Diabetes Medications Flashcards
What do alpha cells of the pancreas secrete?
Glucagon, problucagon
Beta cells from the pancreas secrete
Insulin
C-peptide
Proinsulin
Amylin
Delta cells from the pancreas secrete what?
Somatostatin
Epsilon cells from the pancreas secrete what?
Ghrelin
G cells from the pancrease secrete
What about F cells?
Gastrin
Pancreatic polypeptide
What are the 8 reasons for Hyperglycemia aka Ominous Ocete?
- Increase glucose reabsorption
- Increased lipolysis
- Decreased incretin effect
- Impaired insulin secretion
- Increased glucagon secretion
- Increased hepatic glucose production
- Neurotransmitter dysfunction
- Decreased glucose uptake
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Definition of Type 1 diabetes?
Autoimmune B-cell destruction, leading to insulin deficiency
Definition of Type 2 diabetes?
- Progressive loss of B-cell insulin secretion due to insulin resistance
Definition of Gestational diabetes?
Diabetes diagnosed int eh second or third trimester of pregnancy
Signs and Symptoms of Type 1 DM
- Polyuria, polydipsia, polyphagia
- Weight loss
- Lethargy accompanied by hyperglycemia
Signs and symptoms of Type 2 DM
- Lethargy
- Polyuria, nocturia, and polydipsia can be present
- Significant weight loss is less common
- Most patients are overweight of obese
In additional to medication what other modification must been done according to the ADA algorithm?
Lifestyle management may reveal that 1-2 foods might be the cause of hyperglycemia, need to correct this first
What drinks can a diabetic who is hypoglycemia take to help?
15 g of simple carbohydrate (eg, 8 oz [240 mL] orange juice or milk, 4 glucose tables, or 1 tube of glucose gel and then retest BG 15 minutes later.
Criteria to diagnose Diabetes Melitus
- FPG >126 (or equal)
- 2 hour BG >200 (or equal) during OGTT
- A1c >6.5 (or equal)
- Symptomatic RBG >200 (or over)
Prediabetic A1c levels?
5.7-6.4
Metabolic syndrome
Central obesisty plus any two of the following
(1) raised triglycerides (≥ 150 mg/dL)
(2) reduced HDL cholesterol (< 40 mg/dL) in males or < 50 mg/dL in females)
(3) increased blood pressure (systolic BP ≥ 130 mm Hg, diastolic BP ≥ 85 mm Hg, or treatment of previously-diagnosed hypertension)
(4) raised fasting plasma glucose (≥ 100 mg/dL) or previous diagnosis of type 2 DM
What are are considered modifiable care in managing hyperglycemia?
Behavioral health
Motivational interviewing
Nutrition for weight loss
Exercise for weight loss managment
Microvascular complications in DM
- Retinopathy
- Neuropathy
- Nephropathy
Macrovascular complications in DM
- Coronary Heart Disease
- Hypertension
- Peripheral vascular disease
What are the 5 interventions for complications and mortality
- Smoking cessation
- Blood pressure control
- Metformin
- Lipid reduction
- Glycemic control
When performing SBGM what does Fasting glucose help measure
Measures the effectiveness of basal insulin or agents which decrease hepatic gluconeogenesis overnight (“leaky liver”)
When performing SBGM what does Pre-meal blood sugar?
To help calculate bolus dose of insulin or agents given to improve insulin secretion
When performing SBSM what does Post meal blood sugar (2 hour post prandial) measure?
- Measures the effectiveness of bolus insulin or agents given to increase levels of insulin (pancreas “poop out”)
- Helps determine needed food intake changes
***Most useful for Type 2 DM
What is the purpose of measuring Bedtime blood sugar
To avoid early A.M. lows from insulins or oral agents
What are ADA glycemic recommendations for:
A1c
Preprandial capillary plasma glucose
Peak postprandial capillary plasma glucose
- A1c: <7.0%
- Preprandial capillary plasma glucose: 80-130 mg/dL
- Peak postprandial capillary plasma glucose: <180 mg/dL
What are AACE/ACE glycemic recommendations for
A1c
Preprandial capillary plasma glucose
Peak postprandial capillary plasma glucose
A1c: <6.5
Pre: <110 mg/dL
Post: <140 mg/dL
**More stringent
Symptoms of HYPOglycemia?
Weakness/Fatigue Irritability Shaking Fast heartbeat Sweating Hunger Impaired vision
What are are Symptoms of HYPERglycemia
- Extreme thirst
- Frequent urination
- Dry skin
- Hunger
- Blurred vision
- Drowsiness
- Nausea
Which diabetic medication has the highest rate of efficacy?
Insulin an anabolic hormone, causes weight gain
Which medications cause weight gain?
a. Thizolidinediones
b. Sulfonylureas
c. Insulin
Meformin:
Class?
MOA?
Dosing key?
a. Biguanides
b. Enhances insulin sensitivity of hepatic and peripheral (muscle tissues) allowing for increased glucose uptake
c. Key start slow and go slow (take smallest dose with largest meal)
What drug class does Thizolidinediones (TZD) fall under?
MOA?
a. Glitazones
MOA: Enhances insulin sensitivity in muscle, liver, and fat tissues indirectly
What is fist line medications for DM
Metformin/Biguanides
What are examples of Sulfonylureas?
Glipizide
Glimerpiride
What are examples of Metaglinides?
“Glinides”
Regaglinide
Nateglinide
What are side effects of Sulfonylureas and Metaglinides?
Weight gain
Hypoglycemia
Examples of GLP-1 agonists
Exenatide (Byetta) Liraglutide (Victoza) Albiglutide (Tanzeum) Dulaglutide (Trulicity) Semaglutide (Ozempic) Lixisenatide (Adlyxin)
MOA for GLP-1 agonists
Enhances insulin secretion Suppresses inappropriately high postprandial glucagon secretion Decreases hepatic glucose production Increases satiety Slows gastric emptying Weight loss***
DPP-4 inhibitors drugs?
“Gliptins”
Sitagliptin
Saxagliptin
Linigliptin
MOA of DPP-4 inhibitors
Prolongs the half-life of endogenous produced GLP-1
SGLT-2 inhibitors drugs?
“Gliflozins”
Canagliflozins
Dapafliflozins
MOA of SGLT-2 lowers
Lowers the renal tubular threshold for glucose reabsorption
glucosuria occurs at lower plasma glucose concentrations
alpha-Glucosidase inhibitors?
Acarbose
Miglitol
MOA of alpha-Glucosidase inhibitors?
Breakdown of sucrose and complex carbohydrates in the small intestine, prolonging carbohydrate absorption
What are side effects of alpha-Glucosidase inhibitors?
Flatulaence, bloating, abdominal discomfort, diarhea
What is key when treating hyperglycemia with Sulfonylureas?
Only take with 60 g or less with carbs
What causes the Somogyi effect?
Most likley to occur following episode of untreated nighttime hypoglycemia, resulting in high blood sugar levels in the morning
How can the Somogyi Effect be prevented?
Check their blood glucose levels in the middle of the night (for example, around 3 AM)
Increase food intake or lower insulin dose in the evening.
When treating hypoglycemia what type of sugars should you treat with?
with glucose (dextrose) products or glucagon, not sucrose
Side effects of TZD?
Weight gain
CHF risk
Moderate fracture risk
What is the Dawn Phenomenon?
Surge of hormones that the body produces daily in the early morning hours before waking
How does the Dawn Phenomenon differ in diabetes?
People with diabetes don’t have normal insulin responses to adjust for this, and may see their fasting glucose go up
The rise in glucose is mostly because the body is making less insulin and more glucagon (a hormone that increases blood glucose) than it needs
The less insulin made by the pancreas, the more glucagon the pancreas makes as a result.
