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Year 2 Endocrine > Diabetes mellitus type II > Flashcards

Diabetes mellitus type II Flashcards

1
Q

what are the microvascular complications of diabetes?

A
  • retinopathy
  • neuropathy
  • nephropathy
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2
Q

what are the macrovascular complications of diabetes?

A
  • cerebrovascular disease
  • peripheral vascular disease
  • coronary heart disease
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3
Q

what are the criteria for diagnosis of diabetes?

A
  1. symptoms of diabetes and a casual glucose of over 200 mg/dL
  2. fasting blood glucose over 126 mg/dL on TWO occasions
  3. two hour post prandial glucose over 200 mg/dL
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4
Q

what is the effect of insulin on glycogen formation?

A

increase

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5
Q

what is the effect of insulin on protein synthesis?

A

increase

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6
Q

what is the effect of insulin on lipid synthesis?

A

increase

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7
Q

HbA1C correlates with what parameter of glucose metabolism?

A

3 month blood sugar AVERAGE (RBC lifespan)

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8
Q

how will hemoglobinopathies (eg sickle cell) affect HbA1C levels?

A

falsely elevated

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9
Q

how will recent transfusions or anemia affect HbA1C?

A

falsely low

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10
Q

what will cause falsely elevated HbA1C levels?

A

hemoglobinopathies (eg sickle cell)

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11
Q

what will cause falsely low HbA1C levels?

A

recent transfusions, anemia

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12
Q

what are drug choices for T2DM?

A
  • GLP-1 agonists
  • DPP-4 inhibitors
  • sodium-glucose co-transporter inhibitors
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13
Q

what class of drugs inhibits glucose influx?

A

a-glucosidase inhibitors

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14
Q

what class of drugs promotes insulin secretion?

A

insulin secretagogues

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15
Q

what class of drugs lower hepatic glucose output?

A

metformin

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16
Q

what class of drugs increase peripheral glucose uptake?

A

thiazoladinediones

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17
Q

what are the a-glucosidase inhibitor drugs?

A

acarbose (precose)

miglitol (glyset)

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18
Q

what drug class is the best option for diabetic patients with mild post-prandial hyperglycemia?

A

a-glucosidase inhibitors

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19
Q

what are the contraindications to a-glucosidase inhibitors?

A

malabsorption

20
Q

what are the side effects of the a-glucosidase inhibitors?

A

GI upset, bloating

21
Q

insulin secretagogues (sulfonylureas): MOA

A

stimulate insulin secretion by closing ATP sensitive potassium channels of pancreatic beta cells

22
Q

what are the 1st generation sulfonylureas?

A

chlorpromide

tolbutamide

23
Q

what are the 2nd generation sulfonylureas?

A

glyburide
glipizide
glimipiride

24
Q

what are the meglitinides?

A

repaglinide

nateglinide

25
Q

what are the side effects of the secretagogues?

A

hypoglycemia, weight gain

26
Q

what are the contraindications of the secretagogues?

A

severe renal / hepatic disease

27
Q

biguanides: MOA

A
  • decrease hepatic gluconeogenesis
  • lower Alc 1.5-2.0%
  • decrease appetite / promote weight loss
28
Q

what are the biguanide drugs?

A

metformin

glucophage

29
Q

what are the side effects of the biguanides?

A

LACTIC ACIDOSIS, GI upset

30
Q

what are the contraindications for the biguanides?

A

CRI
CHF
liver disease

31
Q

thiazoladinediones: MOA

A
  • 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
32
Q

what are the thiazolidinedione drugs?

A
  • pioglitazone (actos)

- rosiglitazone (avandia)

33
Q

what are the side effects of the thiazolidinedione drugs?

A

fluid resuscitation / weight gain

34
Q

what are the contraindications of the thiazolidinedione drugs?

A

CHF III and IV

severe liver disease

35
Q

what type of drug is exenatide?

A

GLP-1 analogue (incretin mimetic)

36
Q

incretin mimetics: MOA

A

in response to gut detection of glucose, incretin hormones (glucose like peptide 1) are released and stimulate secretion of insulin from beta cells

37
Q

what are the side effects of the incretin mimetics?

A

hypoglycemia, nausea

38
Q

what are the contraindications of the incretin mimetics?

A

ESRD

severe gastric disease

39
Q

dipeptidyl peptidase 4 (DPP-4) inhibitors: MOA

what are the effects?

A

DDP-4 enzyme degrades GLP-1

  • increase body’s active incretin hormone levels
  • increase pancreatic secretion of insulin
  • decreased liver glucose production
40
Q

what are the DPP-4 inhibitor drugs?

A

siltagliptin
saxagliptin
linagliptin

41
Q

what are the side effects of the DPP-4 inhibitors?

A

nasal congestion

42
Q

pramlitide: MOA

A

lowers post prandial glucagon

43
Q

what are the side effects of pramlitide?

A

hypoglycemia, nausea

44
Q

what are the contraindications of pramlitide?

A

gastroparesis

hypoglycemia unawareness

45
Q

what are the indications for insulin therapy in T2DM?

A
  • significant hyperglycemia at presentation
  • hyperglycemia despite maximal doses of oral agents
  • decompensation
  • surgery
  • pregnancy
  • renal disease
  • allergy or serious reaction to oral agents
46
Q

what is the regimen when medications alone are failing?

A
  1. continue oral agents
  2. add single injection at bedtime NPH or Lantus 10 units
  3. titrate to achieve FBG under 100 mg/dL

Year 2 Endocrine (33 decks)

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