This study source was downloaded by 100000752467928 from CourseHero com on 09 15 2022 17 17 55 GMT 05 00 https www coursehero com file 40217520 tldr Diabetes Cheat Sheetpdf Diabetes Cheat Sheet Drug Interactions Diabetes Drug Interacting Drug s Mechanism Repaglinide 2C8 Inhibitors Gemfibrozil Fluconazole Nicardipine Delvirdine Ketoconazole Repaglinide is a 2C8 substrate decreased metabolism may increase concentration and hypoglycemic effect Sulfonylureas Nateglinide 2C9 Inhibitors Fluconazole Trimethoprim Amiodarone Zafirlukast Sulfonylureas and Nateglinide are 2C9 substrates decreased metabolism may increase concentration and hypoglycemic effect Repaglinide 3A4 Inhibitors Macrolides NOT Azithromycin Verapamil Diltiazem Itraconazole Ketoconazole Fluoxetine Fluvoxamine HIV Protease Inhibitors Delavirdine Repaglinide is a 3A4 substrate decreased metabolism may increase concentration and hypoglycemic effect Acarbose Digoxin Acarbose may decrease digoxin absorption leading to decreased Digoxin levels So Do You Have Diabetes Take Any of the Following Tests Hemoglobin A1c 6 5 Fasting Glucose Test 126 mg dL Glucose Tolerance Test 200 mg dL Random Glucose Test 200 mg dL Any of the Above True x 2 Days That Son Is How You Get Diabeetus Basic Treatment Considerations A1c Goal 6 5 AACE or 7 ADA Non Insulin Dependent Initiate with Metformin Insulin Dependent Initiate with Insulin For A1c 9 ADA or 7 5 AACE consider multiple agents Hypoglycemia Management Defined As Blood Glucose 70 mg dL Symptoms Sweating Tremor Hunger HA AMS Can Take PO Can t Take PO IV Access No IV Access 15 gm Carbs 3 4 Glucose Tab 1 2 Cup Juice Non Diet Soda D50 25 mL 12 5 gm IV Push Glucagon 1 mg SC Wait 15 Minutes Check Glucose Repeat Dose Until BG 70 mg dL Drug A1c Effect Note Metformin 1 1 5 Monotherapy Insulin 0 9 1 1 Varies No Max Dose SGLT2 Inhibitors 0 7 1 GLP 1 Agonists 1 DDP IV Inhibitors 0 7 Meglitinides 0 7 Sulfonylureas 0 8 Thiazoladinediones 0 8 Alpha Glucosidase Inhibitors 0 6 0 7 Pramlintide 0 36 Must Take w Insulin More likely due to potential fluid retention not fat Drugs with Potential Weight Loss Benefit Biguanides Metformin SGLT 2 Inhibitors Canagliflozin Empagliflozin Dapagliflozin Ertugliflozin GLP 1 Agonists Exenatide Liraglutide Semaglutide Drugs with Potential Weight Gain Effect Insulin Sulfonylureas Meglitinides Thiazolidinediones All Chlorpropamide Glimepiride Glyburide Glipizide Repaglinide Nateglinide Pioglitazone Rosiglitazone Drugs That May Cause Hypoglycemia Insulin All Sulfonylureas Chlorpropamide Glimepiride Glyburide Glipizide Meglitinides Repaglinide Nateglinide Drugs with Potential Cardiovascular Benefit SGLT 2 Inhibitors Empagliflozin GLP 1 Agonists Liraglutide Semaglutide Agents Possibly Used for DM Bile Acid Sequestrants Colesevelam Dopamine Agonist Bromocriptine This study source was downloaded by 100000752467928 from CourseHero com on 09 15 2022 17 17 55 GMT 05 00 https www coursehero com file 40217520 tldr Diabetes Cheat Sheetpdf Combination Agents Metformin Alogliptin Empagliflozin Glimepiride Sitagliptin Pioglitazone Actoplus Met Actoplus Met XR Oseni Duetact Linagliptin Jentadueto Glyxambi Rosiglitazone Avandamet Avandaryl Alogliptin Kazano Canagliflozin Invokamet Dapagliflozin Xigduo XR Empagliflozin Synjardy Glimepiride Amaryl M Glipizide Metaglip Glyburide Glucovance Repaglinide PrandiMet Saxagliptin Kombiglyze XR Sitagliptin Janumet Janumet XR Simvastatin Juvisync http www diabetes org living with diabetes know your rights discrimination employment discrimination getting a job html Occupational Restrictions for Insulin Dependent Diabetics Occupation Eligibility for Insulin Dependent Notes Law Enforcement Officer Case by Case Firefighter Case by Case Commercial Divers Case by Case Apply for waiver from state or Diabetes Exemption Program Pilot Class III Only Military Restricted Most branches but does not apply for contractors DKA vs HHS DKA HHS Mortality Rate 2 5 15 More common in T1DM More common in T2DM Hyperglycemia and Dehydration Presentation Ketoacidosis consider adding bicarbonate as part of treatment algorithm Rapid Onset 24 hrs Gradual Onset days to weeks Treat with IV fluids insulin and electrolyte especially potassium repletion Clinical Pearls SGLT 2 Inhibitors Increased Risk of Amputation Cause Exacerbate Renal Failure Increased Risk of UTI Yeast Infections Biguanides Lactic Acidosis Monitor Renal Function Sulfonylureas Glipizide is preferred sulfonylurea in renal failure Glyburide NOT recommended but possible use in pregnancy based on data GLP 1 Agonists Risk of thyroid C cell tumors DPP 4 Antagonists Warning for potential joint pain Meglitinides Major interactions with repaglinide Thiazolidinediones Risk of heart failure myocardial infarction Insulin Preferred in pregnancy breastfeeding This study source was downloaded by 100000752467928 from CourseHero com on 09 15 2022 17 17 55 GMT 05 00 https www coursehero com file 40217520 tldr Diabetes Cheat Sheetpdf Class Name CKD stages 3 and 4 and predialysis stage 5 Insulin Glargine Consider lower dose with ESRD 10 50 mL min 75 of dose 10 mL min 50 of dose Adjust based on response Detemir NPH Regular Aspart Lispro Glulisine First generation sulfonylureas Chlorpropamide eGFR 50 80 reduce dose by 50 eGFR 50 Avoid Tolazamide Avoid Tolbutamide Avoid Second generation sulfonylureas Glipizide eGFR 30 Caution Glimepiride eGFR 60 Caution eGFR 30 Avoid Glyburide Avoid Repaglinide No dose adjustment caution with eGFR 30 Glinides Nateglinide eGFR 60 Avoid may consider on hemodialysis Biguanides Metformin Per FDA do not use if serum Cr 1 5 mg dL in men 1 4 mg dL in women eGFR 45 59 Caution monitor renal function eGFR 30 44 max dose 1000 mg day or use 50 dose reduction and monitor eGFR 30 Avoid Thiazolidinediones Pioglitazone No dose adjustment Rosiglitazone No dose adjustment Alpha glucosidase inhibitors Acarbose serum Cr 2 mg dl Avoid Miglitol eGFR 25 or serum Cr 2 mg dl Avoid DPP 4 inhibitor Sitagliptin eGFR 50 100 mg daily eGFR 30 49 50 mg daily eGFR 30 25 mg daily Saxagliptin eGFR 50 2 5 or 5 mg daily GFR 50 2 5 mg daily Linagliptin No dose adjustment Alogliptin eGFR 60 25 mg daily eGFR 30 59 12 5 mg daily eGFR 30 6 25 mg daily SGLT2 inhibitors Canagliflozin eGFR 45 to 60 max dose 100 mg once daily eGFR 45 Not recommended Dapagliflozin eGFR 60 Contraindicated Empagliflozin eGFR 45 Contraindicated Dopamine receptor agonist Bromocriptine No dose adjustment caution Bile acid sequestrant Colesevelam No dose adjustment GLP 1