Diabetes Mellitus Type 2 Flashcards by Sarah Sanchez

what is waist circumference in a male patient with DM2?

over 40 inches

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what is waist circumference in a female patient with DM2?

over 35 inches

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inflammation of penis and foreskin

balanoposthitis

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a patient has classic symptoms of hyperglycemia; thirst, polyuria, weight loss, and blurry vision. what do we need to diagnose them with DM2?

random plasma glucose of 200 or more

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a patient presents asymptomatic. what do we need to diagnose them with DM2? (3)

fasting plasma glucose over 126
OR
two hour OGTT over 200
OR
HbA1c over 6.5%

must be confirmed with repeated labs

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the higher the HbA1c, the higher the ______ has been the last ___ days

glucose
90

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what class of drugs stimulate insulin secretion by the pancreas? (3)

sulfonylureas
meglitinides
phenylalanine derivative

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what are the 2 sulfonylureas used to stimulate insulin secretion by the pancreas?

glyburide
glipizide

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which sulfonylurea is preferred? why?

glipizide
shorter duration of action = shorter side effects

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how to take glipizide?

30 mins before meals

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which patients should not receive glipizide?

liver failure

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which patients should not receive glyburide? (3)

liver failure
renal failure
elderly

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what are the ADR of sulfonylureas? (2)

hypoglycemia
weight gain

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what is the name of the meglitinide analog that stimulates insulin secretion by the pancreas?

rapaglinide

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what is the name of the D-phenylalanine derivative that stimulates insulin secretion by the pancreas?

nateglinide

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which medications give a brief, rapid pulse of insulin? (2)

rapaglinide
nateglinide

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which 2 class of medications act on the liver, muscle, and adipose tissue to increase uptake of glucose?

biguanides (metformin)
thiazolidinediones (glitazones)

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what is the first line drug for DM2?

biguanides (metformin)

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which drug reduces gluconeogenesis and lipogenesis?

metformin

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what are the ADR of metformin?

GI - start slow
lactic acidosis
diarrhea

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which drug class sensitizes peripheral tissues to insulin and decreases hepatic glucose production?

thiazolidinediones (glitazones)

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how do thiazolidinediones (glitazones) reduce A1c?

by 1-2%

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what are the ADR of thiazolidinediones (glitazones)? (2)

weight gain
fluid retention

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which patients should not receive thiazolidinediones (glitazones)?

heart failure

which drug class decreases glucose absorption from the gut?

alpha-glucosidase enzymes

what are the 2 drugs in the class alpha-glucosidase inhibitors?

acarbose miglitol

how should alpha-glucosidase inhibitors be taken?

with first mouthful of food

which medications/drug class lowers postprandial hyperglycemia by 30-50%?

alpha-glucosidase inhibitors acarbose miglitol

what are the ADR of alpha-glucosidase inhibitors?

flatulence diarrhea

which patients should not receive miglitol?

kidney disease

what does oral glucose stimulate in the body?

the release of GLP-1

what does GLP-1 do? (3)

stimulate insulin secretion suppress glucagon secretion delays gastric emptying

-tide

GLP-1 agonists

once weekly injection of GLP-1 agonists (3)

semaglutide exenatide ER dulaglutide

once daily injection of GLP-1 agonist (1)

liraglutide

twice daily injection of GLP-1 agonist (1)

exenatide

once daily oral of GLP-1 agonist

semaglutide

what are the ADR of GLP-1 agonists? (3)

N/V pancreatitis

-gliptin

DPP-4 inhibitors

ADR of DPP-4 inhibitors (3)

pancreatitis nasopharyngitis hypersensitivity reactions

drug class that increases kidney excretion of glucose, causing glycosuria in people with diabetes

SGLT2 inhibitors

-flozin

SGLT2 inhibitors

which patients should not receive SGLT2 inhibitors?

renal insufficiency

what should we watch out for in patients taking an SGLT2 inhibitor?

UTI

what are the rapid insulins? (LAG)

lispro aspart glulisine

what is the order of insulin by effective duration?

rapid: LAG human regular human NPH insulin detemir insulin glargine

what are the 3 insulin that are considered rapid acting?

LAG lispro aspart glulisine

what insulin is considered short acting?

regular insulin

what insulin is considered intermediate acting?

NPH

which insulin (2) are considered long acting?

glargine detemir

in which patients is home glucose monitoring required?

patients on insulin

how should we do home glucose monitoring?

before meals + log in book bid in alternating pattern

what is the goal of home glucose monitoring?

keep preprandial sugars even during day and bedtime surgars equal to morning sugars

what is the ADA recommended foot exam?

every visit

what is the ADA recommended microfilament test?

every 6 months

what is the ADA recommended eye exam?

yearly

what is the ADA recommended urine microalbumin/creatinine ratio?

yearly

what is the ADA recommended A1c check not at goal?

every 3 months

what is the ADA recommended A1c check at goal?

every 6 months