Pharm - Diabetes Flashcards
3 Techinques for measuring glycemic control
- Patient self-monitoring of blood glucose (SMBG) = finger stick
- Continuous glucose monitoring systems (CGMS) = machine thingy
- Hemoglobin A1c
Hb A1c requirement for diagnosis of Diabetes
Hb A1c over 6.5%
Fasting glucose requirement for diagnosis of Diabetes
Plasma glucose over 126 mg/dL
Pancreatic Islet changes in Type 2 Diabetes
a-cells secrete inappropriately high levels of glucagon
B-cells secrete insufficient levels of insulin (exhaustion) –> decreased B-cell mass
Amyloid plaque deposits
[Oral/IV] glucose stimulates a higher insulin response
Oral
b/c of Incretin
Incretin Hormones
Synthesized in L cells (in ileum and colon)
Stimulates insulin secretion
example: Glucagon-like peptide 1 (GLP-1)
What metabolizes GLP-1?
DPP-4 (dypeptidyl peptidase-4)
Rapid metabolization (T1/2 = 2-3min)
First drug used in T2D?
Metformin = biguanide, decreases hepatic gluconeogensis overnight
Important advantages and disadvantages of Metformin?
- -Weight neutral = no weight gain
- -No hypoglycemia
- -GI side effects (start w/ low dose, titrate up)
- -Contraindication = low kidney function
[Sylfonylureas/Meglitinides] have fast/short acting insulin increasing effect
Meglitinides – take w/ meals
Mechanism of Sulfonylureas and Meglitinides
Increase insulin secretion by closing Potassium ATP channels in B-cell plasma membrane
Thiazolidinediones (TZDs) mechanism and side effects
Activate PPAR-y nuclear transcription factor –> Increase peripheral insulin sensitivity
Side effects: weight gain, edema, heart failure, bone fractures
T2D drug class that decreases/slows intestinal carbohydrate digestion
a-Glucosidase inhibitors = Acarbos, Miglitol
Incretin Mimetic drug class effects:
- -Increase insulin secretion
- -Decrease glucagon secretion
- -Slow gastric emptying
- -Increase satiety
Mechanism of class of drug that includes: Sitagliptin, Alogliptin, Saxagliptin, Linagliptin
DPP-4 Inhibitors = decrease metabolism of Incretins (GLP-1)
SGLT2 Inhibitor drug class mechanism and effect
- -Inhibit glucose resorption (through sodium glucose cotransporter 2) in kidney
- -Increase a-cell glucagon secretion
–Increase urine glucose excretion
What class of T2D drug can cause DKA?
SGLT2 Inhibitors – increased Glucagon:Insulin ratio
Mechanism of Bile acid sequestrant drug class in T2D
Decrease hepatic glucose production
Hypoglycemia is most common with what 2 drug classes?
- Sulfonylurea
2. Insulin
Treatment of hypoglycemia
- Give 15g of glucose (or equivalent in carbohydrate snack)
2. Wait 15 minutes, check again
How does stress affect blood glucose?
Increases blood glucose
Pramlintide mechanism of action
Amylin analog = slow gastric emptying, suppress postprandial glucagon secretion, reduce appetite
Injection before each meal
3 Rapidly acting Insulin analogs:
- Lispro
- Aspart
- Glulisine
Long-acting Insulin analog
Glargine insulin – pH = 4 –> burning at injection
Ultra long-acting Insulin analog
Degludec
Premixed Insulins are rarely used in [Type1/Type2] Diabetes
Type 1
What Insulins don’t have peak action time?
- Glargine = long acting
2. Degludec = ultra long-acting
What is lipohypertrophy and how do you treat it?
Fat tissue accumulation at place of insulin injection
Treat: rotate injection site
What kind of insulin do Continuous Subcutaneous Insulin Infusion (CSII) Systems use?
Rapid-acting insulin
What is ideal post-prandial glucose?
Post-prandial = 3hr period following food intake
Ideal peak value below 180mg/dL
What kind of insulin is normally used IV (ex. inpatient setting)
Regular insulin
Lactic acidosis is a rare side effect of this T2D drug
Metformin
