Diabetes Oral Medications Flashcards
During a fasting state/gluconeogenesis, what do the alpha cells of the pancreas secrete?
Glucagon
What is secreted by the Beta cells of the pancreas?
- Insulin
- C-peptide
- Proinsulin
- Amylin
Metabolic syndrome components of diagnosis
- Hypertriglyceridemia
- HDL (below 40 in men, or below 50 in women)
- Hypertension: >130/85
- Fasting plasma glucose (>100)
Need two of these (or being treated for 2) with waist circumfirence >40 men, >35 women
For diabetic nephropathy, what hypertension medications are typically used?
1st line: ACE and ARB
2nd line: Diuretics
Name the 5 most important invertentions in decreasing order of benefit
- Smoking cessation
- Blood pressure control
- Metformin therapy
- Lipid reduction
- Glycemic control
What does fasting blood sugar help you gauge?
effectiveness of basal insulin or agents that decrease hepatic gluconeogenesis
When is postmeal blood sugar obtained?
2 hours post prandial
Which oral medications work to decrease glucose absorption from the gut?
- Alpha-glucosidase inhibitors
2. Amylin mimetics
Which oral diabetes medications decrease glucose production by the liver?
- Metformin (Biguanides)
Which medications increase glucose utilization by the muscles?
TZDs
Which oral meds increase insulin secretion?
- Sulfonylureas
- GLP-1 activators
- DPP-4 inhibitors
Which drug is associated with black box warning of amputation?
SGLT-2 inhibitors
Which drug is associated with black box warning of thyroid c-cell tumors??
GLP-1s (ex. liraglutide, albiglutide, dulaglutide)
DPP-4 inhibitors ADE
- risk of acute pancreatitis
- Joint pain
Which oral drug has a black box warning of congestive heart failure?
Thiazolidinediones (pioglitazone, rosiglitazone)
Which drug carries with it a risk of bladder cancer?
pioglitazone
Which sulfonylurea is not recommended?
Glyburide
Glipizide and glimepiride are okay
Metformin: Pharmacodynamics
- Improved insulin sensitivity
- Decreased glucose production by liver
- Improved glucose uptake by muscles
Metformin (Biguanides): key points
- 1st line
- start slow to minimize diarrhea
- weight neutral
Thiazolidinedione: effect
enhanced insulin sensitivity in muscle, liver, and fat
-Pioglitazone may decrease triglycerides
Thiazolidinedione: ADE
- weight gain*
- Fluid retention
What is important to remember about Sulfonylureas and Metaglinides regarding carbs?
must keep under 60g a meal for these to work well
Sulfonylureas: ADE
- hypoglycemia**
- weight gain
- 3rd line agents (but usually this is what people can afford)
Glucagon-like Peptide 1 Receptor agonists: Examples
Exenatide, Liraglutide, albiglutide, Dulaglutide, Semaglutide
GLP-1 effects
- enhanced insulin secretion
- suppresses high postprandial glucagon secretion
- Decreased hepatic glucose production
- Increased satiety
- Slowed gastric emptying
- Weight loss
Dipeptidyl Peptidase-4 (DPP-4) “gliptins”
Ex. Sitagliptin (Januvia), Saxagliptin, Linagliptin, Alogliptin
DPP-4 effects
prolong half-life of endogenously produced GLP-1 significantly reducing inappropriately elevated postprandial glucagon and improving beta cell response to hyperglycemia
SGLT-2: examples
“gliflozins”
Canagliflozin (Invokana), Dapagliflozin, Empagliflozin
SGLT-2 effects
- More glucose lost in the urine
- 2nd or 3rd line therapy
alpha-Glucosidase inhibitors: examples
Acarbose, Miglitol
alpha-Glucosidase Inhibitors: effect
- prolong carbohydrate absorption in the small intestine
- reduction in postprandial glucose (no effect on fasting blood glucose)
alpha-glucosidase inhibitors: ADE
flatulence, bloating, abdominal discomfort, and diarrhea
Bromocriptine (dopamine agonist) dosing
Daily dose taken with food within 2 hours of waking from sleep (skip if not in this window)
If a patient presents to you with an A1C < 7.5% what therapy is suggested?
Monotherapy = metformin
If a patient presents to you with an A1C > 7.5% what therapy is suggested?
Dualtherapy = Metformin + GLP-1 or SGLT-2 or DPP-4
If a patient presents to you with an A1C >9% with symptoms what therapy is suggested?
Insulin + oral agents
For adding basal insulin, if a patient has A1C <8% what is the recommended starting dose?
- 1-0.2 U/kg
- titrate every 2-3 days to reach glycemic goal
What is the starting basal dose if A1C is >8%?
0.2-0.3 U/kg
What is the starting dose for prandial insulin?
10% of the basal dose (or 5 units)
Somogyi Effect
Hypoglycemia in the nighttime resulting in rebound high blood sugar in the morning
