KC's diabetes treatment; 3.19 Flashcards
What drugs are used to treat DMI?
Short and long acting insulin mimics
Or a pump
What are examples of short acting insulin?
Regular insulin
Lispro insulin
Aspart insulin
Glulisine insulin
What are examples of long acting insulin?
Glargine insulin
Detemir insulin
What categories of drugs are used to treat DMII?
Biguanides Sulfonylureas Alpha-glucose inhibitors Thiazolinediones Amylinomimetics Incretin modulators
What is an example of a biguanide?
Metformin
What is the result of taking metformin?
Decreased hepatic glucose production (w/o causing hypoglycemia)
What are some side effects of metformin?
Diarrhea
Abdominal bloating
Lactic acidosis
When shouldn’t metformin be used?
Renal impairment Cardiac/respiratory insufficiency Sepsis Lactic acidosis Liver disease (alcohol abuse) Radiographic contrast dyes
How much does HA1c typically lower with metformin use?
1-2%…more when combined with sulfonylureas
What are examples of sulfonylureas (SU)?
Glyburide (hardly used)
Glipizide
Glimepiride
How do sulfonylureas work?
Bind to sulfonylurea receptor on beta cells → insulin release
What are the potential side effects of sulfonylureas?
Hypoglycemia (not seen w/ metformin)
Weight gain (not seen w/metformin)
Potential impairment of cardiac ischemic preconditioning
What drug works by increasing the amount of glucose taken up by muscle and prevents the liver from overproducing glucose?
Thiazolinediones
Besides lowering serum glucose levels, what other benefit do thiazolinediones?
Lowers lipids (decreases macrovascular complications)
What are some side effects of thiazolinediones (TZD)?
Edema
Could precipitate CHF
Increases fracture risk in women
It is expensive
What are examples of incretin modulators?
GLP-1 mimetics
DPP-IV inhibitors
What are the effects of GLP-1 mime tics?
Increases glucose-dependent insulin secretion
Decrease glucagon secretion
Delay gastric emptying
What are the DPP-IV inhibitors?
No hypoglycemia
Pontential weight loss
What are the downsides to incretin modulators?
Nausea/vomiting
Pancreatitis (rarely)
No long term studies
Expensive
What is the therapeutic approach to diabetes?
Diet
Exercise
Education
Meds
How is a patient with an A1c of 7.6-9.0% medicated?
Dual therapy for 2-3 months (metformin + incretin modulator/TZD or SU/glinide)
After a dual therapy regimen for 2-3 months, a patient comes back with an A1c that is not at goal. What is the next level of management?
Triple therapy for 2-3 months (metformin + incretin modulator/TZD + SU/glinide)
After a diabetic goes 2-3 months doing triple therapy, the come in and still aren’t at goal. Now what?
Now they go on insulin…and possibly other meds
A patient comes in and is pre-diabetic. Should this patient be medicated? If so, how?
This patient should be put on metformin 850mg BID
What metabolic abnormalities are associated with diabetes?
Steatohepatitis
Elevated TGs/low HDL
Hyperuricemia
Acanthosis nigricans
What are some common complication of diabetes?
Heart disease/stroke
Kidney failure
Blindness
Non-traumatic lower-limb amputations
