Diabetes Flashcards
Metformin and Renal Impairment
eGFR <30mL/minute—contraindicated
eGFR 30-45mL/minute—Not recommended; decrease dose by 50%.
WARNING: Lactic Acidosis (if accumulated)
Pioglitazone (glitazone)
Insulin Sensitizer—PPAR-y (Proxisome Proliferator-activated Receptor-gamma)
NO HYPOGLYCEMIA RISK.
Side Effects—Liver toxicity, fluid retention and weight gain (worsens HF) and decrease bone mineral density. (Not recommended in postmenopausal women)
Gliptins Warnings
Gliptins—DPP-4 inhibitors (Incretin Mimetics)
- Risk of Acute Pancreatitis. (Especially with Sitagliptin)
- Risk of severe and disabling joint pain. (Arthralgia)
- Saxagliptin and Alogliptin may increase the risk of heart failure.
- Vildagliptin may cause hepatitis. (Monitor LFTs)
SGLT2 Inhibitors
Canagliflozin, Empagliflozin, Ertugliflozin and Dapagliflozin.
Side Effects:
- Dyslipidemia w/ Dapagliflozin and Empagliflozin.
- May cause Ketoacidosis.
- Canagliflozin may increase the risk of bone fracture. It also may increase the risk of leg and foot amputations.
SGLT2 Inhibitors Contraindications
*Severe Renal Impairment and ESRD.
- Canagliflozin and Empagliflozin are not used when eGFR <45 mL/minute.
- Dapagliflozin and Ertugliflozin are not recommended when eGFR <60 mL/minute.
- Dapagliflozin and Ertugliflozin are contraindicated when GFR is <30 mL/minute.
GLP-1 Agonists approved for Obesity
- Liraglutide
- Semaglutide
Given SC—Semaglutide is also available as an oral formulation.
GLP-1 Receptor Agonists
Exenatide, Liraglutide, Lixisenatide, Albiglutide, Dulaglutide, Semaglutide and Tirzepatide.
BLACK BOX WARNING: Medullary Thyroid Carcinoma (MTC)—Parafollicular Tumors. Ultrasound monitoring needed.
Increased the risk of pancreatitis.
Short-acting Insulin (Natural Insulin)
Also called soluble or regular insulin. (Bolus Only)
Onset: 30-60 minutes
Peak: 2-4 hours
Duration: 4-8 hours
*Used as IV in emergencies.
Rapid-acting Insulin
Insulin Aspart, Lispro and Glulisine.
Onset: 5-15 minutes
Peak: 0.5-2 hours
Duration: 3-5 hours
*Insulin Aspart can be used as IV in emergencies.
Intermediate-acting Insulin (NPH)
A suspenion. (Cloudy/Milky)
Onset: 1-2 hours
Peak: 5-10 hours
Duration: 10-16 hours
Used for basal insulin coverage.
Pramlintide
Amylin Analogue. Used adjunct to insulin therapy in type 1 and type 2 diabetes.
When Pramlintide is initiated, the dose of postprandial short-acting insulin is decreased by 50%, to avoid hypoglycemia.
Contraindicated in gastroparesis.
