Diabetes Flashcards
dx for diabetes
fasting blood glucose > 126
HbA1c > 6.5%
non-fasting blood glucose > 200
postive oral glucose tolerance test > 200 at 2-3 hours after bolus of glucose
c-peptide levels are used for…
can differentiate between type 1 and 2
to see how much insulin is being produced by pancreas in newly diagnosed diabetics
- low in type 1 and high in type 2
what is c-peptide level in type II DM
it is high at the beginning of dz because pancreas is putting out a lot of insulin
type 2 diabetes
insulin resistance
insulin deficiency and excess hepatic glucose production
anti-islet cell ab absent (present in type 1)
tx for pregnant women with dm or gestational dm
insulin rather than oral meds
Biguanides
metformin (glucophage): decreases hepatic glucose production and enhances insulin sensitivity in dkeletal muscle
which meds can cause weight loss/weight gain
Metformin: weight loss
Sulfonylureas: weight gain
SE of metformin
abdominal cramping and nausea, metallic taste, b-12 deficiency
*lactic acidosis
metformin contraindicated in
renal insufficiency
sulfonylureas
stimulate intact beta cells of pancreas to release more insulin
- block potassium release, which leads to prolonged ca and prolonged release of insulin
types of sulfonylureas
1st generation: chlorpropamide/diabinese Tolbutamide/orinase 2nd generation: Glipizide/glucotrol glyburide/micronase Glimeperide/ amaryl (2nd or 3rd)
SE of sulfonylureas
hypoglycemia
weight gain
glybuide causes greater incidence of hypoglycemia
sulfonylurea contraindications
ineffective in type 1 DM or where there is absolute deficiency of insulin production
avoid during pregnancy and sulfa allergy
become ineffective after 5-10 years of use
Meglitinides
stimulate beta cells to release insulin
Nateglinide/starlix and Repaglinide/prandin (more effective)
before meals 3-4 times daily
no generic option, so expensive
Thiazolidinediones/glitazones
improve insulin sensitivity in skeletal muscle, fat cells, liver cells and decrease hepatic glucose production
can tae up to 14 weeks to achieve max effects
- avandia and actos
*only ACTOS is approved for concurent use with insulin
SE of thiazolidinediones/glitazones
increased risk of CHF
liver function test before start - check ALT
decreased bone density
weight gain
alpha-glycosidase inhibitors
Acarbose/precose and Miglitol/glyset
decrease prosprandeal glucose by interfere with hydrolysis of carbs and delaying absorption of glucose
osmotic diarrhea
can cause hypoglycemia if given with other meds
poorly tolerated
take with meals
no generic, expensive
Dipeptidyl peptidase-4 (DPP-4) inhibitors
stimulates pancreas to stim insulin release and decrease glucagon
sitagliptin/januvia - cannot be given with insulin
*associated with acute pancreatitis
Pramlintide/symlin
injectible drug - synthetic amylin hormone
type 1 and 2
cannot be given at the same time as insulin, but decreases amount of insulin needed
weight loss
