Diabetes Oral Medications

Question 1

During a fasting state/gluconeogenesis, what do the alpha cells of the pancreas secrete?

Answer 1

Glucagon

Question 2

What is secreted by the Beta cells of the pancreas?

Answer 2

• Insulin
• C-peptide
• Proinsulin
• Amylin

Question 3

Metabolic syndrome components of diagnosis

Answer 3

1. Hypertriglyceridemia
2. HDL (below 40 in men, or below 50 in women)
3. Hypertension: >130/85
4. Fasting plasma glucose (>100)

Need two of these (or being treated for 2) with waist circumfirence >40 men, >35 women

Question 4

For diabetic nephropathy, what hypertension medications are typically used?

Answer 4

1st line: ACE and ARB

2nd line: Diuretics

Question 5

Name the 5 most important invertentions in decreasing order of benefit

Answer 5

1. Smoking cessation
2. Blood pressure control
3. Metformin therapy
4. Lipid reduction
5. Glycemic control

Question 6

What does fasting blood sugar help you gauge?

Answer 6

effectiveness of basal insulin or agents that decrease hepatic gluconeogenesis

Question 7

When is postmeal blood sugar obtained?

Answer 7

2 hours post prandial

Question 8

Which oral medications work to decrease glucose absorption from the gut?

Answer 8

1. Alpha-glucosidase inhibitors

2. Amylin mimetics

Question 9

Which oral diabetes medications decrease glucose production by the liver?

Answer 9

1. Metformin (Biguanides)

Question 10

Which medications increase glucose utilization by the muscles?

Answer 10

TZDs

Question 11

Which oral meds increase insulin secretion?

Answer 11

1. Sulfonylureas
2. GLP-1 activators
3. DPP-4 inhibitors

Question 12

Which drug is associated with black box warning of amputation?

Answer 12

SGLT-2 inhibitors

Question 13

Which drug is associated with black box warning of thyroid c-cell tumors??

Answer 13

GLP-1s (ex. liraglutide, albiglutide, dulaglutide)

Question 14

DPP-4 inhibitors ADE

Answer 14

• risk of acute pancreatitis

- Joint pain

Question 15

Which oral drug has a black box warning of congestive heart failure?

Answer 15

Thiazolidinediones (pioglitazone, rosiglitazone)

Question 16

Which drug carries with it a risk of bladder cancer?

Answer 16

pioglitazone

Question 17

Which sulfonylurea is not recommended?

Answer 17

Glyburide

Glipizide and glimepiride are okay

Question 18

Metformin: Pharmacodynamics

Answer 18

• Improved insulin sensitivity
• Decreased glucose production by liver
• Improved glucose uptake by muscles

Question 19

Metformin (Biguanides): key points

Answer 19

• 1st line
• start slow to minimize diarrhea
• weight neutral

Question 20

Thiazolidinedione: effect

Answer 20

enhanced insulin sensitivity in muscle, liver, and fat

-Pioglitazone may decrease triglycerides

Question 21

Thiazolidinedione: ADE

Answer 21

• weight gain*

- Fluid retention

Question 22

What is important to remember about Sulfonylureas and Metaglinides regarding carbs?

Answer 22

must keep under 60g a meal for these to work well

Question 23

Sulfonylureas: ADE

Answer 23

• hypoglycemia**
• weight gain
• 3rd line agents (but usually this is what people can afford)

Question 24

Glucagon-like Peptide 1 Receptor agonists: Examples

Answer 24

Exenatide, Liraglutide, albiglutide, Dulaglutide, Semaglutide

Question 25

GLP-1 effects

Answer 25

- enhanced insulin secretion - suppresses high postprandial glucagon secretion - Decreased hepatic glucose production - Increased satiety - Slowed gastric emptying - Weight loss

Question 26

Dipeptidyl Peptidase-4 (DPP-4) "gliptins"

Answer 26

Ex. Sitagliptin (Januvia), Saxagliptin, Linagliptin, Alogliptin

Question 27

DPP-4 effects

Answer 27

prolong half-life of endogenously produced GLP-1 significantly reducing inappropriately elevated postprandial glucagon and improving beta cell response to hyperglycemia

Question 28

SGLT-2: examples

Answer 28

"gliflozins" Canagliflozin (Invokana), Dapagliflozin, Empagliflozin

Question 29

SGLT-2 effects

Answer 29

- More glucose lost in the urine | - 2nd or 3rd line therapy

Question 30

alpha-Glucosidase inhibitors: examples

Answer 30

Acarbose, Miglitol

Question 31

alpha-Glucosidase Inhibitors: effect

Answer 31

- prolong carbohydrate absorption in the small intestine | - reduction in postprandial glucose (no effect on fasting blood glucose)

Question 32

alpha-glucosidase inhibitors: ADE

Answer 32

flatulence, bloating, abdominal discomfort, and diarrhea

Question 33

Bromocriptine (dopamine agonist) dosing

Answer 33

Daily dose taken with food within 2 hours of waking from sleep (skip if not in this window)

Question 34

If a patient presents to you with an A1C < 7.5% what therapy is suggested?

Answer 34

Monotherapy = metformin

Question 35

If a patient presents to you with an A1C > 7.5% what therapy is suggested?

Answer 35

Dualtherapy = Metformin + GLP-1 or SGLT-2 or DPP-4

Question 36

If a patient presents to you with an A1C >9% with symptoms what therapy is suggested?

Answer 36

Insulin + oral agents

Question 37

For adding basal insulin, if a patient has A1C <8% what is the recommended starting dose?

Answer 37

0. 1-0.2 U/kg | - titrate every 2-3 days to reach glycemic goal

Question 38

What is the starting basal dose if A1C is >8%?

Answer 38

0.2-0.3 U/kg

Question 39

What is the starting dose for prandial insulin?

Answer 39

10% of the basal dose (or 5 units)

Question 40

Somogyi Effect

Answer 40

Hypoglycemia in the nighttime resulting in rebound high blood sugar in the morning