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)