Diabetes Flashcards
what is a biguanide?
Metformin (Glucophage)
what are the three functions of Biguanides: Metformin (Glucophage)?
- Blocks gluconeogenesis in the liver
- Reduces absorption of glucose in the gut
- Increases skeletal muscle uptake of glucose
does metformin cause hypoglycemia?
no
what are the side effects of Biguanides: Metformin (Glucophage)?
- Rare but possible lactic acidosis
- GI upset: N/V, Bloating
- Decreased appetite
- Kidneys
what are some sulfonaureas?
glipizide, glimepiride, glyburide (-IDE)
How do sulfonaureas work?
Increase the function of the beta cells (increases the insulin)
-the cheerleaders
can sulfonaureas cause hypoglycemia?
yes
what should is important to watch for with sulfonaureas?
Sulfa allergies
Drug interactions: NSAIDS (alter the blood sugar)
what are some meglitinides?
repaglinide, nateglinide (-NIDES)
can meglitinides cause hypoglycemia?
yes
how do meglitinides work?
- Increase the function of the beta cells
what is the advantage of meglinitides versus sulfonaureas?
no sulfa
what are some SGLT2’s?
canagliflozin, dapagliflozin, empagliflozin
-liflozin
how do SGLT2 work?
Blocks the receptor site
Blocks the reabsorption of glucose on the proximal tubules
o Glucose gets excreted in the urine
what are the side effects of SGLT2?
UTI, yeast infections, dehydration
Can cause hypovolemia, hypotension, dizziness
-Be careful when using other anti-HTN drugs
what are some Alpha-glucosidase inhibitors?
acarbose, miglitol
how do Alpha-glucosidase inhibitors work?
- decreased absorption of glucose in the gut
what is the major side effect of Alpha-glucosidase inhibitors?
more gas produced (fart city)
what is the prefered Alpha-glucosidase inhibitor and why?
miglitol preferred over acarbose due to the liver damage
what are some Glucagon-like peptide agonist?
exenatide, exenatide, albiglutide, dulaglutide, liraglutide,
ALL END IN -TIDE
what is a Glucagon-like peptide agonist and what does it inhibit?
- Incretin mimetics
- inhibit GLP-1
what are some amylin mimetics?
pramlinatide,
ALL END IN -TIDE
how does an amylin mimetic work?
body’s natural GLP-1 inhibitor (can also be synthesized)
co-secreted with insulin
inhibit GLP-1
what do DPP4 inhibitors end in?
-gliptin
GLP-1 is responsible for??
*feeling of fullness
*decrease the absorption of glucose in the gut
*decrease glycogen-gluconeogenesis
*increase insulin (glucose dependent)
o cannot overshoot it, no hypoglycemia
what are some Thiazolidinedione’s (glitazones)?
TZD rosiglitazone, pioglitazone (-Zone)
how do Thiazolidinedione’s (glitazones) work?
- Increase fluid (not for CHF)
- Increased skeletal uptake
- Decrease hepatic glucose
who should not take Thiazolidinedione’s (glitazones)?
those with CHF
what are some rapid insulins?
lispro (humolog), aspart (novolog)
what is the onset of rapid insulins?
10-15 mins
what is the peak of rapid insulins?
1-2 hours
what is the only insulin to be given IV?
short/regular
what is the onset of short/regular insulin?
30 mins
what is an intermediate insulin?
NPH
how should we mix insulin?
rapid or short then add intermediate (clear to cloudy)
what are the most common insulins to be taken at the same time together not mixed?
long and rapid acting insulin
What info would we line to obtain from labs to diagnose diabetes??
-HBA1C
-urinalysis- proteins/albumin (how the kidneys are working), ketones, glucose
-cholesterol (triglycerides LDL’s
-blood glucose level
what puts you at risk for diabetes?
-high BMI/ weight
-African American (race)
-gestational diabetes
What education should she receive before starting medications?
-10-15 hours
-information on nutrition and exercise
Diabetic treatment goals? (4 months later)
A1C less than 6.5%
Mean plasma glucose less than 130 mg/dL
what can you die from with DKA?
- Dehydration, hypovolemia (fluids)
- Low pH
- High potassium
-potassium must be what at least to start an insulin drip
3.3
-do not want 100 dL drop per hour of a blood sugar or else it can cause what?
cerebral edema
what are the Hyperkalemia treatments: (kidneys, 12 led EKG- peaked T-waves)?
-sodium polystyrene sulfonate (Kayexalate, definitive)
-calcium gluconate (calms the membrane)
-regular insulin (Temporize)
-sodium bicarbonate (causes alkalosis)
-D50 (temporize)
-Albuterol (beta-2 agonist, lets K in)
-Dialysis (definitive)