Diabetes Flashcards
Criteria for diabetes Fasting BG 75g oral glucose tolerance test BG A1C Random BG with symptoms
Fasting >126
OGTT >200
A1C >6.5
Random BG >200 with symptoms
Diabetic BG goals (A1C, pre and postprandial)
A1C < 7
preprandial 80-130
postprandial <180 (measured 1-2 hours after beginning of meal)
Type 1 vs Type 2 Diabetes
Type 1- Autoimmune beta cell destruction, absolute insulin deficiency, LATA
Type 2- Progressive loss of beta cell insulin secretion, insulin resistnce
Gestational diabetes
occurs in 2nd or 3rd trimester
Recommended treatment regimen for Type 1 Diabetes
Multiple daily injections of prandial and basal insulin
OR
continuous sq insulin infusion pump
Rapid acting analogs to prevent hypoglycemia
Match prandial doses to carb intake, premeal BG, and anticipated physical activity
Recommended treatment regimen Type 2 diabetes
Metformin preferred
Cardiac/Renal disease –> GLP-1/SGL-2 drugs
GLP-1 preferred over insulin
pancreatic cells (gamma, beta, alpha)
gamma- somatostatin
beta- insulin
alpha- glucagon
Glucagon MOA, SE
made by alpha cells of pancreas
Bind to G protein receptors on liver stimulate gluconeogensis and glycogenolysis
causes n/v
Glyburide (glibenclamide)
Sulfonylurea for type 2 diabetics
bind to sulfonylurea receptors on beta cell of pancreas and stimulate insulin secretion
cause weight gain, nausea, skin rash, itching
Do not give to type 1 diabetics, hepatic impairment, renal insufficiency
black box increased CVD mortality
Glipizide (glydiazinamide
sulfonylurea, for type 2 diabetics
bind to sulfonylurea receptors of beta cells of pancreas to stimulate insulin secretion
cause weight gain, nausea, skinrash, itching
do not give to pt with renal insufficiency, hepatic impairment
black box for CVD
Glumepiride (Amaryl)
Sulfonylurea
bind to sulfonylurea receptors on pancreas to stimulate insulin secretion
SE: weight gain, nausea, itching, skin rash
Do not give to pt with hepatic/renal impairment
black box warning CV disease
Sulfonylureas
Glipizide, Glyburide, Glimepiride
Meglitinide
replaglinide (Prandin)
Same MOA as sulfonylureas but more rapid onset
Type 2 diabetics only
Contraindicated in hepatic/renal impairment
Meglitinide
replaglinide (Prandin)
Same MOA as sulfonylureas but more rapid onset
Type 2 diabetics only
Contraindicated in hepatic/renal impairment
D-phenulaline Derivative
Nateglinide (Starlix)
MOA: short term glucose dependent insulin secretion after meals, rapid onset
SE: weight gain
Contra: hepatic impairment
Biguanides
Metformin
MOA: cAMP activated protein kinase to decreases hepatic gluconeogenesis, decrease intestinal glucose aborption and increases insulin sensitivity
GFR cannot be below 30
causes lactic acidosis
TZDs
pioglitazone (Actos), rosiglitazone (Avandia)
MOA: increase insulin sensitivity in muscle, adipose tissue, and liver
SE: weight gain
Black box for CHF
Alpha Glucosidase Inhibitors (acarbose and miglitol)
Acarbose (Precose)
miglitol (Glyset)
SE: farting
Contraindicated in IBG
Dopamine receptor agonist
Bromocriptine mesylate
MOA: inhibit sympathetic tone, decreasing postmeal plasma glucose
For type 2 only
interact with antipsychotic meds, headache, vomiting, somnulence
Colesevelam HCL (Welchol)
Bile acid sequestrant
MOA: bind to bile acid in intestine, impeding reabsorption
cause unpleasant taste, flatulence, constipation, tale with liquid
GLP-1 Receptor Agonists
exenatide, liraglutide, gulaglutide, albiglutide, semaglutide
DO NOT GIVE with hx of medullary thyroid cancer
MOA: stimulates insulin secretion, decreased glucagon, decreased gastric emptying
CAUSES WEIGHT LOSS
Dupeptidyl Peptidase-4 Inhibitors
“gliptin” stigliptin (Januvia), saxagliptin (onglyza), etc
Inhibit enzyme respsonsible for breakdown of GLP-1 and GIP –>increased insulin secretion and decreased glucagon
Do not use in hx of pancreatitis
Pramlintide
Can be used for Type 1 and 2
Promotes weight loss
causes gastroparesis
SGLT-2 Inhibitors
“flozin” (canagliflozin, dapagliflozin, empagliflozin (Jardiance), etc)
MOA: reduce glucose absorption in kidneys
Genitourinary yeast infections, UTI
