Academic Day Seminars

ADS – Diabetes

This was an interesting ADS to refresh me on all things diabetes, a good flashback to third year pharm! However it was also useful because we learned about things that affect us as hospital pharmacists (e.g. protocols, formulary insulins, and algorithms to use).

See below for my tidbits I was taught during this ADS:

  • Drug causes of diabetes include: HAART, atypical antipsychotics, corticosteroids, phenytoin, tacrolimus

Diagnostic labs include:

  • HbA1C =/> 6.5
  • FBH =/> 7
  • OGTT =/>11.1
  • Random glucose =/> 11.1

Hyperglycemia s/sx: always tired, frequent urination, sudden weight loss, wounds that won’t heal, sexual problems, always hungry, blurry vision, numb or tingling hands or feet, always thirsty and vaginal infections

  • Modifiable risk factors: overweight, obesity, poor diet, physical inactivity, hypertension, hyperlipidemia
  • Nonmodifiable risk factors: first or second degree relative with diabetes, ethnicity (African Americans, Latino, Native American, Asian American, Pacific Islander)
  • Complications of T2DM:
    • Microvascular: diabetic retinopathy, diabetic nephropathy, diabetic neuropathy
    • Macrovascular: stroke, heart disease, peripheral vascular disease

 

screen-shot-2017-01-27-at-10-32-40-am

Targets: In-patient hyperglycemia

Guidelines

ICU: Continuous IV infusion

Non-ICU

CDA

8-10mmol/L

Pre-prandial: 5-8mmol/L Random: <10mmol/L

ADA

<6.1mmol/L

FPG: <7mmol/L
Random: <10-11.1mmol/L

screen-shot-2017-01-27-at-10-34-02-am

Inzucchi (2006) was a great reading provided to us with an easy to use algorithm for hyperglycemia.

Prediabetes:

Test

Result

Prediabetes category

FPG

6.1-6.9mmol/L

IFG

2hPG in a 75g OGTT

7.8-11.0mmol/L

IGT

A1C

6.0-6.4%

Prediabetes

Sick Day Med List:

  • Sulfonylurea
  • ACE-inhibitors
  • Diuretics, Direct renin inhibitor
  • Metformin
  • ARB
  • NSAIDs
  • SGLT-2 inhibitor
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