Non-Insulin Overview Flashcards
How does Metformin work?
-Decreases hepatic production of glucose
-Increases intestinal glucose utilization
-Decreases glucose uptake into circulation
Who should Metformin be used in?
-Consider in all Type 2 patients
*adjunct to diet in uncontrolled patients
What are the benefits of Metformin?
-Reduces risk of mortality and CV death
-Decreases lipids
-Minimal hypoglycemia (no insulin release)
-Weight neutral/positive
-CHEAP
Does metformin cause insulin release?
NO -lower risk of hypoglycemia
Who should metformin be avoided in?
-Acute decompensated hospitalized heart failure patients/ unstable heart failure patients/ heart failure with severe renal or hepatic disease
-Alcoholics
-Patients at risk for lactic acidosis
What are the side effects of metformin?
-GI effects (diarrhea, nausea, vomiting, gas)
-Vitamin B12 malabsorption/deficiency
-Dementia Risk?
How do SGLT2 inhibitors work?
Inhibition of SGLT2 leads to glucose excretion in the urine
What non-insulin products can be used as initial therapy?
SGLT2 Inhibitors
GLP-1 Agonists
Who are SGLT2 inhibitors recommended for?
Type 2 patients with or at high risk for:
-atherosclerotic cardiovascular disease
-heart failure
-chronic kidney disease
What affect do SGLT2 inhibitors have on weight?
Can cause significant weight loss
What is another important statistic that SGLT2 inhibitors impact?
SGLT2 inhibitors lower blood pressure which can either be a positive or negative depending on the patient
What are the side effects of SGLT2 inhibitors?
-UTI’s
-Genital fungal infections
-Increased urination
-Hypotension
-Hyperkalemia
-Increased cholesterol
Are SGLT2 inhibitors expensive?
YES, major reason why they may not be used
What patients should SGLT2 inhibitors not be used in?
-Patients with repeat UTI’s
-Patients with bladder control issues
-Dialysis patients
What are the contraindications associated with SGLT2 inhibitors?
-DKA (this drug triggers it in Type 2 patients)
-Severe Genital Infections
-Canagliflozin: bone fractures, decreased bone mineral density, leg and foot amputation
-Canagliflozin+ Dapagliflozin: Acute Kidney injury
-
What are the benefits of using SGLT2 inhibitors?
-Weight loss
-CV benefits (improve outcome of MACE)
-Renal benefits
Do GLP-1 agonists have glucose dependent or independent insulin secretion?
Glucose dependent
*insulin only released when BS is elevated
In Type 2 diabetes which is preferred first: Insulin or GLP-1 Agonists?
GLP-1 Agonists
What contraindications are associated with GLP-1’s?
-In severe renal disease
-History of pancreatitis
-Thyroid tumors (history or family history)
-Gastroparesis
-Proliferative retinopathy
What side effects are associated with GLP-1’s?
-Nausea
-Pancreatitis
-thyroid C-cell tumors
-Gall bladder disease
What other drug class should NEVER be used with GLP-1 agonists?
DPP-IV inhibitors
What A1C indicates that insulin needs to be started?
A1C > 10
What is the singular dual GLP-1 RA and GIP RA?
Tirzepatide (Mounjaro)
Is the mechanism of action of Dual GLP-1 RA and GIP RA glucose dependent?
YES
