Non-insulin Tx

Question 1

Lifestyle change

Answer 1

Less calorie dense foods, smaller portions

Physical activity, weight loss (5-10% of body weight correlates with decreased risk of complications)

Question 2

First line DM2 treatment

Answer 2

METFORMIN

Question 3

Biggest reductions in HbA1c

Answer 3

Most potent: insulin, then Metformin, then sulfonylureas

Question 4

Other non-insulin tx (not really discussed)

Answer 4

Alpha glucosidase inhib
Meglitinides
Bile-acid-binding resin
Dopamine-agonist

Question 5

Weight loss/weight neutral drugs

Answer 5

Metformin, GLP-1 agonist, DPP-IV inhibs, Amylin

Question 6

Weight gain drugs

Answer 6

Sulfonylureas, TZDs, insulin

Question 7

Sulfonylureas (mech/metab/excret/ADR/contra)

Answer 7

(insulin secretagogues) Bind the sulfonyl urea recpetor and release insulin
Given orally, hepatic metab, renal excretion
ADR: weight gain, hypoglycemia, NOT for sulfa allergy or G6PD defic (will cause HEMOLYTIC ANEMIA)
Tolerance develops

Question 8

Metformin (Biguanide) (mech?)

Answer 8

Potentiates SUPPRESSIVE EFFECT OF INSULIN ON HEPATIC GLUCOSE PRODUCTION
does NOT stimulate insulin secretion or increase circulating insulin

Question 9

Metformin (Biguanide) (admin/excret/ADR/pro)

Answer 9

Oral admin, renal excretion
ADR: nausea/vomiting, diarrhea, bloating
Risk of lactic acidosis IF contraindication: contrast, CHF, renal insuff, liver dz, metabolic acidosis
STOP METFORMIN WHEN HOSPITALIZED
No hypoglycemia or weight gain, cheap and can be combined with other drugs

Question 10

TZDs (thiazolidinediones) -azone

mech/ADR

Answer 10

increase insulin sensitivity
expensive
ADR: worsens CHF, CV side effects (rosig), weight gain, risk of bladder cancer (piog)

Question 11

GLP-1 Agonists

Answer 11

Potentiates insulin secretion ONLY IF blood glucose is elevated
Decreases hepatic glucose output, supprses postprandial glucose secretion, slows gastric emptying, increases satiety
SC inj only
ADR: weight loss, expensive, nausea, risk of medullary thyroid carcinoma

Question 12

Why not use GLP-1?

Answer 12

GLP-1 itself is too rapidly broken down by DPP-4 to be a drug

Question 13

DDP-4 inhibs (mech/cons/ADR/admin/risk)

Answer 13

Prevent breakdown of GLP-1 for 24 hrs
Lowers postprandial glucose
Expensive, NASOPHARYNGITIS, HEADACHE
Oral only
Risk for Steven-Johnson syndrome, sever allergic rxn

Question 14

SGLUT2 inhibs

Answer 14

Blocks SGLUT2 to prevent filtered glucose from being reabsorbed in nephron –> excrete glucose
Weight loss
Oral (1/day), hepatic metab
INCREASED RISK FOR UTI/GU infx, hyponatremia, hypovolemia
CONTRAINDICATED IN RENAL DZ