like exenatide (Byetta) and liragluride (Victoza)
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DPP-4 inhibitors like Januvia are being investigated for what adverse effect
pancreatic cancer
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DPP-4 inhibitors have what ending on generic name
-gliptin as Sitagliptin (Januvia) and saxagliptin (Onglyza)
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DPP-4 inhibitors, how do they work
inhibit enzyme that metabolizes incretin, so they are called incretin mimetics. Makes incretin available longer. This increases beta cell prod of insulin and decreases glucagon
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how do TZDs (-azones) work
increase insulin sensitivity
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if patient has a sulfa allergy is there an alt to sulfonylureas with similar action
yes meglitinides like repaglinide
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meglitinides usually taken when
at meal time
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Meglitinides like repaglinide (Prandin) and nateglinide (Starlix) are like what other DM drugs except they act quickly and are used at mealtimes?
like sulfonylureas and also oral but onset is quick and can be used for mealtime glycemic control
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drugs that can increase metabolism of levothyroxine
rifampin ; anticonvulsants
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normal starting dose of levothyroxine for an adult?
75-125mcg
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dx of subclinical hypothyroidism based on what lab results
elevated TSH but normal free T4
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is there goiter in Hashimoto's?
yes but may regress over time
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hypothyroidism can be caused by what meds
lithium, amiodarone
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hypothyroidism associated with what genetic syndrome
Down
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in pancreatic CA pt may have jaundice but will lack hat sx of liver or gallbladder dz
RUQ tenderness
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radiological study for pancreatitis
abd CT
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labs to test for pancreatitis
lipase and amylase
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pancreatitis associated with what diseases
gallstones, etoh abuse, and hypertriglyceridemia
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How to take Orlistat
within 1 hr of a meal
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How hyperinsulemia contributes to HTN
increases renal Na reabsorption and promotes peripheral vasoconstriction
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optimal triglyceride level
LT 150
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effect of high-dose thiazides on lipids
increase
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does hypothyroidism result in increase or decrease in lipds
increase TG and TC
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best 2 classes of lipid drugs for lowering triglycerides
fibrates and niacin
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best lipid drugs for lowering LDL
statins
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best lipid drugs for increasing HDL
niacin
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serious sequela of heat stroke d/t the break down of muscle tissue ; this in turn can lead to what?
rhabdomyolysis ; acute renal failure
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transient electrolyte imbalance in heat stroke
hyponatremia
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transient hematologic condition in heat stroke
polycythemia d/t vol depletion
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why should cooling be controlled and gradual in pt with heat stroke
to avoid vasoconstriction that will inhibit cooling
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What DM meds promote weight loss?
TZDs and GLP-1 agonists like Byetta (exenatide) and Victoza (liraglutide)
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Total cholesterol target of tx
LT 200
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BMI for morbid obesity. Morbid obesity is what class obesity
40+ ; class 3 obesity
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which form of thyroid hormone is converted in peripheral tissues to other form
t4 is converted to t3
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ADA A1c tx goals for those with T2DM
LT 7% for most. 6.5% for those with more risk factors. 8% for elderly and those with risk factors for hypoglycemia.
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2 hr OGTT result that is dx of diabetes
GT=200
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random plasma BG that is diagnostic of diabetes in pt with sx of diabetes
GT/=200
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A1c dx of diabetes
6.5 or higher
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criteria for screening for diabetes in children and ados
start at 10 yo (or at puberty if earlier) and q3yrs if has 2 or more risk factors: obese, ethncity, fh of T2DM, maternal hx of DM
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urination and activity restrictions in pheochromocytoma
void in small amts and avoid full bladder ; avoid bending and compressing abd
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Troussea sign
sing of latent tetany ; bp cuff inflated to GT SBP and left for 3 min. positive if hand contracts ; used to diagnose hypoPTH
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dawn effect
early morning hyperglycemia perhaps resulting from release of cortisol and glucagon
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Somogyi effect
too much insulin taken at night results in rebound hyperglycemia in a.m. as a result of cortisol and glucagon release
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Labs that should be performed before stating anti-thyroid meds
WBC and LFT because of risk of liver damage and agranulocytosis
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How often should a pt with an insulin pump monitor BG
at least qid
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why are DPP-4 inhibitors (e.g. Januvia) and incretin mimetics (Byetta and Victoza) ganing favor over sulfonulureas?
less risk of hypoglycemia
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dietary mods that slow progression of diabetic nephropathy
reduce protein intake
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labs that are indicative of hypoPTH
increased serum and urine phosphates and decreased serum and urine calcium
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why is jogging not recommended exercise for pts with DM
potential nerve damage to feet
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criteria for snacks in T1DM
most anything as long as it aids in maintaining healthy wt
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What med or supp does NOT effect OGTT results
Ca
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ear problem in older pts with DM
malignant otitis externa and risk of progression to meningitis
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what is trismus and what might it be a sign of
tonic contracture of muscles of mastication ; might be a sign of malignant otitis ext
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Which oral DM drugs are safe in prg?
metformin and insulin
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what is the Ferriman-Galwey Scale?
a measure of hirsutism. a score of 8 indicates hirsutism
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after thyroidectomy and euthyroidism is established how often should TSH be checked?
annually
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lifestyle factor that aggravates exophthalmia in Graves Dz
smoking
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Gynecomastia might be a sx of what CA
testicular
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Dermatological sequelae of Cushings Syndrome?
fungal infections
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How do PTU and methimazole tx hyperthyroidism?
inhibit synthesis of thyroid hormone
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what anti-thyroid med blocks secretion and release of thyroid hormone
saturated potassium iodide
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