Diabetes

Question 1

What levels of risk does diabetes infer for coronary events?

Answer 1

Same as a previous event - VERY HIGH

Question 2

4 Ways of diagnosing DM

Answer 2

FPG > 126 (nl 200 & symptoms

75g 2-hr GTT > 200 (nl 6.5

Question 3

List some micro- and macrovascular complications of DM

Answer 3

Micro - retinopathy, nephropathy, neuropathy

Macro - cardiovascular, cerebrovascular

Question 4

Target A1C for DM?

Answer 4

Less than 7

Question 5

6 main categories of DM meds (with individual generics)

Answer 5

Biguanides (metformin)
Sulfonylureas (tolbutamide, glyburide, glipizide)
Thiazolidinediones (-glitazones)
α-glucosidase inhibitors (acarbose)
Meglitinides (repaglinide, nateglinide)
Insulin

Question 6

Describe the MOA, SEs and metabolism/excretion of the biguanides
Any special considerations? (3)

Answer 6

Metformin

• decreases hepatic gluconeogenesis, increases sensitivity
• lactic acidosis, GI upset (diarrhea, cramping), metal taste
• renal clearance
• does not cause hypoglycemia (no increased insulin production), may cause weight LOSS, contraindicated with renal/liver dysfunction

Question 7

Describe the MOA, SEs and metabolism/excretion of the sulfonylureas
Any special considerations?

Answer 7

Tolbutamide, glyburide, glipizide

• stimulates insulin release from β-cells, increased binding at cells
• hypoglycemia, weight GAIN
• renal (glipizide & tolbutamide), liver (glyburide)
• Second-line, contraindicated with renal/liver dysfunction

Question 8

Describe the MOA, SEs (4) and metabolism/excretion of the glitazones
Any special considerations?

Answer 8

Pioglitazone, rosiglitazone

• promotes skeletal uptake, decrease insulin resistance
• hepatotoxicity, edema, weight GAIN, increased LDL
• liver clears
• Be sure to monitor LFTs

Question 9

Describe the MOA, SEs and metabolism/excretion of the meglitinides
Any special considerations?

Answer 9

Repaglinide, Nateglinide

- Same as sulfonylureas, but more expensive