Simple Diabetes

Question 1

Metformin

Answer 1

Biguanide
decr. hepatic glucose production, decr. intestinal glucose absorption, incr. insulin sensitivity

500 mg BID or 850 mg daily

Question 2

Chlorpropamide

Answer 2

1st gen SU, not used

Question 3

tolazamide

Answer 3

1st gen SU, not used

Question 4

Tolbutamide

Answer 4

1st gen SU, not used

Question 5

Glipizide

Answer 5

SU (stimul. insulin secr. from beta cells)

ir: 5-10 mg daily-BID
xl: 5-10 daily

Question 6

Glimepiride

Answer 6

SU (stimul. insulin secr. from beta cells)

1-2 mg daily

Question 7

Glyburide

Answer 7

SU (stimul. insulin secr. from beta cells)
2.5-5, or 1.5-3 if micronized
NOT a preferred agent, avoid with renal impairment

Question 8

Repaglinide

Answer 8

Meglitinide (stimul. insulin secr. from pancreatic beta cells)

A1C < 8%, 0.5 mg TID
>8%, 1-2 mg TID
take 15-30 mins before meals
slightly more effec. than nateglinide

Question 9

Nateglinide

Answer 9

Meglitinide (stimul. insulin secr. from pancreatic beta cells)
near goal A1C: 60 mg TID
otherwise: 120 mg TID
1-30 mins pre-meal

slightly less effec. than repaglinide

Question 10

Pioglitazone

Answer 10

TZD (peroxisome proliferator-actiavated receptor gamma agonist) = incr. peripheral insulin sensitivity

15-30 mg daily
avoid with bladder cancer

Question 11

Rosiglitazone

Answer 11

TZD (peroxisome proliferator-actiavated receptor gamma agonist) = incr. peripheral insulin sensitivity
4-8 mg daily

avoid w/ bladder cancer

Question 12

Acarbose

Answer 12

Alpha-glucosidase inhibitor (inhib. of this enzyme delays gluc. absorption, limits hyperglycemia occurring after meals)
works directly in brush border of small intestine – take with first bite of main meal, can cause GI upset

Question 13

Miglitol

Answer 13

Alpha-glucosidase inhibitor (inhib. of this enzyme delays gluc. absorption, limits hyperglycemia occurring after meals)
works directly in brush border of small intestine – take with first bite of main meal, can cause GI upset