DM medications Flashcards
Diabetes is a disease in which the body in unable to produce insulin or the body’s response to insulin is impaired
The result is increased levels of
glucose in the body and urine
Type I Diabetes
Autoimmune B-cell destruction- body cannot produce endogenous insulin
Onset occurs < 30 years of age
Type II Diabetes
Progressive loss of B-cell insulin secretion resulting in insulin resistance
Usual onset > 45 years of age
Predominant in African American community
Gestational Diabetes
Occurs in the 2nd or 3rd trimester of pregnancy
Complications of Diabetes: Retinopathy (patho and treatment)
Diabetic retinopathy is caused by damage to the blood vessels in the tissue at the back of the eye (retina). Early symptoms include floaters, blurriness, dark areas of vision, and difficulty perceiving colors. Blindness can occur.
Mild cases may be treated with careful diabetes management. Advanced cases may require laser treatment or surgery.
Complications of Diabetes: Neuropathy
Peripheral neuropathy is the most common type of nerve damage in diabetes that typically affects the feet and legs and sometimes affects the hands and arms
Complications of Diabetes: Albuminuria treatment
add ACE inhibitor or ARB
Complications of Diabetes: Macrovascular
Coronary artery disease (CAD)
Stroke
Initiate statin therapy
Risk Factors for Diabetes
Family history
Populations at greatest risk
African Americans, Latino, Native/ Asian Americans, Pacific Islanders
Cardiovascular disease
Hypertension
HDL <35 mg/dL and /or triglycerides >250 mg/dL
Women with polycystic ovarian syndrome (PCOS)
Obesity
Hyperglycemia- Signs and Symptoms
polyuria polydipsia blurred vision fatigue xerostomia headache trouble concentrating abnormal pain
Screening for Diabetes: Testing should begin at age
45 for all patients
Screening for Diabetes: Besides people 45 years old, who else should be screened
Adults with BMI > 25 kg/m2 or BMI > 23 kg/m2 in Asian Americans
and who have >1 additional DM risk factor
Screening for Diabetes: Repeat screening
Repeat screening every year if determined to be prediabetic
Repeat screening every 3 years
___ ___ disease is the leading cause of death in T2DM
Atherosclerotic cardiovascular disease (ASCVD)
conditions associated with clinically significant atherosclerosis
TIA, hospitalized unstable angina, amputation, CHF (NYHA class II-III), >50% stenosis of any artery, CKD (GFR <60mL/min)
DM Medication that is good when they also have ASCD
liraglutide, which is a GLP-1 receptor agonists. Several GLP-1 receptor agonists are good for ASCD. SGLT2 Inhibitors are also used.
DM medication that is good when they have heart failure
SGLT2 inhibitor which include
Empagliflozin and canagliflozin
DM medication that is good when they have Chronic kidney disease +/- CVD
SGLT2 inhibitor which include Empagliflozin and canagliflozin
GLP1RA may be used if SGLT2 is not tolerated, but must use with caution in ESRD
Monotherapy considerations
Monotherapy can be considered if A1C < 9%
Metformin + lifestyle modifications
If A1C is not in target after three months, assess medication compliance and consider dual therapy
Considerations for dual therapy
Dual Therapy can be considered if A1C > 9%
add an agent proven to reduce major CV events and /or CV mortality
If A1C is not in target after three months, assess medication compliance and consider triple therapy
Combination injectable therapy can be considered if:
A1C >10%
blood glucose > 300 mg/dL
symptomatic
ORAL MEDICATIONS
BIGUANIDES SULFONYLUREAS MEGLITINIDES ALPHA-GLUCOSIDASE INHIBITORS BAS GLITAZONES DPP4 INHIBITORS SGLT2 INHIBITORS
INJECTABLES
GLP-1 AGONISTS INSULIN THERAPY (TYPE 1 DIABETES)
BIGUANIDES are aka
metformin
