Glucose control Flashcards
medications that induce hyperglycemia
- glucocorticoids
- antipsychotics
- HIV medications
- Octreotide
insulin MOA
- binds to insulin receptors which facilitates glucose diffusion into the cells
- stimulates uptake of amino acids, phosphate, K, mag
- shifts glucose into storage (glycogenesis)
insulin resistance
- impaired insulin signal that results in decreased glucose uptake
insulin receptor saturation
- occurs with low circulating concentrations of insulin
insulin receptor number
- inversely related to plasma concentration of insulin
- insulin can regulate the population of receptors
half-life of insulin
- 5-10 min
- effects can last 30-90 minutes
basal rate of insulin by the pancreas
- 1 unit/ hr
- insulin response to glucose is greater for oral than IV
long-acting insulin
- glargine (lantus)
- 3-4 hr onset
- 24 hour duration
intermediate acting insulin
- NPH
- 1-2 hour onset
- 18 hour duration
short acting insulin
- regular
- 30 min onset
- 6-8 hr duration
rapid acting insulin
- aspart, lispro, gluisine
- onset 30-90 min
- duration 3-4 hours
what insulin can be given IV
- only short acting (regular) insulin
hypoglycemia
- symptoms from increased norepi (diaphoresis, tachycardia, HTN)
- CNS symptoms (confusion and seizures)
somogyi effect
- rebound hyperglycemia caused by sympathetic nervous system activity in response to hypoglycemia
insulin effect on electrolytes
- K into cells
- mag into cells
- phos into cells
- Na out of cells
afreeza
- inhaled insulin
- rapid acting
sulfonylureas action
- act at pancreatic beta cells to stimulate insulin release
side effects of sulfonylureas
- most common complication is hypoglycemia
- DOA is up to 7 days
- can cross placenta
- weight gain and GI disturbances
- avoid in pt with liver disease
contraindications to sulfonylureas
- hypersensitivity to sulfa drugs
- pts with hypoglycemic unawareness
- poor renal function
2nd gen sulfonylureas names
- glyburide
- glipizide (good for 3 years without tolerance)
- glimepiride
meglitinides names
- repaglinide
- nateglinide
meglitinides MOA
- increase insulin secretion from islet cells
- active only in the presence of glucose (actively eating)(decreased risk of hypoglycemia)
side effects of meglitinides
- hypoglycemia
- weight gain
- URI
biguanides name and what it does
- metformin
- decrease BG concentrations (low hypoglycemia risk)
- positive effect on lipid concentrations
- lead to mild weight reduction
biguanides MOA
- dec hepatic glucose concentration
- dec glucose absorption from intestine
- increases insulin sensitivity
side effects of metformin
- anorexia, nausea, diarrhea
- black box warning = lactic acidosis
metformin peri-op considerations
- risk of lactic acidosis , d/c 48 hours pre-op
- monitor ABG, pH, lactate and renal function intra-op
- increased nephrotoxicity with IV dye
metformin contraindications/ precautions
- renal impairment
- contraindicated SCr >1.5 males >1.4 females
- contraindicated eGFR < 30 ml/ min
- do not initiate with GFR < 45
- age > 80
- hepatic impairment
Thiazolidinediones names
- rosiglitazone
- pioglitazone
thiazolidinediones MOA
- decreases insulin resistance
- decreases hepatic glucose output
- require the presence of insulin, especially effective in obese pts
side effects of thiazolidinediones
- weight gain
- hepatoxicity
- peripheral edema
- CHF exacerbations
- risk of bone fractures
- increase in MI and CV death
DPP (dipeptidyl peptidase) - 4 inhibitors
- sitagliptin
- saxagliptin
- linagliptin
- aloglipitin
- end in “gliptin”
DPP 4 inhibitors MOA
- increases pancreatic insulin secretion
- limits glucagon secretion
- slows gastric emptying
- promotes satiety
side effects of DPP-4 inhibitors
- URI and UTI
- may activate lymphocytes
- headache
- low risk of hypoglycemia
- pancreatitis, angioedema, stevens johnson
incretin mimetics names (GLP- 1 analogs)
- exanatide
- liraglutide
- albiglutide
- dulaglutide
- semaglutide
- end in “tide”
GLP- 1 analogs effects
- prolong gastric emptying
- reduce postprandial glucagon secretion
GLP- 1 side effects
- N/V/D
- pancreatitis
- ARF
- weight loss
incretin mimetics amylin analog
- pramlinide
- black box warning for hypoglycemia in type 1
- gastroparesis
SGLT2 inhibitors names
- canagliflozin
- dapagliflozin
- empagliflozin
SGLT2 inhibitors effects
- increased urinary glucose and Na excretion
- can improve outcomes in CHF pts
SGLT2 inhibitors side effects/ contraindications
- Contraindication: CrCl <30 ml/ml, ESRD, HD
- hypotension, urinary side effects, mycotic infection
- increased risk of amputations - primarily toe
- Increased risk of perioperative euglycemic ketoacidosis
SGLT2 inhibitors stop time prior to surgery
- increased risk of ketoacidosis
- stop 3-4 days prior to surgery
armour thyroid
- made from desiccated animal thyroid (pig)
- suppress the responsiveness and cause regression of TSH sensitive malignant tumors
- 4:1 ratio of T4 to T3
levothyroxine
- 7 day half life and so dose can be held
- T4
- deiodinated and converted to T3 by the body
liothyronine (T3)
- isomer of T3 (3x as potent as levothyroxine)
- rapid onset and short DOA
- higher cardiac side effects
- not for long-term use
antithyroid drugs
- propylthiouracil
- methimazole
antithyroid med MOA
- inhibit formation of thyroid hormone
- blocks peripheral deiodination of T4 to T3
- requires several days for full effect
side effects of antithyroid medications
- transient leucopenia
- rash
- arthralgias
- lupus-like symptoms
- fever
- granulocytosis
iodines
- lugol’s solution and saturated KI solution
iodines effect
- inhibits release of thyroid hormone into circulation
- combined use with propranolol for the treatment of hyperthyroidism before thyroidectomy
treatment of thyroid storm
- cold IV solution
- sodium iodide
- cortisol
- propranolol (non-selective beta-blockers)
- propylthiouracil
(avoid ASA)
