Diabetes Cheat Sheet.

Diabetes Cheat Sheet Drug Interactions Diabetes Drug Interacting Drug(s) Mechanism Repaglinide 2C8 Inhibitors: Gemfibrozil Fluconazole Nicardipine Delvirdine Ketoconazole Repaglinide is a 2C8 substrate (decrea ...

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? 15 gm Carbs IV Access? No IV Access? (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 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 XR Janumet 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