Diabetes Medications/Treatments Flashcards
What is basal insulin?
It’s a long-acting, slow onset insulin given to control hepatic glucose production during a fasting state
lasts 24 hours
important to have a dose before extended periods of fasting (sleep)
What is bolus insulin?
it’s a short-acting, fast-onset insulin given to control the intake of glucose from food
works in about 15 minutes, peaks in about 1 hour, and continues to work for 2 to 4 hours
dosing is based on the amount of carbs in the meals
What is sliding scale insulin?
only used in hospital
amount of bolus fast-acting insulin is adjusted before the meal based on the blood sugar at that time
not recommended as sole blood sugar therapy because it requires more monitoring/man power and may lead to increased pt discomfort with more injections
Explain insulin pump therapy
continuous subcutaneous infusion which acts like your pancreas
- gives a continuous basal dose of RAPID-acting insulin
at meals, the pt programs the pump to deliver bolus insulin
What medication would you give/add to a diabetic pt’s regimen who had kidney cx?
treatment of T2DM: metformin + SGLT2 inhibitor (bc of its protective renal effects)
- ACE inhibitor or ARB for the diabetic nephropathy
What medication would you give/add to a diabetic pt’s regimen who had cardiovascular disease/high risk for cardiovascular disease?
treatment of T2DM: metformin + … ➔ could consider GLP1 agonist for wt loss for improving risk for cardiovascular disease
- Statin - should check their LDL and give statins if LDL is high
- would also give statins to anyone over 40 yrs old
How would you determine a patient’s risk of developing cardiovascular disease? What tests would you need to order?
Would calculate the Framingham Risk score
need to have smoking hx, total cholesterol, HDL, and BP
Explain insulin-to-carb ratios and how you would explain to a pt
The insulin-to-carb ratio is how much insulin you need to manage the glucose spike you get from the meal
every patient’s ratio will be different and figuring out your ratio will take trial and error
ex. ratio is 1unit insulin: 10g of carbs
- if you eat 45 g of carbs in a meal; you need 4.5 units of insulin before your meal to ensure you don’t get postprandial hyperglycaemia
What oral hyperglycaemic medication do all T2DM start with at minimum? and how does it work (MoA)?
Metformin! Biguanide
first line
- increased muscle glucose uptake
- decreases liver glucose production
- decreases glucose absorption in the gut
what side effects are common in metformin?
GI distress - nausea and vomiting
there is a small level of wt loss
it also reduces the level of vitamin B12 at higher doses
What are the first, second, and 3rd line treatments for T2DM?
1st: metformin
2nd: + DPP4i, SGLT2i, GLP1 agonist ➔ DPP4i and GLP1 agonist cannot be used together, pt can be on combo 3 meds if need be
3rd: sulfonylurea - last ditch effort to not put the pt on insulin
How does DPP4i work?
increases insulin release by inhibiting DPP-4 which normally stops GLP and GIP from stimulating insulin secretion
How does SGLT2i work?
Blocks SGLT-2 receptors from reabsorbing glucose from the urine which increases glucose excretion
How do GLP1 agonists work?
they stimulate the secretion of insulin by mimicking the function of GLP1
they also inhibit the production of glucagon ➔ decreases glucose production in the liver and longer satiety feeling
How do sulfonylureas work?
increases insulin release from the pancreas, and encourages tissue receptiveness to insul
