Diabetes Flashcards
Type 1 DM
<20 y/o
- BMI <25
- uncommon family hx
- autoantibodies usually present
- Onset is abrupt
- prone to ketosis: dka
- insulin needed asap
- long-term complications rare at dx
- insulin resistance is uncommon
- Higher requirements of insulin when ill, DKA, or during times of insulin resistance
Type 2 DM
->30 Y/O
-BMI >25
-Family hx common
-insulin resistance very common
-autoantibiodies rarely present
-onset gradual
-ketosis rate: HHS
-long-term complications are common at dx
-insulin is not usually needed asap
-
Dx criteria
- HgbA1c of at least 6.5%
- Screen all adults every 3 years, starting at age 45
- Goal HgbA1c <7% and fasting blood glucose of 80-130
Insulin: Ultra-rapid acting
insulin aspart (flasp), insulin humanis (inhaled)
- Onset: 15-20 min
- Peak: 90-120min
- Duration: 1.5-7 hrs
Insulin: Rapid-acting
insulin aspart (novolog), insulin lispro u-100
- onset: 10-20 min
- peak: 30-90 min
- duration: 3-5 hrs
Insulin Short acting
Regular (humulin R, Novolin R)
–onset: 30-60 min, peak 2-4 hrs, duration: 5-8 hrs
Intermediate acting, NPH (Humulin N, novolin N)
-onset 2-4 hrs, duration 10-24 hrs, peak 4-10 hrs
Regular (u-500)
-onset 15 min, peak 4-8 hr, duration: 13-24 hrs
Long acting insulin
-Insulin detemir (Levemir)
-Insulin gargline (lantus, basaglar)
-insulin gargline u-300 (Toujeo)
-Insulin degludec U-100
DURATION: 16-42 hrs
Basal insulin
- Long acting insulin
- Suppress hepatic glucose production
- Preferred and most convenient for dm2 for initial insulin
- NPH, determir, glargine, degludec
Bolus insulin
- Short, rapid acting
- cover meals (prandial insulin)
- cover glycemic excursions
- type 1 dm patients will require bolus, likely combined w/ basal insulin
- Rapid acting (aspart, lispro, glulisine, regular, ultra-rapid)
Biguanides (Metformin)
- First line
- Decreases hepatic glucose production
- increasing evidence for mechanism within the gut
- reduces hgba1c by 1.5-2% in pts with 9%
- low risk for hypoglycemia
- increases HDL by 2%
- no weight gain, maybe some weight loss
- –S/E: GI, metallic taste, lactic acidosis
Metformin dosing and monitoring
- B12 levels, glucose, SrCr, HgbA1c
- Dose= target of 1000mg BID or 2000mg daily ER
- -contraindicated with eGFR <30 ml/min
- Hold starting day of procedures that contain IV contrast dye, resume 2-3 days after procedure if normal renal fx
Sulfonylureas
- MOA: enhance insulin secretion from pancreas via the portal vein; suppresses hepatic glucose production
- second most common class of oral meds prescribed
Thiazolidinediones
Rosiglitazone, Pioglitazone
- MOA: Alters transcription of many genes involved in glucose & lipid metabolism; energy balance
- enhance insulin sensitivity with metformin and others
- reduces hgba1c by 1-1.5% with max dose
- glycemic onset is slow, max effects 3-4 months
TZDs Adverse effects
Edema new or worsening HF Wt gain bone fractures bladder cancer anovulatory women may resume ovulation
GLP-1 Receptor Antagonists
- MOA: stimulate insulin secretion from pancreatic beta-cells in a glucose-dependent manner. Reduce inappropriately elevated levels of glucagon
- 2nd line agents-esp if have ASCVD or CKD, patients need to avoid hypoglycemia or need to be weight conscientious
- S/E GI., acute pancreatitis, AKI and worsening renal functions
