Diabetes Flashcards
Typical presentation of DM1? (3)
DKA (d/t unaware of condition)
weight loss
Eyesight issues
Treatment Strategy for DM1? (2)
INSULIN (always)
+/- Pramlintide (symlin)
What is the role of Pramlintide in treatment of diabetes?
Reduces gastric emptying, which reduces postprandial BS peaks/spikes
What is a major risk of taking Pramlintide?
Hypoglycemia (warn patient self monitor for symptoms 3 hours after administration)
What medication adjustment must be made in an insulin dependent diabetic who begins taking Pramlintide?
Insulin dose MUST be reduced by 50%
**Pramlintide Can not be combined with insulin in the syringe
Side effects of Pramlintide? (3)
Nausea and vomiting (r/t slowed gastric emptying/overeating)
Diarrhea
Hypoglycemia
Contrindication for Pramlintide
DM related gastropheresis (already slowed emptying compounded and can cause complications
Defining characteristics of DM1? (2)
Autoimmune
Characterized by relative or absolute lack of insulin (beta cells in pancreas destroyed)
Defining characteristics of DM2? (3)
Metabolic Disorder
Body cannot make enough, or properly use insulin
Can lead to the eventual destruction of beta cells in pancreas (leading to insulin dependence)
What is important to know about Gestational diabetes? (3)
Diagnosed in 2nd or 3rd trimester
Usually seen in pts who did not have diabetes prior to pregnancy
Require TIGHT control of blood sugar
Diabetes treatment considerations in patients with HIV? (1)
Screen for pre-diabets and DM prior to starting ART (protease inhibitors)
If normal, screen yearly
If pre-diabetic, repeat every 3-6 months
What suffix do most Portease Inhibitors end in?
-VIER
Used in treatment of HIV and have implications in development of DM
What drugs are primarily associated with drug-induced DM? (3)
Glucocorticoids
Anti-retrovirals for HIV (protease inhibitors)
Anti-rejection drugs (post transplant)
What is the role of Insulin in the body?
Insulin reduces blood glucose levels in the body
What is the typical clinical presentation in DM2? (6)
Polyuria (increased urination) Polyphagia (increased hunger) Polydipsia (increased thirst) Weight changes (often weight gain in T2, weight loss T1 but not always) Changes in vision Changes in sensory function
Who should be screened for Diabetes? (2)
Adults >45, regardless of weight Overweight Adults (BMI >25) or obese with 1 or more risk factors for DM
Diagnostic criteria for Pre-Diabetes? (3)
A1C 5.7-6.4%
Fasting (8 hours) Glucose 100-125
2-hour post load glucose 140-199 during OGTT
Diagnostic criteria for DM? (4)
A1C > 6.5% Symptoms plus: Random glucose >200 Fasting (8 hours) Glucose >126 2-Hour Post load glucose >200 during OGTT
Factors that impact A1C independent of glycemia? (4)
Sickle Cell (0.3% lower)
G6PD (0.7-0.8% lower)
HIV
CKD with hemodialysis
What is the treatment strategy for DM2? (4)
Medical Nutrition Therapy (MNT) + physical activity
Monotherapy or combination therapy
Addition of Insulin (basal or long-acting)
Evaluation and management of other metabolic complications.
Primary action of Secretagogue Medications?
Increase insulin secretion from beta cells
THESE CAUSE PROGRESSION OF DM by burning out the beta cells
What are 3 primary negative effects of secretagogue medications?
THESE CAUSE PROGRESSION OF DM by burning out the beta cells
Weight Gain
Severe Hypoglycemia
What are the 2 classes of secretagogues?
Meglitinides
Sulfonylureas
MOA of Meglitinides?
Stimulate insulin release from the beta cells in the pancreas
What has longer duration of action, Meglitinides or Sulfonylureas?
Sulfonylureas-can be given once daily
Name 2 Meglitinides
Repaglinide (Prandin)
Nateglinide (Starlix)
What suffix do most Meglitinides end in?
-GLINIDE
DDI with Repaglinide (Prandin)? (5)
Gefibrozil Itraconazole Clopidogrel (Plavix) Cyclosporine Atazanavir (protease inhibitor for HIV treatment)
What drug is Repaglinide (Prandin) often combined with?
Metformin
Dosing consideration for Nateglinide (Starlix)? (1)
Must be given before meals
MOA Sulfonylureas?
Stimulate insulin release from pancreatic beta cells
+/- reduces hepatic glucose output
How are second generation Sulfonylureas dosed?
Before each meal
Give drug names for second 2nd Generation Sulfonylureas? (3)
Glimepiride
Glipizide
Glyburide
What drug classes are
Non-Secretagogues? (6)
Alpha-glucosidase Inhibitors Biguanides DDP-4 Inhibitors GLP-1 Agonists SGLT2 Inhibitors TZD
What is the primary function of non-secretagogues?
Augment pancreatic insulin
MOA of Alpha-glucosidase inhibitors?
Delay breakdown of complex carbs and absorption of glucose (work within GI
Tract)
*SLOWS carb digestion and absorption, helping to minimize post-prandial BS spikes
How must Alpha-glucosidase inhibitors be dosed?
MUST be given with meals (with first bite of food)
SE of Alpha-glucosidase inhibitors?
GI issues
Give drug names for Alpha-glucosidase inhibitors? (2)
Acarbose
Miglitol
Benefits of alpha-glucosidase inhibitors as a class? (2)
No weight gain
No hypoglycemia
What effect do alpha-glucosidase inhibitors have on Hbg A1C?
Modest reductions (0.5-1%)
MOA of Biguanides?
Reduce hepatic glucose production (reducing fasting glucose levels)
Side effects of biguanides? (2)
GI issues
Lactic Acidosis
Clinical benefits of Biguanides?
Weight loss
No Hypoglycemia
Improves Insulin Resistance
Low Cost
Can improve lipid-profile
-decrease FA & VLDL synthesis from
liver, decreasing TGDrug names for Biguanides?
Metformin
What is the maximum dose for Metformin?
2g/day
Can be in divided doses
The higher the dose, the more side effects
Contraindications of Metformin? (4)
Moderate to severe liver disease
Chronic/Binge ETOH
Pregnancy
Breast Feeding
If a patient is taking Metformin, when does the medication need to be held?
Renal Failure
Surgery
Anything that may involve IV contrast (stop day of an don’t resume for 48 hours), more of an issue in AKI and risk of higher load contrast
What is the effect of Metformin on Hbg A1C?
Reduction of 1.5-2.0%
Warnings/cautions for use of Metformin? (2)
Address renal dosing (yes or no)
Moderate to severe liver disease
Renal Dose adjustments required
Don’t give metformin if GFR <30
Evaluate risk vs benefit if GFR <45
