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)
What is the A1C target for pre-pregnancy and pregnancy?
7, 6.5
FBG 5.3, 6.7
What should be upped and killed during pregnancy?
Folic acid
Cut Ace/Arb
Which medications are safe for T1DM during pregnancy?
Insulin
Which medications are safe for T2DM during pregnancy
Metformin Glyburide or insulin
What is first line treatment for GDM
Diet and exercise then insulin if needed
What is the first /second-line treatment for GDM
Diet and exercise
Insulin (Metformin/glyburide)
What is the management of T2DM in children?
Address as a family
Metformin
Metformin and Basal
Metformin
What are the A1C targets for functionally independent Elderly?
<7.0
What is the A1C target for Functionally dependant elderly?
<8.0
What is the A1C targets for Frail and or with dementia?
<8.5
What is the A1c targets for end of life elderly
No longer measured
In elderly patients which diabetes medications should be used cautioned
SUs, TZDs, Choose DPP4is over SUs
What does satiety mean?
Feeling of being full
Which drug class is kidney protective?
SGLT2i
What is the effects of SGLT2i on the kidney?
Essentially they found that this class of drugs has renal and cardiovascular protective properties
What drugs should be considered before giving a bolus insulin?
GLP-RA or SGLT2i or DPP4i or if either of these drug classes are contraindicated
What qualifies someone for ESD for the use of SGLT2i?
They needed to have tried metformin and SU. If they do not respond, then they can get adequate coverage of the SGLT2i medication
