Oral DM Meds Flashcards
when would you check a premeal blood sugar?
To help calculate bolus dose of insulin or agents given to improve insulin secretion
Purpose of fasting blood sugar?
Measures the effectiveness of basal insulin or agents which decrease hepatic gluconeogenesis overnight (“leaky liver”)
when do we measure Postmeal blood sugar—2 hour post prandial?
Measures the effectiveness of bolus insulin or agents given to increase levels of insulin (pancreas “poop out”)
Helps determine needed food intake changes
what is the most important measurement for a type 2 DM?
Post-meal blood sugar—2 hour post prandial
What BG lab values are classified as hypoglycemic?
<70mg/dL = alert level
<54 mg/dL = clinically signf.
no specific value = severe hypoglycemic
what is the diagnostic lab criteria for DM?
FPG >126 or
2hr-PG >200mg during OGTT or
A1c >6.5% or
classic sxs w/random PG >200mg/dL
What A1c range is concerned pre-diabetic?
5.7-6.4
microvascular comps assoc. with DM?
retinopathy
neuropathy
nephropathy
macrovascular comps assoc. with DM?
coronary heart disease
HTN
PVD
What are the 5 things you should do to decrease complications and reduce mortality in diabetic patients?
smoking cessation
BP control
Metformin therapy
Lipid reduction
glycemic control
What should you tell your pt to do if hypoglycemia occurs?
consume 15g of simple carbohydrate and then retest BG 15 minutes later
if BS still <70, repeat rule of 15 until norm.
What can cause blood glucose to rise quickly?
infections and corticosteroids
Which DM meds decrease glucose absorption?
alpha glucosidase inhibitors
amylin mimetics
Which DM meds decrease glucose production?
Biguanides (Metformin)
insulin
Which DM meds increase insulin secretion?
Sulfonylureas
Meglinitides
GLP-1 activators
DPP-4 inhibitors
Which DM meds increase glucose excretion?
SGLT2 inhibitors
Which DM meds increase glucose utilization?
thiazolidinediones
Insulin
What major concerns should you consider when selecting a DM med?
hypoglycemia
weight change
CV effects
renal adjustments
FDA warnings
Metformin is contraindicated in pts….
with GFR <30
ADEs of Metformin?
GI upset
potential B12 deficiency
CV effect of SGLT2 inhibitors?
Benefit!
Canagliflozin
Empagliflozin
Black box warning for SGLT2 inhibitors? other ADEs?
Amputation (canagliflozin)
UTIs, risk of bone fx, vulvovaginal candidiasis
Black box warning for GLP-1? other ADEs?
risk of thyroid c-cell tumors
GI upset, injection site rxn, acute pancreatitis
ADEs of DPP-4s?
potential risk of acute pancreatitis
joint pain
Which DM meds may cause weight gain?
TZDs
Sulfonylureas
Insulin
Which DM med is assoc. with an increased risk of HF?
Thiazolidinediones
also increased risk of bone fx and bladder CA
Which DM meds are administered SQ?
Insulin
GLP-1
MOA of Metformin?
Activates AMP kinase
enhances insulin sensitivity of hepatic and peripheral tissues
MOA of sulfonylureas?
Close K-ATPase channels on B cell plasma membranes
MOA of Meglinitides?
Close K-ATPase channels on B cell plasma membranes
MOA of TZDs?
Activates the nuclear transcription factor PPAR-gamma >
improves insulin sensitivity
MOA of alpha-glucosidase inhibitors?
inhibits intestinal alpha-glucosidase
Breakdown of sucrose and complex carbohydrates in the small intestine, prolonging carbohydrate absorption
Name 2 sulfonylureas
Glyburide
Glipizide
Name 2 Meglitinides
Repaglinide
Nateglinide
Name 2 TZDs
Pioglitazone
Rosigitazone
Name 2 alpha-glucosidase inhibitors
Acarbose
Miglitol
Name 2 DPP-4 inhibitors
Sitagliptin
Saxagliptin
Name 2 SGLT2 inhibitors
Canagliflozin
Dapagliflozin
Name 2 GLP-1 receptor agonists
Exenatide
Liraglutide
Dulaglutide
Name a bile acid sequestrant. MOA?
Colesevelam
binds bile acids in intestinal tract, increasing hepatic bile acid production
Name a dopamine -2 agonist, effect?
Bromocriptine
increases insulin sensitivity
Why are Suulfonylureas and Metaglinides freq. prescribed, even though they are considered first line agents?
bc they are often what a pt can afford
Urticaria/facial edema and rare cases of SJS may be seen with what DM medication?
DPP-4 inhibits “Gliptins”
Use of a SGLT2 inhibitor and a diuretic may cause….
orthostatic hypotension and electrolyte abnormalities
ADEs of alpha-glucosidase inhibitors?
Flatulence, bloating, abdominal discomfort, and diarrhea
Effect of bile acid sequestrants on LDL?
may decrease by 12-16%
Admin of Dopamine agonists?
take daily dose within 2 hours of waking from sleep
-skip is morning window is missed!
Basal insulins are ____, while Mealtime insulins are____.
intermediate-acting, longing acting analogs
rapid acting, short
Insulin is an ___ hormone
anabolic
AACE goal BP for DM pts?
130/80 mmHg
Starting dose for basal insulin?
10 units
or 0.1-.02U/kg/day
How frequently should you adjust basal insulin dose?
every 2-3 days until glycemic goal is met
What can you add if pt is not well controlled on basal insulin?
prandial insulin
-begin before largest meal, if not at goal progress to injections before 2 or 3 meals
What DM meds can cause weight loss?
Metformin
GLP-!
SGLT2
PRAML
Who is effected by the dawn phenomenon?
Everyone!
whether they have DM or not
What is the dawn phenomenon?
surge of hormones that the body produces daily in the early morning hours before waking
-ppl with DM don’t have normal insulin responses to adjust for this and may see fasting BS go up
What is the somogyi effect? Tx?
Increased morning blood sugar levels after nighttime hypoglycemia
-tx lower PM insulin dose, night time snack
