Diabetes Management Flashcards
pre-diabetes ogtt
7.8-11.0 mmol/L
pre-diabetes fpg
6.1-6.9 mmol/L
target HbA1c
<7%
7-8.5 if vulnerable
target FBG
4 to 7
target PPG
<10
nonpharma
- quit smoking
- weight reduction
- exercise (150 min/week. at least 3d/wk of moderate intensity)
- diet modification
metformin moa
decrease hepatic glucose prod
metformin dosage form
500mg, 850mg, 1g
metformin AE
GI, anorexia, metallic taste (take with food), (rare) lactic acidosis
metformin CI
crcl<30, hypoxia
metformin ddi
etoh, cationic drugs, iodine contrast
metformin benefits
negligible weight gain
negligible hypogly
su moa
SU bind to SU receptor proteins and inhibits Katp channel mediated K+ efflux, triggering calcium dependent release of insulin from b cells
su requirement
need functional beta cells to work (not for T1)
su AE
hypogly, weight gain
su ddi
BB, etOH, Cyp2c9
tzd moa
peroxisome proliferator activated receptors agonist to promote glucose uptake into target cells
tzd ae
hepatotoxicity (do not initiate if ALT > 3xUNL)
edema
fracture
weight gain
tzd ci
active liver disease, HF class III or IV
a glucosidase moa
delay glucose absorption and decrease PPG (inhibit brush border enzymes for breakdown of complex carbohydrates)
a glucosidase inhibitor ae
flatulence, diarrhoea
a glucosidase inhibitors ci
breast feeding, GI diseases
a glucosidase ddi
yakult!
glp 1 receptor agonist moa
binds to beta cells to
- delay gastric emptying
- increase insulin secretion
- decrease food intake
glp 1 receptor ae
GI NVD, acute pancreatitis
glp 1 receptor benefits
- weight loss
- ascvd benefit
- ckd minimal benefit
dpp4i moa
prevents active glp1 from being converted to inactive glp 1
dpp4i ae
very mild
(sitagliptin) pancreatitis
sglt2i moa
increased renal glucose excretion, decreased blood glucose
sglt2i ae
uti, hypot, hypogly, fournier’s gangrene
sglt2i benefits
ascvd (cana, empa) , hf, ckd
meds to take before meal
su
meds to take with meal
alpha glu
weight loss inducing meds
metformin, glp1, sglt2i
weight gain inducing meds
su, tzd
meds targeting PPG
SU, GLP1, TZD
meds targeting FPG
metformin, SGLT2, TZD
insulin moa glucose
increase glucose uptake, inhibits hepatic glucose output
insulin moa fat
enhance fat storage, prevents lipolysis
insulin moa protein
increase protein synthesis, inhibits proteolysis
rapid acting insulin types
aspart lispro glulisine
15 min before meal
short acting insulin types
regular / actrapid
30 min before meal
long acting insulin types
detemir glargine
intermediate acting types
nph
when injectables started, tzd?
discontinue tzd / reduce by 50%
when injectables started, su?
discontinue (esp if mealtime insulin initiated) / reduce by 50%
when injectables started, dpp4i?
discontinue
mixtard 30 components
70% nph, 30% regular
conversion of mixtard to glargine
20% reduction of NPH
target range for fpg
5 to 7
hyperglycemic hyperosmolar state is which type of diabetes
type 2
diabetic ketoacidosis happens in which type of diabetes
type 1
dawn phenomenon
release of cortisol in waking hours
somogyi effect
bg levels drop sharply at night, body releases glucagon, bg increases
uses of aspirin in DM
those with diabetes and Hx of ASCVD
