Type 2 DM Flashcards
around 1995 there were only ____ classes of drugs besides insulin: _____ and _______. now there are about __ with more on the horizon
1995: 2: metformin and sulfonyureas
now: 9
certain companies are now classifying the “cure” for DM as an A1C < ___ for __ years …. however the real cure may be a possibility for the future
<6.4 for 2 years
NOT IN NOTES, HADLEY MADE A POINT OF IN LECTURE
Txt: increases in insulin should be by ____ at a time
5%
At what age and frequency are average people (no obesity of complications) checked for DM ? and if there are risk factors (aka preDM or suspiscion of preDM)?..
45 years old, every 3 years.
risk factors? every 1 year
what must you have before you can actually Dx someone with type 2 DM?
two abnormal test results
can use the same sample for two separate tests, so that you dont have to re-stick pt
what are way to test for DM?
fasting blood glucose (FBG)
glucose tolerance test
A1C
for those with preDM, _________ can reduce risk of developing typ 2DM by ____. The goal is to get __% loss of INITIAL body weight.
intensive behavioral interventions, dec. by 50%
want 7% dec initial body weight
alcohol for DM pts?
yes its ok! (if moderate)
< 1/day for women
<2 /day for men
what do we use to check for glycemic target?
assessment of glycemic control: use A1C (not FBG or glucose tolerance)
if were testing for glycemic control and they have good control, we will then re-test ____ time a year. if not good control then re-test ____ a year.
good control: 2x year
not good control:4x year
DM txt: sliding scale or no?
NO SLIDING SCALE
general approach to DM treatment
- diet, exercise, pt education
- metformin to start
- maybe add on other meds
- txt comorbid conditions
- (consider txt pre-DM with meds, diet/exercise)
the average decrease in A1C from drugs? but a higher starting A1C means what?
1%
higher starting A1C, usually >1% decrease from drugs (higher starting A1C = bigger response to drugs)
first line oral antiDM drug? what is the starting dose?
biguanides (metformin)
starting dose: 500mg at night for two weeks
why dont you want to increase metformin dosage too quickly?
people will become intolerant (bad GI ADRs more likely)
metformin: restrictions of txt with specific GFR levels, what about if the pt is going to receive contrast for imaging?
cant have if GFR <30
dose adjust GFR 30 to 45 (no current kidney failure: therapy initiated at half initial dose, if GFR falls into this range DURING therapy: drop dose by half)
must stop before having IV contrast
when dosing for metformin, always use _____.
feedback- A1C levels
metformin max dose. why is this good to know?
2500 mg/day
max out on metformin THEN try something else
ADR of alpha glucosidase inhibitors?
GI issues- flatulence/diarrhea, fecal incontinence
which anti-DM drugs have a first phase insulin response? which dont? this first phase is good but with what risk? …
first phase: meglitinides and incretins
(insulin and amylin as well)
(produce insulin at the time of the meal to counter that initial glucose spike.. but leads to hypoglycemia risk if no carbs are in the meal)
no first phase: sulfonyureas
which anti-DM drug increases sensitivity?
TZDs (“glitazones”)
the remaining “ok” TZD/glitazone without CVD risk and beneficial effects on lipids
pioglitazone
which type of anti-DM drug is byetta(exantide)?
what are two major added benefits of it?
incretin: aka GLP1 agonist or “mimic”
weight loss, decreased CVD risk (moderately)
do incretins increase pancreatitis risk?
according to hadley, no, DM is what increases the risk
