diabetes 2 Flashcards
Diagnoses of DM from fasting
fasting glucose over 126mg/dl
diagnosis non fasting glucose
non fasting over 200mg/dl
diagnosis with glucose tolerance test
glucose tolerance over 200 at 2-3 hours after bolus
Onset of type !
less than 20 years
cause of DM I
autoimmunity against pancreatic beta cells and to insulin , familial
cause of DM II
Insulin resistance, then insulin deficiency and excess hepatic glucose production
diffenrence in body habitis of DM I and DM II
DM I often underweight onset prior to 20, DM II overweight and onset often after 30
is DM II familial
yes, 90-100 percent in twins, in DM I is 50% with twins
what is LADA
Latent onset adult diabets 1.5
when should you look for DM 1.5
in all non obease adults who present with apparent type 2 DM or those with DM II who have rapid detoriation of glucose control
what are the two secreatogues
Sulfonylureas and meglitinides (non sulpher)
what aret he type 2 DM drug types
biguanides, sulfonylureas, meglitinides, A-glucosidase inhibitors, thiazolidinediones TZD glitazones, dipeptidyl peptidase-4 (DPP-4)
with which of the type 2 DM drug classes can you also give insulin
most of them: buguanides, sulfonylureas, meglitinides, a glucosidase inhibitors, glitazones, Don’t give insulin to DPP-4 inhibitors.
what type of drug is metformine
Biguanides
how does MOA of biguanides
inhibit glucose production by liver and decrease insulin resistance
how do the secreatogue work,
sulfonylureas and meglitinides increase secretion of insulin
how do the alpha glucosidase inhibitors work
delay absorption of glucose by intestines.
how to the glitazones, work
decrease insuline resistance
how do the DPP-4 work
promote release of insulin after eating meal
what meds delay absorption of glucose by intestines
alpha glucosidate inhibitors
what drugs decrease insuline resistance
biguanides and the glitazones
what drugs promote release on insulin after eating
DPP-4
what drug inhibit glucose production by liver
biguanides
what is the concern with oral diabetic medications and illness
may need to switch to insulin during acuted infection because they potentially will have wose glucose control. Also prior to inpatient surgery
when would type II diabetics be given insulin rather than oral right off
if they become pregnant or develop gestation diabetes to maintain tighter glucose control.
what has been associated wit horal diabetic medications and pregnancy
macrosomia
what oral diabetic drug dose not cause hypoglycemia when used alone
biguanide -metformin/ alpha glucosidase inhibitors - acarbose
what 2 oral drugs can cause hypoglycemia
secreatagogues: sulfonylureas and meglitinides
would metformin or a sulfonylurea cause weight loss
metformin about 4-7 lbs
what is the vitain B12 deficiency offten associated with
metformin
what drug has severe sideefect lactic acidosis
metformin a biguanide
who should not be on metformin
those with impaired renal function
how does sulfonylurease cause insulin release
partial blocking of potassium channels increasing Ca release stage that signals insulin release
what generation of sulfonylureases are most often used
2nd generation Glipizide
most concerning about sulfonylureas
hypoglycemia and then there is often weight gain and lose effectiveness withing 5-10 years
which sulfonylureas is most likely to cause hypoglycemia
gyburide
how often dose metformin
twice daily
how often dose glipizide
one morning dose
what are the two meglitinides secretagogues
nateglinide and repaglinide which is more effective
what drug class would you not want to mix meglitinides with
sulfonylureas because it would increase risk of hypoglycemia
how often are meglitinies taken
3-4 times a day unlike sulfonylureas which are once in the morning
how often are the glitazones dosed
1-2 times each
what are the two glitazones
glitazones: avandia and actos
which of the glitazones may be used with insulin
ACTOS only
what is concerning about glitazones
they increase risk of CHF and possibly MI, increased ALT and wt tain
what diabetic drug must you test liver function
glitazones: avandia and actos
what are the two a glucosidase inhibitors
a-glucosidase inhibitors: Acarbose and miglitol
when are the a-glucosidase inhibitors taken
with each meal,
when would acarbose and miglitol cause hypoglycemia
only if combined with sulfonylurea or insulin, never if given alone
side effects of A glucosidase inhibitors
flatulance abd pain, diarrhea because it works at GI brush border
what drug has a rare fatal hepatic failure
Acarbose: aglucosidase inhibitor
what is unique about hypoglycemia of those on a glucosidase inhibitos
The antadote is Glucose and can not be sucrose.
who can not take acarbose or miglitor:aglucosidase inhibitor
those with chronic intestinal diseases or obstruction
what does preservation o GLP and GIPdo
DDP-4:drive blood glucose to normal to lower insulin release and glucagon supression reducing risk o hypoglyemia
what is a DPP inhibitor
Sitagliptin/januvia: potientiate insulin effects so it is never used with insulin
what of the oral diabetic drugs are never used with insulin
Sitagliptin/januvia: DPP-4 inhibitors
what drugs can cause increase of pancreantitis
DPP-4 inhibitrs: Sitagliptin/januvia and janumet
what is the good first choice drug
Metformin: Biguanides, then ad sulfonylurea if that diesn’t work.
what are the two injectable DM type II drugs
Pramlintide and exenatide
Pramlintide/symlin: injectable
Synthetic amylin - produced with insulin by beta cells, so can used less insulin while stil lowering average blood sugar
Exenatide : injectable
syntehtic extendin -4 - gila monster saliva
can pramlintide be used with insulin?
Yes but they can not be injected inside the same vial or syringe.
why is pramlintide notable
first approved to lower blood sugar in diabetics since discovery of insulin
why is pramalintide injected
at meals times, without causing wt gain or hypoglycemia although nausea is a side effect.
incretin mimetics
Incretin mimetics: exenatide/byetta, lowers blood blucose by increasing insulin secretion
what is unique about exenatides ability to lower blood glucose levels
it only lowers blood blucose in presence of high bloodglucose, so hypoglycemia is not a risk.
