Diabetes (Slide Deck 5) Flashcards
What are the three SGLT2 inhibitors?
Dapagliflozin
Canagliflozin
Empagliflozin
-flozin
What is the MOA of SGLT2 Inhibitors?
SGLT2 is a high-capacity transporter that is responsible for glucose reabsorption (90%) from the glomerular filtrate, & is overexpressed in those with T2DM
These drugs inhibit SGLT2, thereby decreasing the reabsorption of glucose and ↑’ing urinary glucose excretion.
Works in the kidneys
What is the A1C lower capabilities of SGLT2 Inhibitors?
0.5%-0.8%
What is a requirement of SGLT2 Inhibitors?
Functioning nephrons, hence it is renal dependant
Common side efects of SGLT2 inhibitors?
Increased urination and thirst
Mycotic genital infections (Pee Rinse Wipe)
SGLT2 I contraindications?
Dehydration potential: use cautiously in patients at risk for volume depletion effects
Other diuretics since these work at the kidneys
Small decrease in BP
What are some rare/uncertain AEs when on SGLT2 Inhibitors?
Amputations
Bone Fracture
Fourniers gangrene
What are the cardio benefits of SGLT2is?
for secondary treatment in people with ASCVD and major adverse cardiovascular effects
In patients with HF what does SGLT2is do?
Decrease Hospital Heart failure and CV death
What is overbasilizaiton?
Insulin as a ceiling effect of 0.5U/kg/d
What happens if a patient reaches maximum Basal insulin?
We would start them on Bolus 2 injections a day
Consider Metered dose injection
Titrate 1-2U/week until FPG/PPG at target
What should we consider giving patients if they have high risk of ASCVD, CKD or HF or >60 with 2 or more CV risk factors?
GLP1-RA or SGLT2I
What be considered given for patients who are above A1C targets and glucose lowering is required? and they are already on metformin
SGLT2i or GLP1 Ra or Sulfonylureas, Meglitinide, Thiazolidinediones
If one decides to start insulin and A1c is not at target range
GLP1-RA (Stop DPP4i) , SGLT2i, DPP4i
If needed add bolus
What is Tirzepatide?
It is a duel GIP and GLP1 (New)
