KC's diabetes treatment; 3.19

Question 1

What drugs are used to treat DMI?

Answer 1

Short and long acting insulin mimics

Or a pump

Question 2

What are examples of short acting insulin?

Answer 2

Regular insulin
Lispro insulin
Aspart insulin
Glulisine insulin

Question 3

What are examples of long acting insulin?

Answer 3

Glargine insulin

Detemir insulin

Question 4

What categories of drugs are used to treat DMII?

Answer 4

Biguanides
Sulfonylureas
Alpha-glucose inhibitors
Thiazolinediones
Amylinomimetics
Incretin modulators

Question 5

What is an example of a biguanide?

Answer 5

Metformin

Question 6

What is the result of taking metformin?

Answer 6

Decreased hepatic glucose production (w/o causing hypoglycemia)

Question 7

What are some side effects of metformin?

Answer 7

Diarrhea
Abdominal bloating
Lactic acidosis

Question 8

When shouldn’t metformin be used?

Answer 8

Renal impairment
Cardiac/respiratory insufficiency
Sepsis
Lactic acidosis
Liver disease (alcohol abuse)
Radiographic contrast dyes

Question 9

How much does HA1c typically lower with metformin use?

Answer 9

1-2%…more when combined with sulfonylureas

Question 10

What are examples of sulfonylureas (SU)?

Answer 10

Glyburide (hardly used)
Glipizide
Glimepiride

Question 11

How do sulfonylureas work?

Answer 11

Bind to sulfonylurea receptor on beta cells → insulin release

Question 12

What are the potential side effects of sulfonylureas?

Answer 12

Hypoglycemia (not seen w/ metformin)
Weight gain (not seen w/metformin)
Potential impairment of cardiac ischemic preconditioning

Question 13

What drug works by increasing the amount of glucose taken up by muscle and prevents the liver from overproducing glucose?

Answer 13

Thiazolinediones

Question 14

Besides lowering serum glucose levels, what other benefit do thiazolinediones?

Answer 14

Lowers lipids (decreases macrovascular complications)

Question 15

What are some side effects of thiazolinediones (TZD)?

Answer 15

Edema
Could precipitate CHF
Increases fracture risk in women

It is expensive

Question 16

What are examples of incretin modulators?

Answer 16

GLP-1 mimetics

DPP-IV inhibitors

Question 17

What are the effects of GLP-1 mime tics?

Answer 17

Increases glucose-dependent insulin secretion
Decrease glucagon secretion
Delay gastric emptying

Question 18

What are the DPP-IV inhibitors?

Answer 18

No hypoglycemia

Pontential weight loss

Question 19

What are the downsides to incretin modulators?

Answer 19

Nausea/vomiting
Pancreatitis (rarely)
No long term studies
Expensive

Question 20

What is the therapeutic approach to diabetes?

Answer 20

Diet
Exercise
Education
Meds

Question 21

How is a patient with an A1c of 7.6-9.0% medicated?

Answer 21

Dual therapy for 2-3 months (metformin + incretin modulator/TZD or SU/glinide)

Question 22

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?

Answer 22

Triple therapy for 2-3 months (metformin + incretin modulator/TZD + SU/glinide)

Question 23

After a diabetic goes 2-3 months doing triple therapy, the come in and still aren’t at goal. Now what?

Answer 23

Now they go on insulin…and possibly other meds

Question 24

A patient comes in and is pre-diabetic. Should this patient be medicated? If so, how?

Answer 24

This patient should be put on metformin 850mg BID

Question 25

What metabolic abnormalities are associated with diabetes?

Answer 25

Steatohepatitis
Elevated TGs/low HDL
Hyperuricemia
Acanthosis nigricans

Question 26

What are some common complication of diabetes?

Answer 26

Heart disease/stroke
Kidney failure
Blindness
Non-traumatic lower-limb amputations