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ENDO > Diabetes Treatment > Flashcards

Diabetes Treatment Flashcards

1
Q

In general, what are our oral agents to treat diabetes?

A

Insulin secretagoguse, Alpha-glucoside inhibitors, Biguanides (metformin), Thiazolidinediones (TZD’s), and sitagliptin

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2
Q

What are the insulin secretagogues?

A

Sulfonylureas like glyburide

Stimulate pancreas to secrete insulin; or meglitinides (rapid acting stimulators)

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3
Q

How does Sulfonylureas work? Who are they indicated for?

A

Bind to beta cell receptors to increase insulin release

For obese type 2 DM – goal to decrease insulin resistance

Non-obese type 2 DM – goal to improve early phase insulin release

*Must be used as adjunct therapy to Metformin

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4
Q

How would we tell if Sulfonylureas is working?

A

Decrease HbA1c by 1-2%

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5
Q

What is the caution with Sulonylureas?

A

HYPOGLYCEMIA & hepatic problems. WEIGHT GAIN & interacts with alcohol

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6
Q

Which med is our meglitinides?

A

Rapaglinide (Prandin)

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7
Q

Meglitinides have a faster onset, how fast? What is it used for?

A

1 hr (short half-life); used before meals to control post prandial hyperglycemia

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8
Q

Are the meglitinides any better than the Sulonylureas’s?

A

Nope

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9
Q

What does metformin do?

A

Decreases hepatic glucose production; and decreases gluconeogenesis; reduces fasting & post prandial blood sugar

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10
Q

What are the benefits of metformin?

A

Does not cause hypoglycemia or weight gain

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11
Q

What is the first line therapy for DM?

A

metformin! Especially obese patients

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12
Q

What is the adjunct treatment with metformin?

A

Diet!

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13
Q

When we prescribe metformin, how much of a decrease do we expect in A1c?

A

1-2%

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14
Q

What does Metformin activate in its MOA?

A

Adenosine monophosphate-activated protein kinase (AMPK)

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15
Q

When can we not use metformin?

A

Contraindicated if creatinine >1.5 in males & >1.4 in females; alcoholism or CHF → can lead to lactic acidosis

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16
Q

How do we start dosing of Metformin?

A

titrate dose SLOWLY to max of 2000-2500/day

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17
Q

What are some side-effects of metformin?

A

GI upset, N/V/D

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18
Q

If we have a patient we need to get a CT or MRI with contrast, what must we always remember??

A

Hold their metformin the day of test & for 48 hours after!

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19
Q

What medication would we use to sensitize peripheral tissue to insulin, thus decrease peripheral insulin resistance?

A

TZD

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20
Q

What’s our most commonly used TZD?

A

Pioglitizone (Actos)

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21
Q

What must we always check prior to initiating a TZD?

A

LFT’s

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22
Q

What are the benefits of TZD’s?

A

No hypoglycemia & increase HDL and decrease trigs

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23
Q

What are the concerns with TZD’s?

A

Causes weight gain; fluid retention (so don’t use in HF patients)

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24
Q

What’s the black box warning with TZD’s?

A

Increase risk of acute heart failure

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25
Q

What medication inhibits the digestion of starch & sucrose? What enzyme does it inhibit?

A

Alpha-glucosidase enzyme Acarbose (precose)

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26
Q

What are the S/E of alpha glucosidase inhibitors?

A

Flatulence & Diarrhea

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27
Q

Who would we prescribe Acarbose (prescose) for?

A

“Mild DM”

28
Q

What newer medication inhibits DPP-4 enzymes to decrease incretin hormones thus helping patients to control their glucose?

A

Sitagliptin

29
Q

What is the effect of sitagliptin?

A

Potentiates insulin synthesis and release – decreases glucagon production

30
Q

How much does Sitagliptin decrease HbA1c by? Is it well tolerated?

A

0.5-0.8%

Yes, very well tolerated

31
Q

What newer medication can decrease A1c by about 1%, decrease weight by 5-10 pounds, and lowers BP?

A

SGLT2 inhibitors AKA Canaglifozin

32
Q

What is an SGLT2?

A

Protein in proximal renal tubule that reabsorbs glucose in kidneys – thus increasing glucose excretion

33
Q

What are the adverse effects of SGLT2 inhibitors?

A

yeast infections, hypoglycemia (if combined with insulin), hypotension, and impaired renal function (increase creatinine & decrease GFR).

34
Q

What hormones are secreted from Beta cells?

A

Insulin & Amylin

35
Q

When are insulin & amylin secreted?

A

Released in response to increased blood glucose

36
Q

What does the alpha cell secrete?

A

Glucagon

37
Q

What is the function of glucagon?

A

Maintains blood glucose between meals/fasting state

38
Q

Glycogenolysis is…

A

Breakdown stored liver glycogen

39
Q

Glyconeogenesis is…

A

glucose formation from amino acid

40
Q

When else would glucagon levels increase?

A

In strenuous exercise

41
Q

When Amylin is released from a beta cell, what does it do?

A

It inhibits gastric emptying & glucagon release

42
Q

What does the delta cell release?

A

Somatostatin

43
Q

What does somatostatin do?

A

Inhibits release of insulin

44
Q

What hormone is derived from the ileum? What cell?

A

GLP-1 from the L cell

45
Q

What medication increases GLP-1?

A

Sitagliptin [januvia]

46
Q

What 2 meds are our incretin mimetics or GLP-1 agonists?

A

Exenatide [Byetta]

Liraglutide [Victoza]

47
Q

What medication stimulates the release of Amylin? From what cell?

A

Pramlintide [Symlin]

Beta Cell

48
Q

What 2 meds function at the KATP pump within the Beta cell of the pancreas?

A

Glipizide [glucotrol]

Repaglinide [Prandin]

49
Q

What are our rapid acting insulins?

A

Lispro (Humalog) – ultra short

Regular insulin

50
Q

What are the intermediate insulin?

A

NPH aka Humalin N

51
Q

What are our long acting insulins?

A

Insulin glargine (lantus)

52
Q

Which insulins do you give just before meals to control post-prandial?

A

Lispro (Humalog)

53
Q

What must you correlate the dose of Lispro with?

A

Carbohydrate load

54
Q

What can you combine with a Lispro to use 2-3 times daily?

A

Humulin N

55
Q

What insulin do you give just before bed for 24 hours?

A

Insulin glargine (lantus)

56
Q

What happens to glucose levels during 5-8AM?

A

Hyperglycemia

57
Q

What medication can help with the early morning hyperglycemia?

A

Intermediates – Humulin N

58
Q

What insulins can you mix together? When?

A

Intermediate + short In the morning & at night

59
Q

What about Insulin Glargine (lantus) can it be mixed?

A

No, cannot mix with other insulins

60
Q

For an insulin pump, what insulin is used? Is it based off of your BG levels?

A

Lispro Timed bolus delivery before meals or exercise – it’s programmable, therefore YOU must check BG levels and the catheter

61
Q

Do we need insulin during exercise?

A

No, we need insulin immediately after exercise. Because glucose will go into the muscles during exercise.

62
Q

What medication are the incretin mimetics?

A

GLP-1 Receptor Agonists – Exanatide

63
Q

Can you use a GLP-1 while on insulin?

A

No this is an alternative to insulin

64
Q

What do GLP-1 cause?

A

Promotes insulin release, suppress post-prandial glucagon, delay gastric emptying, promotes satiety

65
Q

Do the GLP-1’s cause hypoglycemia & weight gain like sulfonurease?

A

Limited hypoglycemia, but it can cause weight gain

66
Q

How much can the GLP-1’s lower A1c levels?

A

~1.2% (which is better than the DPP-4’s)

67
Q

What are the “other” approaches to DM?

A

Pancreas transplant; islet cell transplant; or animal models

ENDO (7 decks)

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