Treatment of Diabetes Flashcards
What diabetic drug mimics the mealtime release of insulin and used before a meal?
Short-acting insulin
How is short-acting insulin administered?
Not orally, subQ injection
Why does short-acting insulin have lower risk of hypoglycemia?
Has rapid onset and short duration of action which allows a flexible treatment regimen
Excessive doses of insulin can result in what symptoms? (8)
- Headache
- Tachycardia
- Vertigo
- Anxiety
- Confusion
- Diaphoresis
- Lipodystrophy
- Hypersensitivity
What is given as insulin replacement?
basal insulin AND pre-meal insulin
What kind of insulin works over the course of the day to maintain appropriate insulin levels?
Long acting insulin
What is long-acting insulin used for?
Used for basal control and is taken first in the morning
How is long acting insulin administered?
SubQ
What type of diabetic drug delays gastric emptying, decreases glucagon secretion, and decreases the amount of insulin needed?
Amylinomimetic
Pramlintide
How much does a dose of short acting insulin decrease by when also taking preamlintide?
50%
When do you take pramlintide (amylinomimetic)
Take it during right before mealtime
How do you administer pramlintide?
SubQ with different syringe than insulin
Effects of taking a GLP-1 Agonist
1) Activate incretin (responsible for 60-70% of post-meal insulin secretion)
2) Potentiation of glucose-mediated insulin secretion
3) Suppression of post-meal glucagon release
4) Slows gastric emptying and loss of appetite
5) May allow for weight loss!
When is Liraglutide contraindicated?
In patients with a family history of cancer because it has produced thyroid tumors in rodents.
Adverse effects of GLP-1 agonists
Pancreatitis
Headache
Nausea
Diarrhea
What are GLP-1 agonists often associated with? What may this medication reduce?
Associated with weight loss
May reduce risk of heart attack and stroke
What drug precipitates at the injection site and has a prolonged effect with no peak?
Insulin Glargine
What diabetic drug has an enhanced association with albumin?
Insulin Detemir
What diabetic drug is contraindicated with patients with a family history of cancer?
Liraglutide
What drug increases LDL cholesterol and triglycerides and Increases HDL cholesterol? It is cautioned in patients with high cholesterol
Rosiglitazone
What diabetic drug decreases triglycerides
Increases HDL cholesterol?
Pioglitazone
What diabetic drug increases the risk of lower limb amputation?
Canagliflozin
What drug lowers glucose production in the liver and improves the body’s sensitivity to insulin?
Metformin
What effects does metformin have?
1) lowers glucose production in the liver and improves body’s sensitivity to insulin
2) Increases hepatic sensitivity to insulin
3) Reduces energy supply for production
4) Increases glucose uptake in skeletal muscle
What is considered the drug of choice for newly diagnosed patients with T2DM?
metformin
When would you avoid taking metformin?
Poor kidney or liver function, respiratory insufficiency, cardiac insufficiency, and hypotension
What is the main side effect of metformin?
GI distress
What is the main effect of sulfonylureas?
Helps the body secrete more insulin
What kind of patients would you prefer to prescribe sulfonylureas?
Patients who are not overweight
What other medications would you not use sulfonylureas with?
other medications that increase insulin release (meglitinides)
What are some side effects of taking sulfonylureas?
Hypogylcemia
Weight gain
Skin reactions
possible cardiac effects (increase BP, arrythmia)
If metformin is contraindicated, what is the first-line therapy drug that you would prescribe next?
Sulfonylureas
The main effect of meglitinides
stimulate insulin secretion from pancreas
What drug was developed to decrease post-meal hyperglycemia and is taken 15-30 minutes before a meal?
Meglitinides
What are some side effects of meglitinides?
Hypoglycemia
Weight gain
What diabetic drug category is best taken with people who dont have regular eating habits?
Meglitinides
What is the main effect of thiazolidinediones?
-Decreases insulin resistance and improves whole-body insulin sensitivitity
-Promotes/enhances the effects of insulin so body can use the insulin it already has better
-Does NOT release more insulin!
What is typically given with thiazolidinediones?
Spironolactone or other diuretic to prevent fluid retention
Adverse effects of thiazolidinediones
Little weight gain
Increase risk of heart disease
Fluid retention
Who would you caution the use of thiazolidinediones in?
Patients with heart failure
Main effects of alpha glucose inhibitors
Reduces post-meal glucose absorption
When do you take an alpha glucose inhibitor?
At the start of a meal
When would you avoid use of alpha-glucose inhibitors?
In patients with GI disease, especially IBD.
Avoid in patients with liver or kidney disease
What do alpha-glucose inhibitors target?
Target the alpha-glucosidase enzymes and prevent the breakdown of carbohydrates
What is the DPP-4 inhibitor’s main effect?
Prolongs the action of incretin-hormones (GLP-1)
Results in an increase in insulin secretion in response to meals.
Also results in a decrease in glucagon levels
When is DPP-4 inhibitors an adjunct therapy?
When patient is dieting and excercising
Adverse effects of DPP-4 inhibitors
Nasopharyngitis
Headache
What drug does not increase fullness and keeps your weight neutral?
DPP-4 inhibitors
Main effect for sodium glucose transporter 2 inhibitors*
Prevents the kidney from reabsorbing sugar/glucose into the blood and also reduces BP
What are the major side effects in Sodium-glucose transporter 2 inhibitors?
The majority of side effects are in the urinary tract!
-UTIs
-Yeast infections
-Increased urination frequency
Hypotension
