Ch 48 highlights Flashcards
insulin needs increase when
stress infection obesity adolescent growth spurts 2nd and 3rd trimester pregnancy
insulin needs decrease when
increased exercise
1st trimester
insulin that can be mixed in the same syringe
Only NPH and short acting insulin
criterion for the diagnosis of DM
fasting blood glucose > = 126 mg/dl or Random plasma glucose > = 200mg/dl plus symptoms of D.M. or oral glucose tolerance test: 2 hour plasma glucose >= 200 or HA1C 6.5% or higher
2 separate tests for diagnosis
what do you treat gestational DM with
Insulin
what type of DM management does not cause hypoglycemia and which oral agent does
Metformin
(sensitivity to insulin)
Sulfonylureas - does cause hypoglycemia
causes stimulation of insulin production
Meglinitinides (Glinides) - does cause hypoglycemia
works similar to Sulfonylureas
what pt population can you not use Metformin
renal impairment - blackbox warning
severe metabolic acidosis can occur with accumulation of metformin. Highest risk occurs in diabetic patients with significant renal impairment
Can you give someone who is Pregnant Metformin
yes
what antidiabetic causes weight loss and which causes weight gain
Metformin - Weight loss
Sulfonylureas - Weight Gain
When do you take Metformin in r/t meals
Metformin is not taken in r/t meals
Can you use Sulfonylureas in pregnancy
no
How do you take Sulfonylureas
Daily or BID
How are Glinides taken
Repaglinide
Nateglinide
Taken with each meal
what class are these meds in?
Repaglinide
Nateglinide
Glinides
Metformin decreases absorption of
Vit B12
folic acid
deficiencies in these vitamins can contribute to peripheral neuropathy
what vitamin deficiency is a diabetic taking metformin prone to that would be concerning if that pt became pregnant?
Folic acid
can cause neural tube defects
What antidiabetic holds a cardiac risk
Thiazolidinediones (Glitazones) - TZDs
can cause fluid retention and put a pt in heart failure or exacerbate heart failure
What class is this drug? Pioglitazone (Actos)
Thiazolidinediones (Glitazones) - TZDs
what is the indication for TZDs
antidiabetic for type 2 mainly as an add on to metformin
How do TZDs work
decreases insulin resistance
How do Alpha Glucosidase inhibitors work
act in intestines to delay absorption of carbs
what drug class is
Acarbose (Precose)
Meglitol
Alpha Glucosidase Inhibitors
how is Acarbose prescribed? monotherapy or adjunct?
adjunct
use with insulin, metformin or sulfonylurea
what is the indication for using Dipeptidyl Peptidase-4 Inhibitors (Gliptins) - DPP-4
optional second line therapy as an add on to metformin in the treatment of type 2 DM
can be monotherapy but usually adjunct
What class is Sitagliptin (Januvia)
Dipeptidyl Peptidase-4 Inhibitors (Gliptins) - DPP-4
Sodium-glucose cotransporter 2 inhibitors (SGLT - 2 inhibitor) could cause weight gain or weight loss?
weight loss
what drug class Canagliflozin (invokana)
Sodium-glucose cotransporter 2 inhibitors (SGLT - 2 inhibitor)
common side effect for Canagliflozin (Invokana)
female genital fungal infections, urinary tract infections, and increased urination
A diabetic on Beta blockers
dangerous bc it can mask the signs of hypoglycemia\
avoid placing diabetics on beta blockers
Glucagon-like Peptide -1 (GLP-1) Receptor Agonists therapeutic goal
improvement of glucose control for patients with DM type 2
What drug class is Exenatide (Byetta))
Glucagon-like Peptide -1 (GLP-1) Receptor Agonists
What baseline data do you need to prescribe an antidiabetic
Random plasma glucose, fasting plasma glucose, Hemoglobin A1C, Serum electrolytes, urinary glucose and ketones
What hypersensitivity reactions have been seen for Glucagon-like Peptide -1 (GLP-1) Receptor Agonists
anaphylaxis
angioedema
Can you use Glucagon-like Peptide -1 (GLP-1) Receptor Agonists in pregnancy
use in caution with pregnancy
what patient population do you need to avoid when prescribing Glucagon-like Peptide -1 (GLP-1) Receptor Agonists
renal dysfunction
renal transplant patients
history of pancreatitis
what class is Pramlintide (symlin)
Amylin Mimetic
What is Pramlintide (symlin) approved for
DM type 1 or 2
adjunct therapy to use at mealtime in patients who have failed to achieve glucose control despite optimal insulin therapy
hypoglycemia is the biggest concern esp in type 1
what type of DM is Sodium-glucose cotransporter 2 inhibitors (SGLT - 2 inhibitor) used for
type 2
What is the therapeutic goal for Dipeptidyl Peptidase-4 inhibitors (Gliptins)
management of glucose control as an adjunct treatment for type 2 DM
what pt population is high risk for Dipeptidyl Peptidase-4 inhibitors (Gliptins)
pt with history of pancreatitis
Therapeutic goal for Meglinitinides (Glinides)
glycemic control with type 2 dm in combination with diet and exercise
High risk pt population for Glinides
use with caution with patients in liver impairment and those taking gemfibrozil
Therapeutic goal for Sulfonylureas
Maintain glycemic control in patients with Type 2 dm in conjunction with diet and exercise
High risk pt population for Sulfonylureas
Do not use in pregnancy or breastfeeding
Use with caution in patients with renal or hepatic dysfunction
what medications can raise glucose
sympathomimetics
glucocorticoids
What medications can lower glucose
sulfonylureas
for a fasting blood glucose, how many hours do you fast
8
Name the short duration: Rapid acting insulin
Insulin lispro (Humalog) Insulin aspart (Novolog) Insulin glulisine (Apidra)
Name the Short Duration: Short Acting insulin
Regular Insulin (Humulin R, Novolin R)
Name the Intermediate duration insulin
Humulin N, Novolin N
Name the long duration inuslins
Insulin glargine (U-100) - lantus Insulin detemir -Levemir
Name the Ultralong Duration inusulins
Insulin Glargine (U-300) - Toujeo Insulin degludec - Tresiba
what insulin can be inhaled at mealtime for type 1 or type 2
Afrezza
Insulin lispro Humalog onset
15-30 min
Insulin aspart Novolog onset
10-20 min
Insulin glulisine (Apidra) onset
10-15 min
Regular Insulin (Humulin R, Novolin R) onset
30-60 min
Humulin N, Novolin N onset
60-120 min
Lantus onset
70 min
Levemir onset
60-120 min
INsulin glargine (U-300) onset
360 min
Insulin degludec onset
30-90 min
postprandial insulin control
humalog
novolog
apidra
How often is NPH given (humulin N, Novolin N)
2-3 times/day
how often is lantus given
1-2 /day
How often is U-300 given
once per day in place of lantus
what do you give if hypoglycemia develops while taking Acarbose
IM or IV glucose
You cannot use oral glucose bc receptors are blocked. It will not work
Acarbose
Miglitol
Which is associated with hepatic dysfunction
Acarbose
Which antidiabetic is more effective in African American population
Miglitol
What common Side Effects does Miglitol and Acarbose have
alpha -glucosidase inhibitors
GI (slows motility) - delays absorption of dietary carbs and thereby reduces the rise in blood glucose after a meal
Acarbose increases the risk for
anemia (can decrease the absorption of iron)
what drug class
Glucotrol
Glucotrol XL
Sulfonylureas
what dietary item must be avoided when taking a sulfonylurea
Alcohol will cause a disulfiram like reaction
How is Glucotrol taken
once daily with breakfast
what is a glycosylated hemoglobin level
HA1C
what anti-hypertensives can you give a diabetic
Aces
Arbs
what patient population can you not use metformin
Heart failure
liver impairment
renal impairment
due to being at high risk for lactic acidosis
liver and renal - build up
heart failure - when not pumping efficiently, anaroebic byproduct is lactic acid
Glipizide (Glucotrol)
Glyburide (Diabeta)
Sulfonylureas
when are glinides taken
with every meal
When are sulfonylureas taken
Daily or BID
which antidiabetic will you have weight loss
metformin
Which antidiabetic will you have weight gain
sulfonylureas and glinides
sitagliptin
is what class
Gliptins
adverse effects of sitagliptin
stevens-johnson
anaphylaxis
angioedema
pancreatitis
pt with severe hypoglycemia with limited life expectancy or advanced macro microvascular complications where should your target A1C sit
below 8
when is insulin glargine given (lantus)
once daily at bedtime
