Insulin Sensitizers Flashcards
What are the 2 classes of insulin sensitizers
Biguanide and TZD thiazolidinedione “zone”
How does metformin work (2 main functions)
1) by inserting GLUT4 transporter into skeletal and adipose tissue
2) stops liver production of glucose (decrease gluconeogenesis and decrease glycogenolysis)
In newly dx pt, start metformin at __ months if A1C < __ % above target
3, < 1.5%
If A1C is > __ % above target at the time of dx start metformin OR
If pt is symptomatic ________ and/or _________
> 1.5%
symptomatic hyperglycemia, metabolic decompensation
What are the most common side effects of metformin
GI, nausea + diarrhea
What is a rare side effect of metformin
lactic acidosis
How is metformin excreted
renally
People taking metformin are twice as likely to experience ____ deficiency
vitamin B12
When should you hold metformin and when should you resume
sick days, eGFR <30, day of IV contrast test, and 2 days before surgery, resume once renal function is normal
What is the minimum dosing of metformin and max. When should you dose adjust
500mg (twice a day) - 2550mg
Dose adjust when eGFR 30-45 (stage 3b) to 500-1000mg
Does metformin cause weight gain
no
How does TZD work
stimulates PPARy in the adipose tissue
As a consequence of TZDs mechanism of action, what do you need to test for
LFT q2 months for the first year, then periodically after
What are the 4 major side effects of TZDs
1) weight gain: due to PPARy taking glucose form blood to adipose tissue
2) edema: PPARy causes fluid retention in collecting duct
3) CHF: causes by edema/fluid retention
4) bone fractures: PPARy steals osteoblasts and causes differentation towards adipocytes = osteopenia
What’s 1 major contraindication to TZDs
heart failure
What are the 2 drugs associated with TZDs, what are the major side effects associated with them and dosages
1) rosiglitazone: risk of heart attack obtain written consent before starting, start: 2mg, max: 8mg
2) pioglitazone: risk of bladder ca, start 15mg, max: 45mg
