Diabetes Flashcards
T/F: The goal for types of nutrition is a balanced intake with most carbohydrates from non-starchy vegetables
True
What is the equation for net carbs
Take total carbohydrate grams and
SUBTRACT the grams of fiber
What type of weight loss goals should be determined for patients with diabetes and prediabetes
Diabetes: At least 5% of weight loss
Prediabetes: 7 to 10%
How much exercise is needed for a patient is needed per week
150 minutes per week (no more than two days without exercise/ 2 to 3 days of resistance training)
What is the drug of choice for type 2 diabetes
Metformin
What is the MOA of metformin
Decreases hepatic glucose production, decreases intestinal glucose absorption, increase insulin sensitivity
What are the clinical effects of metformin
A1C: decrease by 1 to 2 percent, FBG: 50-70 mg/dL
How is metformin excreted
Urine (kidneys)
What are the most common adverse effects of metformin
Diarrhea. N/V, abdominal bloating/flatulence. malabsorption, and heartburn
What are the rare adverse effects of metformin
LACTIC ACIDOSIS. headache, taste disturbances, and loss of energy
What is the starting dose for metformin
500 mg once a day with food in order to reduce gastrointestinal adverse effects
What is the maximum clinically effective dose
2000 mg per day
What patients are contraindicated for using metformin
eGFR is less than 30/ml/min/1.73m2 (if eGFR later falls below 45/ml/min/1.73m2 then asssess benefits and risks of treatment
What are drug interactions with metformin
Amiloride, digoxin, morphine, procainimide, alcohol
What are the thiazolidinediones (TZDs)
PIOGLITAZONE and Rosiglitazone
What is the MOA of TZDs
Improve insulin sensitivity, enhance glucose in muscle and adipose tissue, inhibit gluconeogenisis,
T/F: TZDs have a delayed onset of action of 2-4 weeks with full effect not seen until 12 weeks
True
What are the clinical effects of TZDs
A1C: 0.5-1.5%
FBG: 30 to 60%
What are the liver enzymes used in TZDs
CYP2C8 and CYP3A4
What patients cannot receive TZDs
Patients with congestive heart failure (Class 3 or 4)/ Monitor weight gain dyspnea (shortness of breath) and edema
What must be monitored for using TZDs
Liver enzymes (Do not initiate if ALTis greater than 2.5 times the ULN
What are the adverse effects of TZDs
edema, weight gain, change in lipids, upper respiratory infection
What patients are not recommended to get TZDs
Patients with heart disease and liver disease
What is the mechanism of SGLT2 inhibitors
Block the reabsorption of filtered glucose leading to glucosuria
What are the sodium glucose co-transporter 2 inhibitors
Canagliflozin (Invonaka), Dapaglifozin (Farxiga), Empaglifozin (Jardiance), Ertuglifozin (Steglatro)
How are the SGLT2 inhibitors excreted
Urine and Feces
Which SGLT2 is known for increased of amputation
Canagliflozin
Which patients are contraindicated in SGLT2 inhibitors
End Stage Renal disease
What are the adverse effects of SGLT2 inhibitors
KETOACIDOSIS, genital mycotic infections, UTIs, dehydration and increased urination,
Which SGLT2-inhibtor is has an additional indication to reduce Cardiovascular death
Empaglifozin
What is MOA of DDP-4 inhibitors
increase increntin (GLP-1 and GIP) inhibiting glucagon release and increasing insulin secretion
What are the DDP-4 inhibitors
Sitaglipitin (Januvia), Saxagliptin (Onglyza), Linagliptin (Tradjenta), Alogliptin (Nesina)
What are the advantages of giving DDP-4 inhibitors
They can be given in patients with renal insufficiency
Which DDP-4 inhibitors have an FDA alert, what for
Saxagliptin and Aloglipitin/ may increase risk of heart failure
What are the DDP-4 side effects
Headache, nasopharyngitis, hypoglycemia, edema (Saxagliptin)
What is the MOA of sulfonylurea
Stimulate insulin secretion from pancreatic beta cells, improves insulin sensitivity
What are the sulfonylureas
Glyburide: once-twice daily with breakfast
Glipizide: once-twice daily (immediate release formulation should be taken 30 minutes before food)
Glimepride: once daily with breakfast or first main meal
What are the adverse effects of sulfonylurea
Hypoglycemia, dizziness, gastrointestinal disturbances, allergic skin reactions
