Diabetes Mellitus Type 2 Flashcards
what is waist circumference in a male patient with DM2?
over 40 inches
what is waist circumference in a female patient with DM2?
over 35 inches
inflammation of penis and foreskin
balanoposthitis
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
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
the higher the HbA1c, the higher the ______ has been the last ___ days
glucose
90
what class of drugs stimulate insulin secretion by the pancreas? (3)
sulfonylureas
meglitinides
phenylalanine derivative
what are the 2 sulfonylureas used to stimulate insulin secretion by the pancreas?
glyburide
glipizide
which sulfonylurea is preferred? why?
glipizide
shorter duration of action = shorter side effects
how to take glipizide?
30 mins before meals
which patients should not receive glipizide?
liver failure
which patients should not receive glyburide? (3)
liver failure
renal failure
elderly
what are the ADR of sulfonylureas? (2)
hypoglycemia
weight gain
what is the name of the meglitinide analog that stimulates insulin secretion by the pancreas?
rapaglinide
what is the name of the D-phenylalanine derivative that stimulates insulin secretion by the pancreas?
nateglinide
which medications give a brief, rapid pulse of insulin? (2)
rapaglinide
nateglinide
which 2 class of medications act on the liver, muscle, and adipose tissue to increase uptake of glucose?
biguanides (metformin)
thiazolidinediones (glitazones)
what is the first line drug for DM2?
biguanides (metformin)
which drug reduces gluconeogenesis and lipogenesis?
metformin
what are the ADR of metformin?
GI - start slow
lactic acidosis
diarrhea
which drug class sensitizes peripheral tissues to insulin and decreases hepatic glucose production?
thiazolidinediones (glitazones)
how do thiazolidinediones (glitazones) reduce A1c?
by 1-2%
what are the ADR of thiazolidinediones (glitazones)? (2)
weight gain
fluid retention
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
