Diabetes Flashcards
What are the diagnosing criteria for diabetes?
FBG > 100
GTT > 200
Random glucose: > 200
Hemoglobin A1C > 7.5%
Why do we use hemoglobin A1C in monitoring for diabetic patients?
It gives a reading of the blood sugar averages over the past 3 months
How do we treat T1DM?
Insulin therapy
Diet
Exercise
How do we treat T2DM?
Diet
Exercise
Drug therapy (PO or insulin therapy)
Rapid Acting Insulin
Used before meals
Onset: 5-15 minutes
Peak: 30-90 minutes
Duration: up to 5 hours
Short Acting Insulin
Can also be used before meals
Onset: 30-60 minutes
Peak: 2-3 hours
Duration: 5-8 hours
Intermediate Acting Insulin
Used between meals to help maintain blood sugar
Onset: 2-4 hours
Peak: 4-10 hours
Duration: 10-14 hours
Long Acting Insulin
Used to maintain blood sugar over a 24 hours period
Onset: 2-8 hours
No peak
Duration: up to 24 hours
What is the first line drug choice to T2DM?
Biguinides (metformin)
What is the mechanism of action of biguinides?
Inhibits glucose production and output from the liver
Can also sensitize insulin receptors and reduce glucose absorption in the gut
What are common side effects of biguinides?
GI symptoms (N/V/D, loss of appetite), Vitamin B12 deficiency
What is a severe adverse effect of biguinides?
lactic acidosis (most common with AKI/CKD)
When are biguinides contraindicated?
Renal impairment and heart failure due to the increased risk for lactic acidosis
How much do biguinides lower A1C?
1-2%
What is the mechanism of action of sulfonylureas?
Promote insulin release by stimulating the pancreatic beta cells
What are common side effects of sulfonylureas?
hypoglycemia and weight gain
What medication class should be avoided with sulfonylureas and why?
Beta blockers due to the fact that they can reduce the effectiveness by decreasing insulin release
What at the sulfonylurea drug names?
Glipizide, Glimepiride, and Glyburide
How much do sulfonylureas lower A1C?
1-2%
What is the mechanism of action of the glinides?
Stimulate the pancreas to release insulin, primarily used prior to meals
What is the mechanism of action of the SGLT-2 inhibitors?
They block the reabsorption of glucose in the kidneys (promote increased glucose excretion)
What is a common side effect from SGLT-2 inhibitors
Elevated glucose levels in the urine which can cause UTI’s, yeast infections, and dehydration
hypotension is also a common side effect
Should SGLT-2 inhibitors be given to a patient with renal impairment?
No as glucose can further damage the kidneys
How much do SGLT-2 inhibitors lower A1C?
0.7-1.2%
What are things to monitor for patients on SGLT-2’s?
Kidney functions, BP, urine glucose levels
What is a piece of education for patients on SGLT-2’s?
Promote hydration as the increase in glucose excretion can increase dehydration levels
What is a benefit to the SGLT-2’s?
cardiovascular protection, possible weight loss, no hypoglycemia
What is the SGLT-2 inhibitor endings?
-gliflozin
What is the mechanism of action of the TZDs?
decrease blood glucose by decreasing insulin resistance, increases insulin sensitivity
What are common side effects of TZDs?
Weight gain, URI, headaches, sinusitis, myalgia, hyperlipidemia
What is a strong adverse effect of TZDs?
fluid retention
What a contraindication for TZD use?
CHF as it can increase fluid volume and promote fluid retention and edema, thus worsening heart failure
How much to TZDs lower A1C?
0.5-1%
What is the only TZD on the market at present time?
Pioglitazone
What is the mechanism of action of the DPP-4 inhibitors?
Enhance incretin hormones that stimulate glucose-dependent release of insulin and suppress post-prandial release of glucagon by inhibiting the DPP-4 enzyme
What are common side effects of DPP-4’s?
URI, headache, inflammation of nasal passage
What is a severe adverse effect of the DPP-4’s?
pancreatitis
What is the ending of the DPP-4 inhibitors?
-gliptins
What is the advantage of DPP-4 inhibitors over GLP-1 receptor agonists?
DPP-4’s are an oral formulation whereas GLP-1’s are an injection
What is the mechanism of action of the GLP-1 receptor agonists?
Activate the GLP-1 receptors which slow gastric emptying, stimulate glucose-dependent release of insulin, inhibit postprandial release of glucagon, and suppresses appetite
What is a benefit of the GLP-1’s?
Weight loss
What are some adverse effects of GLP-1’s?
N/V/D, injection site soreness, puritis pancreatitis, renal impairment, tertatogenic effects, hypoglycemia when combined with sulfonylureas
When are GLP-1’s contrainidacted?
Patients with ESRD as they are excreted in the urine, unchanged
What is the black box warning for the GLP-1’s?
Thyroid cancer, history of thyroid cancer, or family history of medullary thyroid cancer
What do the GLP-1 receptor agonists end in?
-glutide (except exantide)
