Diabetes and Hyperlipidemia Flashcards
Anion Gap
Measured cations minus measured anions
Total Daily Insulin Dose =
1/2 Basal insulin dose +
1/2 Meal insulin dose
Causes of relative Insulin deficiency (DKA)
Acute Stress:
Infection
Inflammation
Infarction
(4-I’s)
Metformin mechanism
decreases gluconeogenesis in liver, raises blood levels of lactate
Lab Findings in T1DM
High glucose Ketones present Low bicarbonate High Anion Gap Electrolyte (K) loss Increased BUN, creatinine --> fluid depletion
12 hour half life insulin
Detamir, NPH
Regions most at risk for mircovascular injury
eyes, kidneys, small nerves
Metformin side effects
Nausea, abd pain, bloat, diarrhea
lactic acidosis (?)
24 hour half life insulin
Glargine
What drug should every Type 2 diabetic patient receive?
metformin
Untreated T2DM can result in
HHS - hyperosmolar hyperglycemic states
Symptoms of HHS
- Thirst/polyuria: glycosyria/dehydration
- Fatigue: hyperglycemia/dehydration/electrolyte disturbance
- Muscle cramps: electrolyte disturbance, dehydration
- Neurologic symtoms: dehydration
Short acting Insulins
Aspart, Lispro, Glulisine, Regular
Acarbose (Alpha glucosidase inhibitor)
–> inhibits upper GI enzymes that convert complete polysaccharide carbs into mono –> slow absorption of glucose
Every non-insulin agent drops HbA1c by approximately
1%
Pioglitazone (Thiazolidinediones) mechanism
lower blood glucose by enhancing glucose effects, enhance fat storage
Signs of HHS
- Dehydration
- Tachycardia
- Hypotension
- Impaired consciousness/coma
If HbA1c is greater than _____% then begin insulin
10%
Only drugs with proven CHD morbidity/mortality benefits
Statins
Causes of HHS
New diagnosis
Therapy Stopped
Acute stress (4-I’s)
Sulfonylureas (Glipizide, glimmepiride, glyburide) mechanism
depolarlize the cell –> calcium influx –> insulin release (irrespective of glucose presence)
GLP-1 agonists (exenatide, liraglutide, -tide) mechanism
enhance insulin secretion but reliant on glucose to initiate insulin secretion
Type 1 diabetes can be treated with oral drugs or insulin therapy.
False - T1DM is only treated with insulin.
Classes of drugs to treat peripheral neuropathy
Anticonvulsants (gabapentin, pregabalin)
Antidepressants (TCA, duloxetine)
Statin Benefit Group
ALL diabetics (40-75, LDL >70) atherosclerotic CVD LDL >190 age 40-75 w LDL >70 + DM age 40-65 w LDL >70 - DM - CVD + 10yatheroCVD>7.5%
DPP-IV inhibitors (-liptin) mechanism
make endogenous GLP-1 last longer
At what levels should triglycerides be lowered and why?
over 500-1000, in order to prevent pancreatitis
Therapy: fibrates, niacin, fish oil
most common form of primary hypercholesterolemia
polygenic hypercholestorolemia
moderate intensity statins
decrease LDL by 30-50%
Acarbose (Alpha glucosidase inhibitor) side effects
flatulence, diarrhea
Mechanism of the PCSK9
LDL receptors with PCSK9 attached get broken down, cannot take in and clear LDL –> high LDLemia
Sulfonylureas/meglitinizes mechanism
depolarlize the cell –> calcium influx –> insulin release (irrespective of glucose presence)
Causes of monogenic hypercholesterolemia
LDL receptor mutation affecting LDL clearance
Familial defective apolipoprotein
PCSK9 or apoB100 mutation
high intensity statins
Decrease LDL by >50%
Types of secondary hypercholesterolemia
Hypothyroidism
Aromatase inhibitor therapy
SE of statins
myopathy, rarely rhabdomyolysis
Biguanide (metformin) action
insulin sensitizer
acts on liver to decrease gluconeogenesis
GLP-1 agonists (exenatide, liraglutide)
insulin secretagogues
–> glucose dependent
thiazolidinediones
insulin sensitizer
PPAR Y agonist in muscle and adipose tissue
Sulfonylureas (glipizide, glyburide, glimerpiride)
insulin secretagogues
(acts on SUR on beta cell membrane)
–> glucose independent
DPP-4 inhibitors (sitagliptin, saxagliptin, linagliptin)
Insulin secretagogues
(inhibit DPP-IV, make endogenous GLP-1 last)
–> glucose dependent
Which drug has concerns for coronary artery disease?
Pioglitazone (thiazolidinediones) –> not used much anymore
Meglitinides (repaglinide, nateglinide) mechanism
insulin secretagogues
This drug has side effects including flatulence and diarrhea
Acarbose (Alpha glucosidase inhibitor)
SGLT2 inhibitor (canagliflozin)
increase urinary glucose excretion
These drugs help with weight loss
GLP-1 agonists (exenatide, liraglutide) SGLT2 inhibitors (canagliflozin)
Which drugs can cause hypoglycemia?
sulfonylureas (glipizide, glyburide, glimerpiride)
meglitinides (repaglinide, nateglinide)
How do you treat both DKA and HHS?
fluids
insulin
electrolyte (potassium) replacement
Do not use these drugs in patients with a history of pancreatitis
GLP-1 agonists (exenatide, liraglutide)
DPP-4 inhibitors (sitagliptin, saxagliptin, linagliptin)
