DM LOs

• Rapid acting insulin 


  Mimics the increase of insulin secreted by pancreas in response to a meal

  • Glulisine, Aspart (Novolog), Lispro (humalog), inhaled insulin
• Short acting insulin 


  Mimics increase of insulin secrted by pancreas in response to meal

  • Regular (Humulin R, Novolin R, Relion R)
• Intermediate insulin 


  Mimics continous insulin secretion by pancreas

  • NPH (Humulin N, Novolin N, Relion N)
• Long acting insulin


  Mimics continous insulin secretion by pancreas

  • Detemir (Levemir), Glargine (lantus, Toujeo), Degludec
• What meds are orally administered


  Secretagogues, Sensitizers, DPP-4 inhibitors, Semaglutide
• What meds are parenterally administered

  All insulin products, GLP-1 agonists, Amylin analog
• Dosage forms for insulin

  SubQ is most common, IV used in hyperglycemic emergencies (rapid/short only), insulin pump also available (rapid/short only)
• Proper tx of hypoglycemia

  If BG <70, preferred tx is oral glucose tablets (15-20 g)

  • If BG <70 after 15 mins, ingest another 15-20 g
  • Once normal, consume meal/snack to prevent recurrence
  • If glucose unavailale, use high sugar source (NOT chocolate or high fat candy/food)

  Other options include glucagon (if severe) or IV dextrose (for emergency)
• Sulfonylurea that is preferred in renal disease


  Glipizide
• Sulfonylurea that should be avoided in elderly and renal insufficiency 


  Glyburide
• Identify drug class used to tx diabetes that should be skipped if meal is missed


  Meglitinides = repaglinide, nateglinide

  Pramlintide
• Which med requires 50% reduction in mealtime insulin doses upon initiation


  Pramlintide
• How to improve tolerability / decrease side effects of Metformin


  Take w/ food, titrate slowly, consider switcing to extended release
• Renal dosing requirements related to Metformin


  Obtain GFR annually in all pts, if GFR <45 assess risks of continued use, d/c metformin if GFR <30

  • DO NOT initiate metformin if GFR 30-45
• 2024 ADA and 2023 AACE meds for ASCVD

  SGLT2 inhibitors: Canagliflozin, Empagliflozin

  Long acting GLP-1 agonist: dulaglutide, liraglutide, semaglutide
• 2024 ADA and 2023 AACE meds for Heart Failure

  SGLT2 inhibitors: dapagliflozin, canagliflozin, empagliflozin
• 2024 ADA and 2023 AACE meds for CKD

  SGLT2 inhibitors: dapagliflozin, empagliflzoin

  • Canagliflozin approved for diabetic nephropathy w/ albuminuria >300 mg/day
• 2023 AACE meds for previous stroke/TIA

  Semaglutide, Dulaglutide, Pioglitazone
• T2DM meds if cost is an issue

  Sulfonylureas or TZDs preferred
• T2DM meds when hypoglycemia is a concern

  DPP-4 inhibitors, GLP-1 agonists, SGLT2 inhibitors, TZDs
• T2DM meds when weight is a concern

  GLP-1 agonists or SGLT2 inhibitors preferred
• Meds that are options for gestational diabetes

  Insulin, Metformin, Glyburide
• What patients should be on statin therapy

  All patients w/ DM and ASCVD = high intensity statin

  Diabetics 40-75 y/o = moderate intensity statin
• What patients should be on antiplatelet therapy

  All diabetics w/ hx of ASCVD = aspirin

  Diabetics w/ CAD, PAD, and low bleeding risk = combo of aspirin and low dose rivaroxaban
• Antihypertensive drugs for diabetics

  1st line = ACE and ARBs

  If >130/80 but <150/90 = begin one agent

  If >150/90 = begin two agents, ACE/ARB + CCB/diuretic
• Basal insulin and when to use

  Intermediate or Long acting insulins

  • Target fasting BG levels FIRST w/ basal insulin
• Bolus insulins and when to use

  Short or rapid acting insulins

  • Use SECOND to target postprandial BG or instead, add GLP-1 agonist, DPP-4 inhibitor, or SGLT2 inhibitor
• How to pick starting dose for T2DM pt being started on insulin for the first time (ADA and AACE)

  Choose basal insulin to target fasting BG first (long or intermediate)

  • ADA: starting dose at 10 units/day or 0.1-0.2 units/kg
  • AACE: if A1C <8% then 0.1-0.2 units/kg but if A1c >8% then 0.2-0.3 units/kg
• How to calculate weight based starting dose insulin for T1DM

  TDD of insulin - weight (kg) x 0.5 units = units/day

  • Divide by 2, 50% TDD as basal dose, 50% remaining divide this half into 3 for pre-meal coverage
• How to calculate correction factor / sensitivity factor

  Rule of 1800 - rapid acting

  • 1800/TDD units = mg/dL change in glucose level per 1 unit insulin

  Rule of 1500 - short acting

  • 1500/TDD units = mg/dL change in glucose per 1 unit of insulin
• How to calculate insulin:carb ratio

  Rule of 500

  • 500/TDD: 1 unit insulin for every ___ grams of carbs