non insulin oral drugs Flashcards
- Outline blood glucose and hemoglobin A1c goals for adults with diabetes.
+/- 7.0%
fasting is 70-130
2 hr post meal-less than 180
- Discuss major factors that would be important to consider in individualizing a hemoglobin A1c goal
how motivated they are, life expectancy, established complications, comorbidities, resources and support system
- Use knowledge of the mechanisms and common adverse effects of various glucose-lowering medications to decide which medications should be avoided in patients with renal insufficiency, congestive heart failure, or pancreatitis
dont use metformin in renal insufficiency or HF or liver disease
dont use TZD’s in HF
- Describe routine screening, monitoring and preventive care for individuals with diabetes.
Glucose-monitoring:
Adults with diabetes need to monitor their blood glucose levels throughout the day and occasionally at night. They should check their glucose levels at least twice per day and ideally at specific timepoints (fasting, before lunch, before dinner and at bedtime). They are asked to record these measurements, the amount of insulin they administer to themselves and in some cases, the type and amount of food they eat at each meal.
Patient education:
Diabetic patients should be educated on how to recognize and treat hypoglycemia, how to handle treating their diabetes with their daily work/life schedules, when and how to eat, and how to exercise.
Clinic visits:
Physicians should review blood sugar records, meal records and activity logs. The frequency and severity of hypoglycemia episodes should be addressed. Hemoglobin A1c should be checked at least twice per year and up to 4 times per year in order to monitor the effectiveness of the patient’s glycemic control.
Sulfonylureas
glyburide, glipizide, glimepiride
Sulfonylureas close ATP-sensitive K+ channels in the β-cell
Pros- Inexpensive, combination pills available with:
Metformin, Thiazolidinediones
Cons
Weight gain
Hypoglycemia
Loses effectiveness with longer duration of diabetes
Biguanide: metformin
Potentiates the suppressive effect of insulin on hepatic glucose production
Does NOT simulate insulin secretion OR increase circulating insulin levels
Risk of lactic acidosis
Pros Mechanism of action No hypoglycemia Inexpensive No weight gain Combination pill with: Sulfonylureas, Thiazolidinediones DPP-4 inhibitor, SGLT-2 inhibitor
Cons
Side effects: GI, Nausea, Bloating, diarrhea
Risk of lactic acidosis with: Contrast media
CHF, Renal insufficiency, Liver disease
Thiazolidinediones (TZDs)
TZDs are ligands for nuclear peroxisome
proliferator-activated receptors (PPAR)-γ
TZDs increase insulin sensitivity
Simulation of adiponectin production and action
Acts on fat and muscle cells to stop release of FA’s
Pros Mechanism of action Promise of other beneficial effects – not borne out Cons weight gain Major side effect Worsening of CHF Expensive Risk of bladder cancer with > 1 yr of pio cancer with > 1 yr of pioglitazone
GLP-1 agonists:
Augments insulin secretion only if blood glucose is elevated
- Stimulates glucose- dependent insulin secretion
- Suppresses postprandial glucagon secretion
- Decreases hepatic glucose output
- Slows gastric emptying Inhibits food intake
- Normalizes blood glucose
Pros
Multiple mechanisms of action to lower postprandial glucose
Effects are glucose- dependent
Weight loss
Cons
SC injections
Side effects
Expensive
DPP-4 inhibitors:
Blocks breakdown of GLP-1 and other incretins
Pros Multiple mechanisms of action to lower postprandial glucose Oral Once daily Weight neutral Combination pill with metformin
Cons
Less potent glucose-lowering effect
Expensive
Side effects
SGLT-2 inhibitors
block glucose reuptake in the kidney
Pros
Novel mechanism for controlling glucose
Weight loss
Pill
At least 1 avail as combo pill with metformin
Cons
Increased risk for urinary tract and GU infections
Increased risk for low potassium
Expensive
long-term safety
