Diabetes Flashcards
Causes of DM
Autoimmune, insulin resistance, chronic pancreatitis, cystic fibrosis, steroid induced
Types of non-insulin therapies for DMII
SGLT-2i, DPP-4 inhibitors, sulfonylureas, metformin, PPAR-y inhibitors, GLP-1 agonists
Screening for DM
At age 45 and every 3 years afterwards. Or earlier if BMI >25, HLD, HTN, family h/o DM, PCOS, h/o CVD, sedentary lifestyle, suspectible ethnic groups
Diagnosis of DMII
Hba1c >6.5% or fasting glucose >126 or 2 hour OGGT 75g >200
Ideal Ha1c
Depends on age and comorbidities. If elderly and h/o CVD, better to be between 7.5-8.5%, <7 for patients with long expectancy and limited comorbidities
Pre prandial and post prandial glycemic targets
Pre: 80-130mg/dl
Post: <180
Managment of DM-1
Basal + bolus insulin
Injectables for DM-II tx
GLP-1 agonists, insulin
DM agents with CV benefits
SGLT-2(empagliflozin) and GLP-1 agnosits (liraglutide)
Compare metformin
reduced hepatic gluconeogeneis, drops HA1c by 3-4%, reduces weight , CVD benefit, B12 deficiency
Compare SGLT-2
Prevents renal reabsorption, decreased CVD risk, weight loss, renal bneefit, increase risk of DKA/fractures/amputation (canagliflozin) , Ha1c by 2.5-3%. Not for GFR < 45%
Compare DPP-4 (gliptins)
blocks DPP-4, prevents breakdown of incretins that stimulate insulin secreiton, Ha1c 2.5-3%, no weight benefit, risk of pancreatitis
Compare sulfonylureas
Increase b-cell insulin secretion, ha1c 3-4%, no weight benefit, risk of hypoglycemia
Compare thiazolidinediones
Promotes adipogenesis and lipid availability, Ha1c 2.5-3.5%, INCREASES weight, increased CHF risk, last line tx
Compare GLP-1
Synthetic incretin, Ha1c 2.4-3.5%, weight reduction, risk of thyroid tumors, injection reaction, CVD benefit
