Endocrinology-diabetes Flashcards
Prediabetes
Fasting glucose 100-125
A1c 5.7-6.4
2hr test > 140-199
Diabetes :First line therapy
Metformin
No wt gain
No hypoglycemia
Decreases coronary events
Pt with diabetes taking metformjn can have what side effect?
Vitamin B 12 deficiency
Second generation sulfonylurea - how does it work?
Downside?
Increased insulin secretion
Hypoglycemia
Wt gain
Meglitinides. - repa and Nate
Repaglinide
Nateglinide
How wrk?
Downside?
Inc insulin secretion
Hypoglycemia
Wt gain
Frequent dosing
Thiozolidinediones (glitazones)
Pioglitazone
Rosiglitazone
Do what?
Downside?
Increase insulin sensitivity
Good:No hypoglycemia
Bad: wt gain, bone fractures, inc risk bladder cancer
Alpha glucosidase inhibitor
Acarbose
Miglitol
How works?
Good and bad..
Slows intestinal carb digestion
Good:No hypoglycemia
Bad:Flatulence and diarrhea
Frequent dosing
GLP1 agonist
Exenatide
Liraglutide
Stimulate insulin secretion
Good: No hypoglycemia
Wt reduction
Bad: GI side effects, risk of pancreatitis
DPP -IV inhibitors
Sitagliptin
Linagliptin
Increase insulin secretion
Usually second line agent
Good:No hypoglycemia, well tolerated
Bad: modest efficacy
Prediabetes best treatment
Diet and exercise first!!! Intensive
Not metformin.
Metformin first line for once diabetes diagnosis is made.
Diabetes - tried metformin and what is next agent?
GLP1 agonist
Exenatide
Diabetic that fails po meds. What next?
Basal insulin
Diabetic on metformin and basal supplementation.
A1C rises, but glucose ok
Next treatment step?
Add prandial insulin
or GLP1 receptor agonist
Diabetes –how to make diagnosis ?
> 6.5
Or FBG > 126
Glucose > 200 with symptoms of crisis
OGTT> 200
