Diabetes Type 2 Flashcards
Physiologic problems with DM Type 2?
Reduced Glucagon-like peptide-GLP-1
Insulin resistance
Loss of amylin
What is Glucagon-like peptide (GLP-1)?
Released from distal ileum and colon in response to foods containing carbs and fats
Risk factors for DM Type 2?
HDL>250
Delivering baby over 9 pounds
History of vascular disease
Atypical psychotics
Who should we screen for diabetes?
BMI>25 + other risk factor
Over age 45
What children should be screened for Type 2 DM?
BMI>85th percentile or wt. for ht.>85th percentile or wt.>120% of ideal plus 2 risk factors
- Start at age 10 or at puberty
- FPG every 2 years
What are other causes of insulin resistance?
PCOS
Acromegaly
Cushing’s syndrome
Most common microvascular complication in Type 2 DM?
Neuropathy
When should the average woman be screened for GDM?
24-28 weeks
How is GDM diagnosed?
FPG>95
1 hr>180
2 hr>155
3 hr>140
How often should a person on insulin check their blood sugars?
3x per day
Which drugs are the secretagogues?
Sulfonylureas
Meglitinides
How do Sulfonylureas work?
Stimulate insulin release
At higher doses decrease hepatic glucose release
Which drugs are Sulfonylureas?
Glyburide
Glipizide
Glimepiride
ADRs of Sulfonylureas?
Hypoglycemia: elderly, renal impairment
Weight gain
Rash, photosensitivity, blood dyscrasias, weakness, confusion, cholestatic jaundice
What is best Sulfonylurea to use?
Glipizide
-Give 30 mins before first meal
Drug interactions/contraindications with Sulfonylureas?
Propanolol
ETOH-do not take
Contraindicated in pregnancy
Sulfonamides/Salicylates
Which Secretagogues are short-acting?
Meglitinides
Which Meglitinide is a derivative of phenylalanine?
Nateglinide
-Less A1C reduction but more rapid than Repaglinide
ADRs of Repaglinide?
Hypoglycemia
Which drugs are Biguanides?
Metformin
Drug of choice for Type 2 DM?
Metformin
ADRs of Metformin?
GI symptoms: 50%
Lactic acidosis: patients w/ renal failure, CHF, hypoxemia, ETOH
No hypoglycemia
No weight gain
Contraindications with Metformin?
Metabolic acidosis
Renal impairment:
-SCr>1.5 men
-SCr>1.4 women
What are the TZDs?
Rosiglitazone
Pioglitazone
Which TZD can we not give insulin with?
Rosiglitazone: edema
How do TZDs work?
PPAR gamma receptor activators
- Regulate glucose metabolism
- Increased insulin sensitivity in fat, liver, and skeletal muscle
Cardio effects of TZDs?
Rosiglitazone: increased HDLs and decreased TGs
Pioglitazone: increased LDLs and HDLs
ADRs of TZDs?
Edema/weight gain
Cardiac failure
-Especially w/insulin
Contraindications to TZDs?
Liver disease
Class III and IV heart failure
ETOH abuse
Which TZD has a risk for MI?
Rosiglitazone
What are the Alpha-Glucosidase inhibitors?
Miglitol
Acarbose
-No weight gain or hypoglycemia
Adverse effects of Alpha-Glucosidase inhibitors?
Gas and diarrhea: bacteria want carbs
How do Alpha-Glucosidase inhibitors work?
Inhibit carb absorption in intestines
Contraindications to AG inhibitors?
Cirrhosis
Intestinal disease
What are the DPP-4 inhibitors?
Sitagliptin
Saxagliptin
What is Colesevelam?
Bile acid sequestrate
- Not for mono therapy
- Adjunct to diet and exercise
- Previously used for LDL reduction
Adverse effects of Colesevelam?
Constipation/nausea/indigestion
Increases TGs
Contraindications for Colesevelam?
Bowel obstruction
Hypertriglyceridemia-induced pancreatitis
TG>500
What is Exenatide?
GLP-1 agonist; not oral: injection
Adjunct therapy
What monitoring do we need with Exenatide?
Renal function
ADRs for Exenatide?
N/V/D: 40% Weight loss Hypoglycemia Antibodies to drug Can't use in Type 1 DM
Treatment for hyperosmolar hyperglycemia?
Fluids
Insulin bolus
Which diabetes patients get most CVD benefits from blood sugar control?
Type 1 DM patients
