PHARMACOTHERAPY MANAGEMENT OF DIABETES MELLITUS Flashcards
What is T1D diabetes?
Juvenile onset diabetes mellitus, insulin dependent diabetes mellitus
19% occurrence
Sudden
Insulin needed for survival
What is T2D diabetes?
Adult onset diabetes mellitus, non insulin dependent diabetes mellitus
90% occurrence
Gradual
What is the pharmacotherapy for T1D?
- insulin (exogenous)
- type of insulin depends on insulin delivery system
Best practices:
- multiple daily injections
- continuous subcutaneous insulin infusions
Mimic endogenous insulin secretion, basal and bolus to manage blood glucose levels
What is “BASAL”?
background insulin that addresses hepatic glucose production
What is “BOLUS”?
Secreted in response to energy intake and glucose
What are the bolus insulins?
Rapid acting insulin analogues (clear)
Short acting insulin’s (clear)
What are the basal insulins?
Intermediate acting (cloudy)
Long acting insulin (clear)
What are the pre mixed insulins?
Premixed regular insulin - NPH (cloudy)
Premixed insulin analogues (cloudy)
What are the T1D considerations?
Basal-bolus insulin regimens are the best insulin regimens for T1DM
Insulin regimens should not be tailored to individual, should be counselled about risk, prevention and treatment of hyperglycaemia
What is the pharmacotherapy for T2D?
Oral vs injectable
Combination therapy - address multiple pathophysiology defects
Efficacy of a drug= old.. decreased A1C
Effectiveness of a drug= decreases weight, A1C, hypo, CV risk
Diagnosis for T2D?
- lifestyle changes expected to reduce blood glucose levels
- start metformin
- adjust or advance therapy
What is biguanide?
Enhances insulin sensitivity in liver and peripheral tissues by activation of AMP activated protein kinase
What is incretin?
Increases glucose dependent insulin release, slows gastric emptying, inhibits glucagon release
What is SGLT2i?
Reduces glucose reabsorption by the kidney
What is alpha glucosidase inhibitor?
Activates insulin receptors to regulate metabolism of carbohydrate, fat and protein
