IC12-13 DM Flashcards
Monitoring for DM
HbA1c
Macrovascular: BP, Lipids
Microvascular: Eye exam, foot exam, kidney function
MOA of metformin
Decrease hepatic glucose production, increase muscle glucose uptake and utilisation
Max dose of metformin
IR: 2550MG (3 x 850)
XR: 20000MG
What are the special populations for metformin
Children older than 10 years and pregnant women
ADR of metformin
GI disturbances, metallic taste, decreased serum vit B12 in long term use, rarely lactic acidosis
Contraindications of metformin
GFR < 30ml/min
Hypoxic states
HF, liver impairment, respiratory failure
Alcoholism
Metformin % decrease in Hba1c
1.5%
Metformin effects on weight and hypoglycemia
Negligible effects on weight and hypoglycemia
MOA of sulfonylureas
Stimulate insulin secretion by beta cells, need functional beta cells and decrease hepatic insulin output and increase insulin uptake by muscles
Sulfonylurea effects on weight and hypoglycemia
Weight gain and risk of hypoglycemia
DDI of sulfonylureas
Beta blockers: mask hypoglycemia
Alcohol: disulfiram like reaction
CYP2C9 inhibitors: amiodarone, fluoxetine
Sulfonylureas % Hba1c by?
1.5%
MOA of DPP4 inhibitors
Inhibit DPP4 enzyme, increase conc of incretins, decrease gastric emptying, decrease food intake
Example of DPP4i
Sitagliptin, Linagliptin, Vildagliptin
ADR of DPP4 inhibitors
Severe joint pain
Acute pancreatitis
Skin rash, bullous pemphigold
Contraindications of DPP4i
Hx of acute pancreatitis
DPP4i % Hba1c reduction
0.5-0.8
DPP4i effect on weight
Weight neutral
MOA of SGLT2i
Increase glucose excretion renally
Renal considerations for SGLT2i
Do not initiate when
Canagliflozin: < 30 ml/min
Empagliflozin: < 45ml/min
Dapagliflozin: < 45ml/min
ADR of SGLT2i
Hypotension, genital mycotic infections, UTI, Fournier’s gangrene, euglycemic DKA
SGLT2i % Hba1c reduction
0.8-1.0%
SGLT2i effects on weight and hypoglycemia
Slight weight loss, no hypoglycemia
MOA of acabose
Inhibits alpha glucosidase enzyme from breaking down complex carbohydrates to simple carbohydrates for absorption through bursh border
Indications for acabose
Not as monotherapy, as add on if PPG is not at control
Max dose of acarbose
Weight based dosing
</= 60kg: 150mg per day
> 60kg: 300mg per day
ADR of acarbose
Flatulence, increase in LFT
Contraindications for acarbose
GI diseases
Liver cirrhosis
CrCl < 25ml/min
Acarbose % Hba1c reduction
0.5-0.8%
Insulin % Hba1c reduction
2.5%
Indications for insulin
Pregnancy
Symptomatic for hyperglycemia: 3Ps
Hba1c > 10%
Blood glucose > 16.7 mmol/L
Steroid induced hyperglycemia
Steroid increases production of glucose, use NPH
MOA of GLP1 agonists
Increase active GLP1 (incretin), decrease gastric emptying, decrease food intake
Examples of GLP1 agonists
Liraglutide (SC OD), semaglutide (PO ODor SC weekly), dulaglutide (SC weekly)
Contraindication of GLP1 agonists
Family hx of thyroid cancer
Hx of pancreatitis
PO semaglutide dosing instructions
Dosed on empty stomach, 30 mins before first meal of the day + no more than 120ml of water
GLP1 agonist % Hba1c reduction
1-2%
GLP1 agonist effect on weight and hypoglycemia
Weight loss, no risk of hypoglycemia
