DM meds

Question 1

metformin

Answer 1

biguanide
decrease BS by decreasing glucose production, increase glucose uptake by muscle cells, dont alter insulin so no traditional hypoglycemia
onset = several days, peak = 2-4 weeks
30 min before meals
hold 48 hours post contrast, and before procedures
I: glycemic control, DM2 prevention, PCOS
dont use with HF, k/l disease or excessive OH
abdominal bloating, nvd, acidosis in patients with increased creatinine, dont use in patients with increased ALT

Question 2

linagliptin, sazagliptin, sitagliptin

Answer 2

DPP4i
inhibit DPP4 from activating incretin, increase insulin release by increasing incretin activity, decrease glucagon release, decrease hepatic glucose production, slow digestion and decrease appetite
GI issues (n/d, pain), flu like symptoms, skin rxns, pancreatitis
combo with diet and life, mono or combo with met
low hypoglycemic incidence

Question 3

glucagon

Answer 3

activate hepatic glucagon receptors, stimulate glycogenolysis and glucose release
25-35 min 1/2 life
tule of 15

Question 4

glipizide, gluburide

Answer 4

sulfonylureas
bind and close R-ATP channels in beta cells, stimulate insulin secretion, increase response to insulin, decrease glucose release from liver
hypoglycemia especially with k/l dysfunction
not for preganant
OH, NSAIDs, tagamet, sulfa ATB can all potentiate SE

Question 5

dulaglutide, exonatide, semaglutide

Answer 5

GLP1 receptor agonists
decrease glucose dependent insulin secretion, inhibit postprandal release of glucagon and suppress appetite, slow gastric emptying
adjunct with metformin
peak = 2 hr, 1/2 life = 2.5 hr
nvd, injection site rxn, HA, upper respiratory infection, weight loss
no ESRD or severe RD or hx of pancreatitis
black box: thyroid c-cell tumors

Question 6

dapagliflozin

Answer 6

SLG2i
prevent kidneys from reabsorbing glucose by blocking SLG2, glucose out in urine
UTI risk increase, genital mycotic infection, hypotension, faint, dizzy, fatigue
no ESRD or severe, not for type 1, can be given with others, HF

Question 7

Lispro

Answer 7

Rapid acting
15 min, 1 hr, 2-4 hr
With food
Conjugate with intermediate or long acting

Question 8

Human Regular

Answer 8

Short acting
30-60 min, 2-6 hr, 3-8 hr
Before meals
Tube feeding pts, also used in insulin

Question 9

Neutral protamine hagedrone

Answer 9

Intermediate acting
Slows down absorption to last longer
2-4 hr, 4-10 hr, 10-20 hr
Cloudy! Agitate
Typically injected 2 times daily for glycemic control with meals and throughout night
Admin with rapid acting and short acting - clear before cloudy

Question 10

Glargine

Answer 10

Long acting
70 min, no peak, 24 hr
Never mix
1x a day (at night) - correct with lispro first if needed, then admin