Diabetes Cheat Sheet

Types 1 Diabetes Type II diabetes

Caused by the autoimmune destruction of beta-cells Caused by insulin resistance and insufficient insulin
in pancreas secretion, increase hepatic glucose production
Patient cannot produce insulin on their own Linked to obesity, inactivity, & family history
Discovered in younger patients usually
Most common type
Prone to diabetic ketoacidosis (DKA)
Prone to nonketotic hyperosmolar state (NKHS)
Pre-diabetes
Gestational diabetes
Increased risk for DM
Treatment: lifestyle changes and metformin Diabetes that develops during pregnancy
Annual monitoring required & Tx of CVD risks are BG goals are more stringent
needed
If mom is uncontrolled, can cause baby to be
macrosomia (large) + risk of hypoglycemia
Symptoms at birth and T2DM
Hyperglycemia Hypoglycemia Treatment: lifestyle modifications then insulin
Shakiness
Polyuria Irritability Drugs that affect blood glucose
Polyphagia Hunger
Headache, Dizziness Cause Hyperglycemia Cause Hypoglycemia
Polydipsia
Confusion, blurred vision
Blurred vision Weak/Sleepy Beta blockers
Sweating (diaphoresis) Fluoroquinolones Linezolid
Fatigue
Rapid Heartbeat Steroids (systemic only) Lorcaserin (Belviq)
Statins Octreotide (hyper- too)
Diagnosis Criteria Diabetes diuretics Pentamidine
Polyuria, polydipsia, Immunosuppressants Quinine
Pre-Diabetes (cyclosporine/ tacrolimus) Beta blockers
polyphagia
Protease inhibitors Fluoroquinolones
A1C (%)= 5.7-6.4 A1C greater than or 2nd generation
equal to 6.5 anti-psychotics
Lifestyle Modifications
1. Reduce weight, blood pressure, and cholesterol
DASH Diet
Choleerol control: any patient with diabetes and ASCVD or ASCVD risk >20% should receive a
high intensity atin
Blood pressure control: a goal of BP of <130/80 mmHg is appropriate for patients with diabetes and ASCVD
2. Smoking cessation
3. Goal is to lose 1 lb a week for safe weight loss and moderate exercise 150 minutes a week
4. Annual eye and foot exam yearly
daily foot exams by patient
5. Vaccines (Flu, Pneumovax 23, Hep-B)

References:
American Diabetes Association Standards of Medical Care 2021
Lexicomp
 Complications of DM
Microvascular complications Macrovascular complications
CVD
Retinopathy ASCVD in DM is leading cause of death in patients
Kidney disease (use ACEi/ARB) ADA recommends Empagliflozin or Liraglutide
Peripheral neuropathy in pts with longstanding DM + ASCVD
Duloxetine/Pregabalin (1st line) (shown to decrease CVD and mortality)
Foot care CAD/PAD
Hypoglycemia treatment
Leads to seizure, coma, and death
Treatment:
1. Take 15g of glucose
2. Recheck BG in 15 mins
3. If still hypo, repeat step 1
4. Once BG is normal, eat a small meal or snack to prevent recurrence
Give glucagon if patient is unconscious or not able to take something by mouth. Give 1 mg SC, IM, or IV.
Check BG in 15 minutes

Therapy Options for patient with albuminemia, diabetes, or HTN (or some sort of combo)
Patient has diabetes + HTN (no albuminemia) -> Thiazide, CCB, ACEi, ARB
Patients has diabetes + albuminemia (no HTN) -> ACEi or ARB
Patient has diabetes, HTN, albuminemia -> ACEi or ARB

Blood glucose goals ASCVD HF or CKD No ASCVD or CKD

(ADA Guidelines) GLP1 Agonist Minimize Hypoglycemia
(liraglutide, SGLT Inhibitors DPP4 Inhibitors
exenatide and (cana and empag) GLP1 Agonist
semaglutide) SGLT2 Inhibitors
A1C <7%
Pre-prandial BG 80-130
Postprandial <180 IF SGLT Inhibitors(cana and To Promote weight lost
SGLT Inhibitors
A1C is measured quarterly empag) not tolerated, then use GLP1 Agonists
(cana and empag)
if not at goal, two times GLP1 Agonist -GLT2 inhibitors
a year if at goal
Cost Consideration
Dulaglutide (Trulicity) Dapagliflozin (Farxiga) SU
TZD

ADA Guidelines for Type II Diabetes Treatment

Monotherapy Dual therapy Triple therapy
Start if A1C is >8.5% at baseline
Select second drug based on patient
comorbidities Most 3-drug combos are acceptable
ASCVD: choose drug with CV benefit EXCEPT:
either a GLP-1 agonist (liraglutide, metformin + DPP-4 + GLP-1
Lifestyle modifications and
semaglutideor exenatide XR) or an
metformin (unless CI) Metformin + Basal insulin + SU
SGLT2 inhibitor (empagliflozin or
canagliflozin)
HF or CKD: SGLT2 inhibitor If A1C is >10%
(empagliflozin or canagliflozin) or BG >300 : start basal insulin
can use GLP-1 agonist (liraglutide,
semaglutide or exenatide XR) if eGFR + bolus insulin or GLP-1 agonist
is less than adequate or not tolerated
 Insulin Dosing
Type 1
Use Basal Bolus strategy = Long-acting + Rapid-acting
Start at Total Daily Dose (TDD) of 0.6 units/kg/day (ABW)
Divide TDD into 50% Basal & 50% Bolus (rapid)
Divide Bolus Rapid insulin over 3 meals
Final regimen = 1 Basal + 3 Bolus
Meal-time insulin may be adjusted based on CARBS in a meal
Use "Rule of 500" (Rapid) OR "Rule of 450 (Regular)
500 or 450
= g of carbs covered by 1 unit of insulin
TDD
Correction Factor = Amount of insulin needed to return to Normal BG.
May be added to regular Bolus insulin dose to cover carbs. (Rule of 1800 for rapid, Rule of 1500 for regular)
1800 or 1500
= correction factor
TDD
BG now - Target BG
Correction dose =
correction factor
Type 2
Basal insulin is used for PTs who fail multiple PO agents.
1. Start Basal = 0.1-0.2 units/kg/day (ABW) OR 10 Units/day
2. Dose is titrated 10-15% or 2-4 units weekly to reach Fasting Goal.
3. If A1C still remains above goal -- ADD 1-3 Rapid bolus insulin doses
4. Use 1:1 (unit per unit) conversion of TDD when converting from different insulins
a. Except NPH BID-Glargine QD = Use 80% of NPH
b. Toujeo QD Lantus or Basaglar QD = Use 80% of Toujeo
Factors to consider for treatment:
Biggest A1C% Decrease (> 1%) : Insulin, Metformin, SU's, TZDs, GLP-1 agonist
Biggest Hypoglycemic Risk : Insulin, SU's, Meglitinides, Promlintide
Weight Gain: Insulin, Su's Meglitinides, TZDs
Weight Loss: SGLT-2, GLP-1, Pramlintide
Cardiac Benefits: Empagliflozin, Liraglutide
Cheapest: Metformin, SU's, TZDs
Injection Formulations: Insulin, GLP-1, Promintide
Medications to avoid in specific situations:
eGFR or CrCI < 30: Metformin, SGLT-2, Exenatide, Glyburide
Heart Failure: TZDs, Alogliptin, Saxagliptin
Peripheral Neuropathy, PAD,
Canagliflozin
or Diabetic Foot Ulcers :
Gastroparesis or GI disorder: GLP-1, Pramlintide
Sulfa allergy: SU'S
G6PD deficiency: SU'S
Lactic Acidosis: Metformin
Hepatotoxicity: TZD, Alogliptin
Hypotension/Dehydration: SGLT-2
UTI/Genital infections: SGLT-2
K+ abnormalities: Canagliflozin (Hyper), Insulin (Hypo)
Pancreatitis: DPP-4, GLP-1
Ketoacidosis: SGLT-2
Cancer: Pioglitazone, Dapagliflozin, GLP-1
 GENERIC BRAND MOA ADRs BBW/Warnings CONTRAINDICATION NOTE
BIGUANIDE: Lactic Acidosis Take w FOOD
Glucophage N/V/D ETOH Increase Lactic
Metformin Glucose production Hepatic/Renal Imp GER < 30 Acidosis risk
Fortamet (Gluconeogenesis) Flatulence D/C before imaging
•1st line in Intravascular (Do NOT start
Glumetzo Abdominal procedure & restart
Type-2* Intestinal glucose absorption Iodinated contrast if GER 30-40) 48 hrs after.
Riomet Insulin Sensitivity cramping Leaves ghost shell in stool.
ETOH
Repaglinide Prandin Megtlitinides: Weight gain Type 1 DM Take 15-30 mins BEFORE
Hypoglycemia meal,
Insulin secretion HA DKA
Nateglinide Starlix Liver /renal imp SKIP dose. if skipping meal.
Post Prandial BG URTI Gemfibrozil
Glipizide Glucotrol Sulfonylureas: ALL SUs 30 mins BEFORE
Hypoglycemia Type-1 DM Breakfast
Glimperide Amaryl Insulin secretion Weight gain DKA Glipizide IR - 30 mins
Post-Prandial BG G6PD
Nausea Sulfa allergy before meals.
Glyburide Glynase (Glucose Independent) Deficiency Glyburide - Avoid renal imp.
Thiazolidinediones (TZD): Weight gain Exacerbate
Pioglitazone Actos Peripheral Insulin sensitivity Peripheral HF/MI
Edema Hepatic failure NYHA Class Take w/o regard to meals
PPAR-gamma receptors URTI Edema 3-4 HF May take several weeks to
Effect transcription on cells so Good Iipid profile Urinay Bladder work
Rosiglitazone Avandia takes time - weeks to months (HDL TG's, TC) tumors
SGLT.2 Inhibitors: Risk of Leg/Foot
Reduce Glucose reobsorption amputations.
Caution:Diuretics,RAAS,NSAlDs
Canagliflozin Invokana Ketoacidosis (Hypotension & AKI)
in renal tubules +
Genital Mycotic Monitor K+ (Capagliflozin)
increase glucose excretion infxns
60-80 grams of sugar Weight Loss Urosepsis Genital yeast infxns.
Empagliflozin Jardiance eGFR < 30 Dehydration due to urination.
excreted Hypoglycemia Pyelonephritis
Weight loss effect Hypotension Urinary Tract infxns
AKI
due to asmotic effect and Hyperkalemia Leg /Foot amputations
Dapagliflozin Farxiga
sugar losing calories. (Capaglflozin) (Canagliflozin)
Sitagliptin Januvia
Nasopharyngitis Risk of Heart
Saxagliptin Onglyza DPP-4 inhibitors: Take In the morning.
URTI/UTI Acute Pancreatitis Failure May cause pain &
Insulin resistance
Linagliptin Tradjenta glucagon secretion Peripheral (Saxagliptin inflammation in pancreas
Edema Rash & Alogliptin)
AlogIiptin Nesina
Acarbose Precose Flatulence Hypoglycemia can be Tx
w/ sucrose
Diarrhea
Take with 1st bite of each
Miglitol Glyset Abdominal Pain meal
Only used in SPECIFIC
Colesevelam Welchol situations Constipation Binds to ADEK vitamins
Do NOT use
Breastfeeding w/ metoclopramide
Bromocriptine Cycloset (Inhibits or other Dopamine
Lactation) ogaonists
 GENERIC BRAND MOA ADRs BBW/Warnings CONTRAINDICATION NOTE
Exenatide Byetta
Byetta & Adlyxin 60 mins
Exenatide XR Bydureon Nausea V/D/ Thyroid C-cell tumors BEFORE meal
Victoza GLP-1 Agonists: Constipation Pancreatitis Family Hx of ALL others w/o regard for
Liraglutide Saxenda Insulin secretion Do not use in Thyroid cancer
Weight Loss food.
Glucagon secretion severe GI disease
Dulaglutide Trulicity
Bydureon, Trulicity, Tanzeum
Albiglutide Tanzeum 1x/wk (dosing)
Lixisenatide Adlyxin
May be used in both
Pramlinitide Symlinpen Synthetic Amylin analogue N/V/HA Weight loss Severe Hypoglycemia type 1 and 2 DM
Gastroparesis Must REDUCE meal-time
Anorexia
Insulin by 50%
GENERIC BRAND MOA ADRs BBW/Warnings CONTRAINDICATION NOTE
Aspart Novolog RAPID-Acting Insulin: Hypoglycemia
Glulisine Apidra AKA Post Prandial or meal-time Hypokalemia
Lispro Humalog Onset = 10 -30 min
Peack = 0.5 - 3 hrs Acute Bronchospasm Asthma NOT recommended in PTs
Afrezza (Inhaled insulin) (Asthema/COPD) COPD who smoke
Duration = 3 - 5 hrs.
SHORT-Acting Insulin:
Can be used in IV
AKA Prandial or Meal-time
Regular Insulin Humlin R Hypoglycemia solutions.
Insulins Onset = 15 -30 mins Give 30 mins BEFORE meal
Relion Hypokalemia Available w/o
Peak = 2.5 - 5 hrs.
prescription
Duration = 4 - 12 hrs.
MUST have Rx U-500
Onset = 15 -30 mins WEIGHT insulins syringe 5x concentration of U-100.
Humulin Do NOT Mix w/
Concentrated Peak = 4-8 hrs. GAIN NO dose conversions. Recommended If PT req. >200
Regular Insulin R U-500 other insulins
Duration = 13 - 24 hrs LIPODYSTROPHY Do NOT use other units/day
syringe
Humulin-N INTERMEDIATE-Acting Insulin: NPH insulin are CLOUDY.
NPH Insulin Novolin N Onset 1-2 hrs Available w/o can MIX w/ Rapid or Short
Novolin-N Relion Peak = 4 - 12 tars (draw up rapid/short 1st clear
Dutation = 14 - 24 hrs Prescription BEFORE Cloudy)
Detemir Levemir
Lantus LONG-Acting Insulin:
Glargine Lantus Solostar Hypoglycemia
ONSET = 3 -4 hrs Do not mix w / other insulin’s
Basaglar DURATION = 6 - 24 hrs Hypokalemia
Toujeo
Degludec Tresiba
Novolog Mix 70/30
Humalog 75/25 Available w/o
Pre-Mixed Humalog 50/50
NPH & Protamine insulin is
Insullins Pre-Mixed Insulins
Humulin 70/30 Prescription CLOUDY.
Novolin 70/30