Diabetes mellitus type II Flashcards
what are the microvascular complications of diabetes?
- retinopathy
- neuropathy
- nephropathy
what are the macrovascular complications of diabetes?
- cerebrovascular disease
- peripheral vascular disease
- coronary heart disease
what are the criteria for diagnosis of diabetes?
- symptoms of diabetes and a casual glucose of over 200 mg/dL
- fasting blood glucose over 126 mg/dL on TWO occasions
- two hour post prandial glucose over 200 mg/dL
what is the effect of insulin on glycogen formation?
increase
what is the effect of insulin on protein synthesis?
increase
what is the effect of insulin on lipid synthesis?
increase
HbA1C correlates with what parameter of glucose metabolism?
3 month blood sugar AVERAGE (RBC lifespan)
how will hemoglobinopathies (eg sickle cell) affect HbA1C levels?
falsely elevated
how will recent transfusions or anemia affect HbA1C?
falsely low
what will cause falsely elevated HbA1C levels?
hemoglobinopathies (eg sickle cell)
what will cause falsely low HbA1C levels?
recent transfusions, anemia
what are drug choices for T2DM?
- GLP-1 agonists
- DPP-4 inhibitors
- sodium-glucose co-transporter inhibitors
what class of drugs inhibits glucose influx?
a-glucosidase inhibitors
what class of drugs promotes insulin secretion?
insulin secretagogues
what class of drugs lower hepatic glucose output?
metformin
what class of drugs increase peripheral glucose uptake?
thiazoladinediones
what are the a-glucosidase inhibitor drugs?
acarbose (precose)
miglitol (glyset)
what drug class is the best option for diabetic patients with mild post-prandial hyperglycemia?
a-glucosidase inhibitors
what are the contraindications to a-glucosidase inhibitors?
malabsorption
what are the side effects of the a-glucosidase inhibitors?
GI upset, bloating
insulin secretagogues (sulfonylureas): MOA
stimulate insulin secretion by closing ATP sensitive potassium channels of pancreatic beta cells
what are the 1st generation sulfonylureas?
chlorpromide
tolbutamide
what are the 2nd generation sulfonylureas?
glyburide
glipizide
glimipiride
what are the meglitinides?
repaglinide
nateglinide
what are the side effects of the secretagogues?
hypoglycemia, weight gain
what are the contraindications of the secretagogues?
severe renal / hepatic disease
biguanides: MOA
- decrease hepatic gluconeogenesis
- lower Alc 1.5-2.0%
- decrease appetite / promote weight loss
what are the biguanide drugs?
metformin
glucophage
what are the side effects of the biguanides?
LACTIC ACIDOSIS, GI upset
what are the contraindications for the biguanides?
CRI
CHF
liver disease
thiazoladinediones: MOA
- PPARy agonists
- induce adipose differentiation
- promote fatty acid storage / fat cell redistribution
- large insulin resistant cells —-> small insulin sensitive cells
- net result: flux of FFA to subcutaneous tissue away from viscera; increase in insulin sensitivity
what are the thiazolidinedione drugs?
- pioglitazone (actos)
- rosiglitazone (avandia)
what are the side effects of the thiazolidinedione drugs?
fluid resuscitation / weight gain
what are the contraindications of the thiazolidinedione drugs?
CHF III and IV
severe liver disease
what type of drug is exenatide?
GLP-1 analogue (incretin mimetic)
incretin mimetics: MOA
in response to gut detection of glucose, incretin hormones (glucose like peptide 1) are released and stimulate secretion of insulin from beta cells
what are the side effects of the incretin mimetics?
hypoglycemia, nausea
what are the contraindications of the incretin mimetics?
ESRD
severe gastric disease
dipeptidyl peptidase 4 (DPP-4) inhibitors: MOA
what are the effects?
DDP-4 enzyme degrades GLP-1
- increase body’s active incretin hormone levels
- increase pancreatic secretion of insulin
- decreased liver glucose production
what are the DPP-4 inhibitor drugs?
siltagliptin
saxagliptin
linagliptin
what are the side effects of the DPP-4 inhibitors?
nasal congestion
pramlitide: MOA
lowers post prandial glucagon
what are the side effects of pramlitide?
hypoglycemia, nausea
what are the contraindications of pramlitide?
gastroparesis
hypoglycemia unawareness
what are the indications for insulin therapy in T2DM?
- significant hyperglycemia at presentation
- hyperglycemia despite maximal doses of oral agents
- decompensation
- surgery
- pregnancy
- renal disease
- allergy or serious reaction to oral agents
what is the regimen when medications alone are failing?
- continue oral agents
- add single injection at bedtime NPH or Lantus 10 units
- titrate to achieve FBG under 100 mg/dL
