Diabetes Flashcards
4 different diagnostic lab measurements of diabetes
A1C equal or >6.5%, fasting plasma glucose equal or >126, random glucose >200 with symptoms of hyperglycemia (ployuria, polydipsia, blurred vision, weight loss), and 2 hr gtt equal or >200mg/dL
Compare c-peptide levels in type 1 vs type 2 diabetes
Type 2 has elevated c-peptide due to high insulin levels (at the beginning), type 1 has low c-peptide and +anti GAD ab
When to start screening for complications of disease in type 1 vs type 2
Type 1 start 5 yrs after diagnosis, type 2 start immediately
A1C goals?
LDL goal in diabetics?
LDL
BP goal in diabetics
140/90
How often do you monitor A1C?
3 months, 6 months if well controlled
Biguanide- name and moa
Metformin, increases insulin sensitivity, decreases glucose production in liver.
Thiazolidinedione (TZD)- name and moa
Pioglitazone (Actos), Rosiglitazone (Avandia)- decrease gluconeogenesis, decrease insulin resistance
Sulfonyureas- name and moa
Glipizide, Glyburide, glimepiride- stimulate pancreatic beta cells to release insulin
Meglitinides- names and moa
repaglinide (prandin), nateglinide (starlix)- insulin secretagogues
Alpha-glucosidase inhibitors- names and moa
Acarbose, Miglitol- delays carb absorption in the gut
GLP-1 receptor agonists- name and moa
exenatide ( -tide)- promote satiety by slowing gastric emptying, suppress post-prandial glucagon secretion, potentiate insulin secretion
DPP4 Inhibitors name and moa
sitagliptans (-gliptans)- blocks dpp4 which usually breaks down natural incretins
SGLT2 inhibitors name and moa
canagliflozin (-gliflozin)- increases urinary excretion of glucose in urine by blocking reabsorption in kidney.
Metformin- r,b, side effects, monitoring
Caution in elderly >65, renal dysfunction (creat >1.5 in men, 1.4 in women, can still use but decrease dose). check creatinine before starting, stop with IV contrast for 48 hrs before, rare Lactic Acidosis. Low risk for hypoglycemia, weight loss, improves CV disease outcomes in overweight pts, used in kids and adolescents. Cat B in preg, Check for b12 deficiency
Pioglitazone (Actos) r,b, side effects, monitoring
TZD- caution in elderly due to declining ventricular function, black box for class 3-4 HF, monitor lft’s, avoid in NAFLD or hepatic dysfunction. ? Increased risk of macular edema and increased risk of bladder cancer >1yr use, increase in distal limb fractures in women. Can increase HDL, Decrease TG, decrease risk of stroke, death, and MI (with actos/pio). Cat C in preg, expensive.
Glipizide r,b, side effects, monitoring
Sulfonyureas- weight gain and hypoglycemia avoid glyburide in elderly due to long half life and in renal dysfunction. Okay to use the others in renal dysfunction. All ok in OSA, CHF. Glyburide used in gestational diabetes.
Replaglinide (Prandin) r,b, side effects, monitoring
Meglitinide- rapid acting (half life
Acarbose r,b, side effects, monitoring
Alpha Glucosidase inhibitor- don’t use in creat >2, avoid incirrhosis, gi disease, monitor lft’s.Reduces risk of cv events (STOP NIDDM study), weight neutral, cat b in preg
Exenatide (byetta) r,b, side effects, monitoring
GLP-1 rec agonist, caues nausea, vomiting ,diarrhea, weight loss, pancreatitis, hypoglycemia (when used with insulin or sulfonyurea), >thyroid c-cell tumor risk. avoid with creatinine clearance
DPP4 Inhibitors r,b, side effects, monitoring
ie Januvia, don’t add to sulfonylurea in elderly, SE uri, sore throat, diarrhea, pancreatitis, ?chf exacerbation, weight neutral, expensive. Linagliptin not renally excreted and good choice in elderly.
Gliflozin’s r,b, side effects, monitoring
SGLT2 Inhibitors- decrease weight and blood pressure, increase hdl, uti’s and vag yeast infections, ? increase in bladder cancers
Initial management of patient in DKA
Initial volume replacement with NS at rapid rate, followed by NS+KCL.
