Diabetes Melletius Flashcards by JHope .

What is treatment for Type 1 and Type 2

Type 1
insulin
Amylin mimetic

Type 2
Lifestyle AND/or
oral meds AND/or
insulin

How well did you know this?

Not at all

Perfectly

what is screening criteria for Type 2?

all adults 45y
overwt/obese (BMI >25 or 23 Asians) w/ risk
Repeat min 3yrs

How well did you know this?

Not at all

Perfectly

What is normal, ADA, AACE guidelines for glycemic contol

NORMAL
Pre prandial glucose- <100
Peak post prandial glucose- <140
Hgb A1C- 4-5%

ADA
Pre prandial glucose- <80-130
Peak post prandial glucose- <180
Hgb A1C- <7%, elderly 8%

AACE
Pre prandial glucose- <110
Peak post prandial glucose- <140
Hgb A1C- <6.5%

How well did you know this?

Not at all

Perfectly

What are looser targets?

A1c- 7.5-8% older comorbidities +2, hypogly prone
tigher younger <6.5, <7 healthy

If not at goal 3mo check up

How well did you know this?

Not at all

Perfectly

Why is hypoglycemia a concern?

TREat at BG <70
54 clinically significant
Sx/ shaking, tachycardia, diaphoresis, weak, anxious, huger, HA, dizzy, irritable

How well did you know this?

Not at all

Perfectly

Exercise goals for DM?

LOW CHO
achieve 5% loss
150min/wk moderate-intense activity
Resistane 2-3x/wk

How well did you know this?

Not at all

Perfectly

name wt loss meds

Short term Phetermine
Long- Orlistat
Lorcaserin
Naltrexone/buproion
LIIRAGLUTIDE

Surgery-consider BMI >40

How well did you know this?

Not at all

Perfectly

What is standard of care for prediabest and DM?

All METFORMIN and lifesyle changes

Insulin- hyperglycemia, >10%A1C

Dual RX- if AIC great than 1.5% of NEW GOAL

RE-eval Q3 mo , add/changes if NO T AT GOAL

How well did you know this?

Not at all

Perfectly

What drug is benefical for CV?

SGLT2 inhibitors- CHF

GLP1s

How well did you know this?

Not at all

Perfectly

Who are the GLIPTINS?

DDP-4 INHIBTORS
Sitagliptin
Saxagliptin
Linagliptin
Alogliptin

How well did you know this?

Not at all

Perfectly

What are the FOZINS?

SGLT-2 INHIBITORS
Canaglifozin
Dapaglifozin
Empaglifozin

How well did you know this?

Not at all

Perfectly

MEET THE GLINIDES?

METGlNIDE
Repaglinide
Nateglinide

How well did you know this?

Not at all

Perfectly

MEET SUGAR BOSE…

ALPHA- GLUCOSIDASE INHBITOROS
Acarbose
Miglitol

How well did you know this?

Not at all

Perfectly

WHO ARE THE BILE ACID SEQUESTORS?

Colesevalem

How well did you know this?

Not at all

Perfectly

NAME THAT TZD-ZONE?

THIASOLADINEDIONES
Rosiglitazone
Pioglitazone

How well did you know this?

Not at all

Perfectly

What is 1st line along w/ diet and exercise with LITTLE CAUSE FOR HYPOGLYCEMIA?

Biguanide (METFORMIN)
Prediabetes benefits
NO HYPOGLYCEMIA

MOA- 1- DEC LIVER glu output- dizzy when fasting
2. INC peripheral glu uptake
NO effect on INSULIN SECRETION
Dec A1c, FBG, LDL, TG
INC HDL

PK-RENAL
DOSE LOW, START SLOW
ADE- AN, N initiaitn-titrate, DIARRHEA, DEC B12
RARE- NEUROPATHY, METALIC,
BBW- LACTIC ACIDOISIS

AVOID- RENAL IMPAIRMENT, CR<30-45
D/C PRIOR TO CONTRAST IMAGING-24HRS
Cimetidne (gi ulcer)- inc levels

What is dose for Metformin?

Iniital 500mg BID or 850 QD w/ meals
progress to 500/wk

MAX- 2000/dy

If A1c not met at 3 mo., BUT pt does NOT have ASCVID OR CKD, then….add one of the following

SGLT2
GLP
DDP4
sulfonylurea-$
TZDs

BasAl Inulin

What RX helps with major CV event and mortality?

SGLT2s: Empagliflozin > canagliflozin

GLP-1 receptor agonist: Liraglutide > semaglutide > exenatide extended release

What RX help w/ Reduction in HF and reduction in CKD progression?

SGLT2s: empagliflozin, canagliflozin

What RX in DM help w/ Weight Loss?

SGLT2s
GLP-1 RA:
#1Semaglutide
> Liraglutide > dulaglutide > exenatide >lixisenatide

What RX mimic incretin hormone with DM2 who are not adequately controlled with metformin, need to lose wt and has CVD risk, BUT has Hypoglycemic risk?

GLP-1 Receptor agonists: TIDES
MOA: Mimics the effects of an incretin hormone called glucagon-like peptide-1 (GLP-1)
Stress response to high BG levels
Inhibits release of glucagon after meals
Slows the rate of gastric emptying-full quicker..less wt

stimulates production of insulin

ADE- HYPOGLYCEMIA, NVD, dizzy. INJ site reaction***
BBWC- medullary THYROID carcinoma Cell Tumor
SLOW gi- altr oral drugs rates

AVOID- Renal impaired CrCL<30
GI dz
Pancreatitis

What is regimen for GLP-1?

INJECT
Exenatide IR .
0.5 – 1 % BID

Exenatide ER
1.5- 2 % Weekly

***Liraglutide- FDA APPROVed wt loss and CVD
1-1.5 %Daily

Dulaglutide ,Semaglutide
1-1.5 %Weekly

What DM RX has Benefit in decreasing ASCVD/CHF/CKD Weight loss, BUT INC risk of UTIs?

Sodium Glucose Co-Transporters

MOA-Inhibits glucose and sodium reabsorption in renal proximal tubule. INC urinary glucose excretion

DEC: A1c 0.6-1.2%, FBG and PPG. weight and BP

PK- LIVER, Excretion: fecal and renal

ADE- Hypoglycemia risk is low
too much acid in the blood   
Polyuria 
UTI 
Hypotension 
Dapaglifozin: Nasopharyngitis

AVOID- RENAL DZ., Elderly, LIVER DZ

WHat is a 3rd line option that prolongs incretin hormone/ GLP?

``` DPP4 GLIPTINS,, Inhibits DPP-4 enzyme that activates GLP, thus GLP last longer. GLP reacts to INC sugar, slow emptying. Maintains BS homestatis. DEC GLUCAGON Insulin secretion- NO HYPOGLY DEC A1C- 0.7% DEC FBG ``` PK-RENAL ADJ, T1/2 = 12.4 hrs Lina: BILE elim, T1/2 = >100hrs ADE- HA, PANCRETITIS, URI, JT PAIN**** SITA- FDA- JT PAIN***, PANCREATISIS Sax: UTI, SKIN, CHF-FDA*** Lina- HYPOGLY, JT PAIN AVOID- LIVER FAILURE

What DM is rarely used, avoided in CHF and induce CYP3A4?

THIAZOLIDINEDIONES-ZONES ``` MOA Peroxisome proliferator activated receptor (PPAR) agonist to incr glu uptake INC insulin sensitivity DEC hepatic glu OUTPUT NO HYPOGlYCemia ↓ A1C- 0.6-1.3%, ↓ FBG ↑HDL & LDL- ROS ↓ TG - PIO ``` PK- SLOW ONSET OF ACTION 4 MONTHS ``` ADE-WT GAIN, HEPATIC DZ- monitor LFT Edema-CHF risk Anemia BBW-Avoid heart failure- PIO PREG D,X Liver Dz ***Bladder CAncer- PIO MI- Rosi FX risk ``` DI- PIO- CYP3A4-DEC; ***OCP, HMGCOA Osteoporosis AVOID- CHF

What is the older agent with increase in hypoglycemia?

Sulfonylureas- P/B-rides MOA-Stimulate insulin secretion pancreatic β cells Clinical- $, old, >40 new onset, <5y, dec vessel damage, easy ↓FPG by 60-70 mg ↓A1c 1-2% PK-All LIVER, EXCEPT***glyburide- KIDNEY feces ADE- HYPOglycemia***, Wt gain, GI Derm-rash photosens PREG D,X DI- INC SU effects- antacids, fluconazole DEC SU effects- rifampin, cyclo Hepatic meta Renal excrete: Tolazamide; glyburide - careful dose adj in elderly hypoglycemia MC; wt gain, derm: rash, photosen, pruritus, hyersen rxn, GI: N/V, abnrml LFT, dyspepsia, abnrml taste, dizziness, drowsiness, constipation ↑hypogly: antacids, H2 blockers, PPIs, large dose ASA, Gemfibrozil ↓hypogly: rifampin Oldest agent, inexpensive, FBG <200, good choice for new-onset >40yo or have DM <5yrs, no previous tx w/ insulin not 1st line in overwt pts, glipizide/ glimepriride prefer in CrCl <50

What is not longer due to INC risk of HYPOGLY?

Glyburide

HYPOGLYCEMIA risk?

glyburide, glipizide, glimepiride- Sulfonylureas-- repaglinide, nateglinide- Metaglinide Insulin

What inhibit hepatic glucose output?

Metformin | Colesevelam- UKNO

What are the insulin sensitizers?

PIOglitazone ROSgliazone Metformin-periphery

What slow absorption of CHO

Acarbose | Miglitol

What INC glucose dependent- insulin AND DEC glucagon secretion?

GLP- glutides, tides | DDP4-gliptins

Which cause wt gain?

TZD-zone SU- B/P-ide Metglinides INsulin

Which are ideal for Wt loss?

Metformin-min GLP- slow gastric empty-full SGLT-diuetic Pramitdine