Diabetes Type 2 Flashcards
1
Q
released from distal ileum and colon in response to food containing carbs and fats
A
GLP-1 (glucagon-like peptide)
2
Q
T2DM Patients have a loss of what?
A
first phase insulin response
loss of amylin
3
Q
a fasting plasma glucose of greater than what is considered a diagnosis of DM?
A
FPG>126
4
Q
what is an impaired fasting glucose (IFG) “pre diabetes”
A
100-125
5
Q
what is an impaired glucose tolerance test (2 hour post-load glucose)
A
140-199
6
Q
who should be screened for DM?
A
any patient BMI >25
age >45 (no risk factors) and repeat every 3 years
7
Q
what children should be screened for T2DM?
A
BMI>85th percentile Plus 2 of the following Family hx ethnicity associated w/ risk signs of insulin resistance maternal hx or gestational DM
8
Q
what is involved w/ Polycystic ovarian syndrome
A
Hyperandrogenism Hirsutism Menstrual irregularities Obesity infertility
9
Q
condition w/ excess growth hormone
A
acromegaly
10
Q
condition w/ excessive corticosteroids
A
cushing’s syndrome
11
Q
what are microvascular complications of DM?
A
Retinopathy
Nephropathy
Neuropathy
12
Q
what are macrovascular complications of DM?
A
Atherosclerotic Cardiovascular diagnosis
Dyslipidemia
13
Q
what is the A1C goal for people w/ T2DM?
A
<7.0%
14
Q
what can patients who have IGT or IFG do you prevent progression of DM?
A
weight loss <7%) and increase physical activity
14 grams dietary fiber/ 1000 kcals
15
Q
what are complications w/ gestational DM?
A
maternal morbidity
fetal macrosomia
higher rate of pre-eclampsia
mother at risk for developing T2DM later
16
Q
risk factors for GDM?
A
severely obese previous GDM or large infant presence of glycosuria diagnosis of PCOS strong family hx
17
Q
when are women screened for GDM?
A
at 24-26 weeks gestation
do an OGTT
18
Q
women with GDM should be screened for DMT2 when?
A
6-12 weeks postpartum
19
Q
what is the cornerstone of management of T2DM?
A
diet (>7% weight loss) and exercise (150 min/wk minimum)
20
Q
what other changes changes can help someone w/ T2DM lower CV risk
A
Smoking cessation
Lipid management
Blood Pressure control
Antiplatelet therapy
21
Q
patient on oral meds for glucose control use SMBG to do what?
A
help them achieve their glycemia goals
22
Q
when should A1C be taken for someone at goal?
A
twice a yaer
23
Q
when should A1C be checking for someone not at goal?
A
every 3 months
24
Q
what drugs class has the MOA of “Direct stimulation of insulin release from viable pancreatic beta-cells thus reducing blood glucose levels (↑ insulin secretion)”
A
sulfonylureas
25
at high doses what do sulfonylureas do?
decrease hepatic glucose production (decrease levels of glucagon)
26
how much do sulonylureas decrease A1C by?
1.5%
27
why are 1st generation sulfonylureas not used?
resulted in hypoglycemia
28
what are the names of the 2nd generation sulfonylureas
Glyburide
Glipizide
Glimepride
29
what type DM can't you use sulfonylureas in?
GDM
| T1DM
30
ADRs of sulfonylureas?
Hypoglycemia (elderly, hepatic or renal impairment)
| weight gain
31
when should glyburide be administered?
Administer with breakfast or first main meal
32
what sulfonylureas has the greatest risk of hypoglycemia due to longer 1/2 life and no recommended with CrCl<50
not a first line agent
Glyburide
33
sulfonylurea that is administered 30 minutes before first main meal and not recommended with CrCl<10
glipizide
34
sulfonylureas that you Administer with first main meal
| Not recommended if CrCl < 22 ml/min
glimepiride
35
when is there reduced GI absorption w/ sulonylureas
Reduced GI absorption if blood glucose > 250 mg/dL
36
when do you monitor FPG w/ sulfonylureas
in 2 weeks
| A1C in 3 months
37
contraindications w/ sulfonylureas
sulfa allergy
avoid with ETOH
pregnant
38
drug interactions w/ sulfonylureas
```
Sulfonamide antibacterials
Propranolol
Salicylates
Phenylbutazone
ETOH
```
39
oral diabetic med that Stimulate insulin release from pancreatic beta-cells
Shorter half life than sulfonylureas
Rapid release of insulin that only lasts 1-2 hours
meglitinides
40
when do you take meglitinides?
with meals
| targetes postprandial glucose levels
41
what are the 2 meglitinides?
repaglinide
| nateglinide
42
meglitinide that is Approved for monotherapy or in combination w/metformin.
Taken before meals 3 X/day
Allergy to sulfas not an issue
ADR hypoglycemia
repaglinide
43
meglitinide that is Phenylalanine derivative
Faster onset of action and shorter duration of action than repaglinide; less A1C reduction than repaglinide
Approved for monotherapy an combination w/metformin.
Taken 3X/d before meals
nateglinide
44
adrs w/ meglitinides?
hypoglycemia
| weight gain
45
monitoring w/ meglitinides
FPG at 2 weeks
Postprandial glucose at initiation
A1C at 3 months
46
DOC for treatment of T2DM
Metformin
47
MOA of metformin
Does not affect insulin secretion but requires the presence of insulin to be effective.
decreases production of hepatic glucose production.
decreases intestinal glucose absorption.
increases peripheral glucose uptake.
increases insulin sensitivity
48
what type patient does metformin work best in?
patients w/ significant hyperglycemia
49
ADRs w/ metformin
```
GI symptoms (decrease if taken w/ food)
lactic acidosis (increase w/ renal failure, CHF, hypoxemia, ETOH)
```
50
monitoring for metformin
SCr at baseline
FPG at 2 weeks
A1C at 3 months
51
worst side effect w/ metformin
lactic acidosis
52
contraindications w/ metformin
SCr >1.5 in men and 1.4 in women
| acute or chronic metabolic acidosis
53
precautions to use w/ metformin
```
radiocontrast studies
Age >80 (unless normal GFR)
hypoxic states
liver dysfunction
alcoholism
heart failure requiring pharmacologic tx
```
54
benefits of metformin
No weight gain
No hypoglycemia as monotherapy
Inexpensive
Approved for use as monotherapy and in combination with other therapy
55
what are 2 thiazolidinediones (TZDs) (Insulin sensitizers)
rosiglitazone and pioglitazone
56
how much do TZDs decrease A1C?
0.5%-1.4% (May take 4 weeks for effect)
57
what is required for TZD action?
endogenous insulin
58
beneficial CV effects w/ pioglitazone
increased HDL
| decreased triglycerides
59
with rosiglitazone what CV benefits are there?
```
increase LDL (not beneficial)
but increase HDL
```
60
ADRs w/ TZDs
fluid retention
weight gain
redistribution of adipose tissue
new onset heart failure (higher when combined w/ insulin)
61
Contraindications w/ TZDs
alcohol abuse
elevated liver enzymes (D/C if LFTs elevated 2-3 times ULN)
Hf NYHA class III or IV
62
BBW and TZDs
increased risk of CHF and MI risk
63
what drugs Delays intestinal carbohydrate absorption
Inhibits alpha-glucosidase found in the small intestinal brush border
Prevent glucose absorption and post-prandial glucose levels
alpha-glucosidase inhibitors
64
what are 2 alpha-glucosidase inhibitors
acarbose
| miglitol
65
how much do alpha-glucosidase inhibitors decrease A1C by?
A1C 0.5-0.8%
66
ADRs of alpha-glucosidase inhibitors
loose stools
| flatulence
67
monitoring w/ alpha-glucosidase inhibitors
Post prandial glucose at initiation
| A1C in 3 months
68
contraindications w/ Alpha-Glucosidase Inhibitors
Chronic intestinal disease
| Cirrhosis
69
what drug class Prevent degradation of endogenous glucagon-like peptide-1 (GLP-1) and insulinotropic polypeptide (GIP)
Incretin hormones released in response to meal
Increase insulin synthesis and release from beta cells
Intracellular signaling
GLP-1 also lowers glucagon secretion from pancreatic alpha cells
Dipeptidyl peptidase-4 (DPP-4) inhibitor
70
what drugs are Dipeptidyl peptidase-4 (DPP-4) inhibitor s
Sitagliptin (Januvia®)
| Saxagliptin (Onglyza)
71
how much do Dipeptidyl peptidase-4 (DPP-4) inhibitor s decrase A1C
A1C 0.5-0.7%
72
benefits for DPP-4 inhibitors
weight neutral
approved for monotherapy or combo
weight neutral
73
Bile acid sequestrant: received FDA indication in January 2008 for Type 2 diabetes as an adjunct to diet and exercise
previously approved for LDL reduction
Colesevelam (WelChol)
74
efficacy of Colesevelam (WelChol)
0.4-0.8% A1C decrease
75
has Colesevelam (WelChol) been studied as monotherapy
no
76
ADRs of Colesevelam (WelChol)
constipation/ nausea/ indigestion
| increase triglycerides
77
Contraindications w/ Colesevelam (WelChol)
Bowel obstruction
History of hypertriglyceridemia-induced pancreatitis
Triglycerides >500 mg/dL
78
what is a glucagon-like peptide peptide 1 (GLP-1) agonist?
exenatide (byetta)
79
what is the efficacy of exenatide?
decrease A1c by 0.5-1%
80
what is exenatide FDA approved for?
T2DM in patients on metformin, sulfonylurea, TZD or a combo who aren't at goal
81
is exenatide approved with use for basal insulin?
No
82
ADRs w/ exenatide
N/V/D
modest weight loss
anti-exenatide antibodies
83
what ADR can exenatide cause w/ espeically sulonylureas
hypoglycemia
84
what monitoring needs to be done w/ exenatide?
renal function
| A1C in 3 months
85
contraindications w/ exenatide?
T1DM
86
precautions w/ exenatide
ClCr <30 (changes dose)
gastroparesis
hypoglycemia
87
SubQ injection that is FDA approved for Type 1 or 2 diabetes in patients on optimal insulin therapy who are still not at goal
With or without metformin and/or sulfonylurea therapy
pramlintide
88
what is pramlintide administered in conjuction w/?
mealtime insulin
89
additional med for people with CHD and DM?
81 mg aspirin
90
what are the first lines for HTN for people w/ DM?
ACEI or ARB in combo w/ thiazide diuretic
91
what is the goal BP for a diabetic patient?
<130/80
92
if a DM patients is over the age of 40 w/ a risk factor or overt CVD what should be added?
statin
93
if a statin isn't tolerated what should a DM be placed on as well?
BAR (bile acid resin)
niacin
fibrate
94
is a life threatening condition similar to DKA
Extreme hyperglycemia and fluid deficits
Arises from inadequate insulin but occurs primarily in older type II patients
hyperosmolar hyperglycemic state (HHS)
95
what is the different between hyperosmolar hyperglycemic states (HHS) and DKA?
HHS lacks lipolysis, ketonemia, and acidosis
96
Diagnostic criteria for hyperosmolar hyperglycemic states (HHS)
Plasma glucose > 600mg/dL
| Serum osmolality of > 320 mOsm/kg
97
Tx for hyperosmolar hyperglycemic states (HHS)
Rehydration
Correction of electrolyte imbalances
Continuous insulin infusion
Reduce blood glucose levels gradually to avoid cerebral edema
