12 Type 2 DM Ma Flashcards
What is the approximate average glucose with an A1c of 7%?
~150, each percentage increase or decrease add/subtract 30
How should you manage your insulin if you’re sick?
Check blood glucose every 3-4 hours. Adjust by 1-2 units of regular or lispro insulin for every 30-40 mg/dL above target goal. If blood glucose > 240, check urine for ketones
What is required for T2DM diagnosis?
A1c > 6.5 OR 2hr OGTT > 200 OR FPG > 126 (8hr fast): any of the previous three need a repeat. Symptoms of DM + RBG > 200
According to the ADA, what are the DM Glycemic Goals?
A1c < 7%. FPG 70-130. PP < 180
What is the new BP goal for DM?
<140/80
What are the common symptoms of HYPOglycemia?
SWEATING! Shaky, increased HR, dizzy, anxious, hungry, blurry vision, weakness or fatigue, HA, irritable
What are the brand names of Metformin (Biguanides)?
Glucophage, Glucophage XR, Fortamet, Glumetza
How should Metformin be titrated to avoid GI effects?
Week 1: 1 tablet PO. Week 2: 1 tablet BID. Week 3: 2 tablets QAM, 1 tab QPM. Week 4: 2 tabs BID
What is the BBW with Biguanides (Metformin)?
Lactic acidosis. Blood lactate > 5, decreased blood pH, electrolyte disturbances; malaise, rapid breathing, SOB, severe weakness, coma
What are the contraindications to Metformin use?
Renal: SCr > 1.5 in men, > 1.4 in women. Acute/chronic metabolic acidosis. Radiological studies with iodinated contrast (48hrs prior and after procedure - hold)
What are some precautions before Metformin use?
Chronic hepatic dysfunctino (decreases lactate CL), Alcoholism. CHF
What are the current recommendations for primary prevention of CVD in patients with DM at CV risk (10 year risk > 10%)?
ASA 75-162mg/day (in case of allergy, Clopidogrel 75mg/day may be substituted)
What vaccines must DM patients be up to date on?
Annual influenza vaccine indicated to all DM patients > 6 months of age. Pneumococcal vaccine recommended for all DM patients > 2 years x1 dose
What is response like for doses of Sulfonylureas?
Response plateaus after half max dose for each respective SFU
What are the common side effects with SFUs?
Hypoglycemia (NEVER administer to fasting patient, skip meal skip dose). Weight gain. GI upset. Photosensitivity, skin rash, erythema, pruritus
When are Sulfonylureas contraindicated?
Type 1 DM. DKA (want to use insulin)
Which Sulfonylureas should be avoided with sulfa allergies?
Glipizide, Glyburide
Which Sulfonylureas should be avoided with renal problems?
Glipizide: CrCl < 10, Glyburide: CrCl < 50, Glimepiride: CrCl < 22
What are the Meglitinides used?
Nateglinide (Starlix). Repaglinide (Prandin)
What is the MOA of Meglitinides?
Cause glucose-dependent insulin release
What are the common ADRs with Meglitinides?
Hypoglycemia (NEVER administer when fasting, avoid meal avoid dose). Weight gain
What are the advantages of Meglitinides?
Less hypoglycemia than sulfonylureas. Reduced post-prandial glucose
What are the disadvantages of Meglitinides?
AE. Cost $$$. More frequent dosing
What are the Thiazolidinediones (TZDs) used?
Pioglitazone (Actos). Rosiglitazone (Avandia) - MI risk
What is important to remember about TZDs PK?
DELAYED (may not be apparent for 3 months)
What is the MOA of TZDs?
Increase insulin sensitivity in muscle, adipose and liver. Little risk of hypoglycemia, give w/o regards to meals
What is the BBW associated with TZDs?
CHF (not recommended for patients w/ HF (Class III, IV)). MI (Rosiglitazone only)
When are TZDs contraindicated?
HF (class III, IV). DMI, DKA. ALT > 2.5x ULN
When should you use precaution with TZDs?
Cardiac disease. Edema. Hepatic disease
What are the common ADRs with TZDs?
Edema (fluid retention). Weight gain. Increased LFTs
What are the advantages of TZDs?
Reduce insulin resistance. Improved lipid profile (pioglitazone)
What are the disadvantages of TZDs?
MI risk (Rosiglitazone). ADRs: CHF, Liver disease. Cost $$$
What are the Alpha-Glucosidase Inhibitors used?
Acarbose (Precose), Miglitol (Glyset)
What is the MOA of Alpha-Glucosidase Inhibitors?
Decrease post-prandial glucose levels: inhibits alpha-glucosidase in small intestine –> delayed hydrolysis of disaccharides/complex carbohydrates. Not very useful in patients on high protein, low carb diets (Atkins)
What are the ADRs with Alpha-Glucosidase Inhibitors?
GI effects (flatulence, diarrhea, cramps), increased LFTs
When are Alpha-Glucosidase Inhibitors contraindicated?
Hypersensitivity. Severe digestive problems (IBD, ulcerations, obstructions, etc.)
What is some counseling to do for TZDs?
Take with first bite of meal. DO NOT TAKE if meal is skipped. Treat hypoglycemia w/ GLUCOSE, not sucrose. SLOW titration to avoid GI effects
When are Alpha-Glucosidase Inhibitors useful?
If close to goal with elevated post-prandial BG and do not want to start insulin
What are the Dipeptidyl Peptidase-4 (DPP4) Inhibitors used?
Sitagliptin (Januvia), Saxagliptin (Onglyza), Linagliptin (Trajenta)
What are the ADRs associated with DPP-4 Inhibitors?
HA, Nasopharyngitis, URTI, Pancreatitis
Which DPP-4 Inhibitor does NOT require renal adjustment?
Linagliptin (Trajenta)
What are the advantages of DPP-4 Inhibitors?
No hypoglycemia. Weight neutral/loss
What are the disadvantages of DPP-4 Inhibitors?
Limited efficacy. Adverse effects. Cost $$$
What is the only non-insulin medication approved for T1DM?
Amylin Analogue (Pramlintide (SymlinPen). Adjunct for mealtime insulin users. Injected SC immediately before meals
What are the Incretin Mimetics used?
Exenatide (Byetta), Liraglutide (Victoza)
