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PHARM 343 > Current Issues in Diabetes Management > Flashcards

Current Issues in Diabetes Management Flashcards

1
Q

Metformin
- Use in Type 1 Diabetes

A
  • Reduces insulin requirement
  • Reduces/Maintains weight
  • Reduces A1c if started at diagnosis (Mixed effects otherwise)

AE: GI side effects

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2
Q

Metformin
- When to use

A

Can help lower insulin use and decrease weight gain in overweight patients

Can help lower insulin use and help with weight in pediatrics
- Stronger efficacy in reducing A1c in younger patients

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3
Q

SGLT2i
- Use in Type 1 Diabetes

A
  • Weight loss
  • Better glycemic control
  • Reduction of insulin dose

AE: Diabetic Ketoacidosis
- Ensure to select patient carefully to assess risk factors and provide monitoring techniques

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4
Q

SGLT2i
- Diabetic Ketoacidosis Symptoms

A

High blood sugar
Thirst
Nausea
Vomiting
Abdominal Pain
Confusion

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5
Q

SGLT2i
- Who is affected by Diabetic Ketoacidosis

A

More common in Type 1
Can occur even in euglycemic patients

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6
Q

SGLT2i
- Limiting Factor

A

Risk of DKA is the reason why SGLT2i have not been approved for Type 1 diabetes
- Is not the primary cause, just exacerbates other conditions/patient factors

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7
Q

GLP-1 Receptor Agonists
- Use in Type 1 Diabetes

A
  • Reduce insulin need
  • Improve glycemic control
  • Reduces weight
  • Variable effectiveness in patients

AE:
- Diabetic Ketoacidosis (Less than SGLT2i)
- Nausea
- Hypoglycemia (When used with insulin)

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8
Q

GLP-1 Receptor Agonists
- When to use

A

Most effective with overweight patients with detectable C-peptide levels
- Early initiation produces great results and can even eliminate insulin dependency later

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9
Q

Low Carbohydrate Diet
- Effects of nutrition therapy

A

Switching to low glycemic index carbohydrates
- Can reduce A1c by 1.0 - 2.0%

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10
Q

Low Carbohydrate Diet
- Calorie Intake

A

For people that are obese or overweight
- Reduce calorie intake to maintain healthier body to reach treatment goal

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11
Q

Low Carbohydrate Diet
- Consistiency

A

Spacing meal consumption and carbohydrate intake can help control blood glucose and weight

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12
Q

Low Carbohydrate Diet
- Registered Dietician

A

People with diabetes should get nutrition counseling

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13
Q

Low Carbohydrate Diet
- Patient decision

A

In the end patient should decide the dietary plan best suited to them

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14
Q

Low Carbohydrate Diet
- Recommendations

A

Less than 45% of daily energy from carbs

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15
Q

Low Carbohydrate Diet effect on Diabetes Management

A

Increased risk of Hypoglycemia if used with Insulin, sulfonylyrea, megltinides
- Have to decrease dose

Increased risk of DKA if used with SGLT2i
- Usually stop in community setting

Need to weight benefits and risks:
- Metformin, GLP1ra, DPP4i, acarbose

Need constant blood glucose monitoring

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16
Q

Deprescribing
- Indications

A

Risk of hypoglycemia

Risk of other antihyperglycemic adverse effects

Renal clearance decreases

Harm is more likely than benefit
- Frail, dementia, limited life expectancy

17
Q

Deprescribing
- Medications with risk of hypoglycemia

A

Insulin (NPH and Regular have highest risk)
Sulfonylurea (Glyburide has highest risk, gliclazide has lower risk)
Meglitinides (Low risk)

18
Q

Deprescribing
- Medications that are renally cleared

A

Metformin
Sulfonylurea
Insulin

19
Q

Deprescribing
- Medications with other potential adverse effects

A

SGLT2i can cause DKA

20
Q

Drug-Disease Interactions
- Cancer

A
  • Metformin: Lower risk
  • Insulin: Long acting analogue has risk
  • Pioglitazone: Bladder cancer
21
Q

Drug-Disease Interactions
- Drugs that cause diabetes

A
  • Atypical Antipsychotics
  • Antidepressants
22
Q

Drug-Disease Interactions
- Drugs that increase blood glucose

A

Beta Adrenergic Agonists (Decongestants)
Glucocorticoids (Prednisone)
Protease Inhibitors (Ritonavir)
Calcineurin Inhibitors (Cyclosporine)
Thiazide Diuretics ()

23
Q

Drug-Disease Interactions
- Beta Blockers

A

Medication Induced Hyperglycemia
- Blocking of epinephrine prevents release of insulin

Can exacerbate hypoglycemia
- Inhibits hepatic glucose production
- Masks symptoms of hypoglycemia (tremors, palpitations, tachycardia)
- Patient will still sweat

24
Q

Emerging Treatments for Type 2 Diabetes

A

Tirzepatide
- Both GLP1ra and GIP

Insulin Icodec
- Once weekly insulin formulation, similar efficacy to daily insulin

Generic DPP4i and SGLT2i

Biosimilar Insulin

25
Q

Biologic and Biosimilar

A

To ensure tracability record brand name and active ingredient name

Only interchange with a biosimilar with explicit knowledge and consent from patient and their health care provider

PHARM 343 (35 decks)

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