Diabetes Treatment Flashcards
Biguanides
Metformin
dose related transient (except diarrhea) GI s/e
titrate slowly and take w food
alcohol increases risk of hypo
DDI radio contrast media
renal dose adjust
Sulfonylureas
Gliclazide, Glyburide, Glimepiride
AE: weight gain and hypoglycemia: don’t skip meals
renal dose adjust
Meglitinide
Repaglinide
AE: hypoglycemia
Take 0-30min before food
Thiazolidinediones
Rosiglitazone, Pioglitazone
CI: HF (edema)
AE: wt gain, increased risk of: fractures (both), MI (R), bladder cancer (P)
Alpha-glucosidase Inhibitors
Acarbose
AE: diarrhea, flatulence, cramps
Avoid in GI obstruction, ulceration, hernia
Hypoglycemia must be treated with dextrose NOT sucrose
Take w 1st bite of each meal
DPP4 Inhibitors
Sitaglitpin, Linagliptin, Saxagliptin, Alogliptin
AE: headaches, UTI, URTI, gas, bloating
rare: pancreatitis, severe joint pain
GLP1 Agonists
Subcut
Delaglutide, Exenatide, Liraglutide, Semaglutide, Lixisenatide
AE: n/v/d initially, allergic rxn (E), retinopathy (S)
CI: medullary thyroid cancer, MEN2 family hx
Caution or CI below eGFR 15-30
SGLT2 Inhibitors
Canagliflozin, Dapagliflozin, Empagliflozin, Ertugliflozin
AE: wt loss, lowers SBP, UTI, genital yeast infections, volume depletion, hyperkalemia, increased SCr, fracture risk
Renal: ineffective below 60 eGFR
Dose before breakfast
SADDMANS
Sulfonylureas
ACEI
Diuretics
Direct Renin Inhibitors
Metformin
ARBs
NSAIDs
SGLT2 inhibitors
Goal is to reach target A1C within
3-6 months
Symptoms of hypoglycemia
Confusion, drowsiness, dizziness, weakness, headache, vision changes, insomnia, nausea, hunger, trembling, palpitations, anxiety, sweating
Treatment of hypoglycemia
15g of carbs q15min until BG>4
eg. 3 tsp sugar, 1 tbsp honey, 4 Dex4 tabs
Statins indicated in diabetes when
age 40+, clinical CVD, microvascular complications, diabetes for over 15y and age >30, other risk factors eg ACR>2
ACEi/ARB indicated in diabetes when
age >55 w CV risk factors or end organ damage, clinical CVD, microvascular complications
Antihyperglycemic drugs w CV benefit
old: Empa, Cana, Lira
new: Dapa, Dela, Sema
Antihyperglycemic drugs w renal benefit
Empa, Cana, Dapa
Cloudy insulins
NPH and protamine mixes are cloudy
Somogyi effect
nocturnal hypoglycemia causes surge of counterregulatory hormones leading to nightmares, hunger, sweating and high AM FBG - treat by lowering evening dose of postponing dinner NPH
Dawn phenomenon
mildly elevated AM FBG due to decrease in tissue sensitivity to insulin at 5-8am caused by counterregulatory hormones - treat by increasing evening dose or NPH and bedtime
DKA signs and symptoms
Diabetic Ketoacidosis
signs: BG>14
sx: headache, n/v/dry mouth, abdominal pain, fruity acetone breath, deep laboured breathing, decreased LOC
DKA causes
alcohol, extensive exercise, infection, less food or insulin, drugs (clozapine, olanzapine, cocaine, lithium, terbutaline)
DKA treatment
fluid, electrolytes, insulin
DKA when to go to the ER
unable to take fluids or keep BG>4, taking extra insulin but BG stilll elevated, diarrhea/vomitting>4h, ketones>3
Urine vs blood ketone testing
urine is delayed, blood is quicker more accurate
go to ER if ketones >3
Aspart, Lispro, Glulisine onset, duration
rapid acting
10-15m onset
3-5h duration
Regular insulin onset, duration
short acting
30m onset
6.5h duration (17-24h with U500 Entuzity)
NPH insulin onset, duration
intermediate acting
1-3h onset
12-18h duration
Glargine, Detemir onset, duration
long acting
1.5h onset, 24h duration (36h toujeo)
Degludec onset, duration
ultra-long acting
1h onset, 42h duration
What does 30 mean in Novomix 30?
30% short acting (aspart) 70% intermediate (NPH)
what does 25 or 50 mean in Humalog mix 25 or 50?
25 or 50% short acting (lispro) the rest is NPH
which antihyperglycemics cause weight gain? loss?
gain: sulfonylureas, thiazolidinediones
loss: GLP1 and SGLT2
which antihyperglycemics cause hypoglycemia?
sulfonylureas, repaglinide
Ozempic key points
2mg pen usually for 0.25mgx4weeks then 0.5mgx2 weeks total 6 wks
4mg pen for 1mg/wk total 4wks
Comes with 4-6needles, dial air shot, inject sc (pinch, 90 angle) around stomach (rotate sites), hold for 5 sec, discard in sharps count.
Same needles as insulins
Saxenda initial titration and days supply
90mg/box = 44 days supply following usual dose schedule: Start at 0.6mg/wk and inc by 0.6mg every week until maintenance dose of 3mg.
Saxenda Vs Victoza
Both liraglutide
Victoza for diabetes 2x3ml pack
Saxenda for weight loss 5x3ml pack
