Diabetes Flashcards
How do you diagnose diabetes?
- Fasting plasma glucose > 126 (standard)
- Random plasma glucose > 200 with classic symptoms of hyperglycemia
- HbA1C > 6.5
What can falsely elevated HbA1C?
Things that decrease erythrocytosis and increase lifespan of erythrocytes –> iron deficiency anemia, aplastic anemia, renal failure, hyperbilirubinemia
What can falsely lower HbA1C?
Things that decrease lifespan of erythrocytes –> Hemolytic anemia, HIV meds, liver disease, blood loss
When should you screen for complications in type 1 diabetes?
5 years after diagnosis
When should you screen for complications in type 2 DM
at diagnosis
What are the A1C goals in the following pts according to the ADA?
- new diagnosis and long life expectancy
- children (type 1)
- limited life expectancy, complex older patients
- new diagnosis and long life expectancy –> 6.5%
- children (type 1) –> 7.5%
- limited life expectancy, complex older patients –> 8.5%
What is the goal glucose pre meal?
80-130
Which is the only oral diabetes medication for use in children and adolescents?
Metformin
When should you hold metformin?
Stop if GFR < 30
Do not start if GFR < 45
Stop prior to IV contrast and 48 hours after
Which two oral diabetes medications are insulin sensitizers - meaning they increase insulin resistance?
Metformin and pioglitazone (actose)
Precautions for pioglitazone use
- cardiopulmonary disorders (fluid overload due to retention in class III and class IV HF)
- avoid in hepatic dysfunciton
- avoid in osteoporosis
- category C in pregnancy
- increased risk of pancreatic, bladder, prostate cancers
Which class of oral DM medications are most useful in “little old ladies who eat irregularly”?
Meglitinides like repaglinide and nateglinide
- helpful for erratic eating schedules because it only works when they eat
Side effects of sulfonylureas as a class
ex. glipizide, glyburide, glimepiride
- weight gain and hypoglycemia
Alpha glucosidase inhibitors
- MOA
- who shouldn’t take it
- precautions
ex. Acarbose and miglitol
- MOA: delays carb absorption in the gut
- avoid use in Cr > 2, cirrhosis, GI diseases
- must keep GLUCOSE available, OJ wont work because they can’t break down the disaccharides
Side effects of GLP1 inhibitors
- nausea, vomiting, diarrhea, WEIGHT LOSS
- Pancreatitis
- hypoglycemia with sulfonylureas
- thyroid C-cell tumor risk
Do GLP1 inhibitors need to be decreased in renal failure?
yes, except liraglutide (victoza)
Mechanism of action for GLP1 inhibitors
- potentiate insulin secretion
- suppress postprandial glucagon secretion
- slow gastric emptying
- promote satiety (no weight gain)
Mechanism of DPP4 inhibitors
blocks dipeptidyl peptidase 4, and enzyme that breaks down natural incretins. It allows natural GLP1 to remain in the system longer
Particularly good at postprandial blood sugar control
Side effects of DPP4 inhibitors
URI, sore throat, diarrhea, pancreatitis
- can have debilitating joint pains
weight neutral
Mechanism of SGLT2 inhibitors
- blocks re absorption of glucose in the kidney
- increased urinary excretion of glucose
- less effective as renal function decreases
Desirable and undesirable side effects of SGLT2 inhibitors
Desirable SE
- improve renal function
- lose weight
- lower BP
- increase HDL
DECREASED RISK OF MI, STROKE, CARDIOVASCULAR DEATH
Undesirable SE
- B12 deficiency
- predispose to DKA if lowers glucose too far
- increase fractures
- risk of foot amputation (glc in blood usually causes vasc dilitation)
- increased UTI and genital infections
Bioavailability of insulin:
- which site increases exercise induced hypoglycemia?
- which site decreases exercise induced hypoglycemia
- Exercise accelerates absorption in thigh
- arm reduces exercise induced hypoglycemia by 60%
- abdomen reduces exercise induced hypoglycemia by 60%
Which long acting insulin has less weight gain? Detemir (Levemir) or glargine (lantus)?
Detemir (levemir)
When should rapid acting insulins be added with meals in DM management?
Add with meals if 2 hour postprandial glucose level is high
