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IM > W1L9 Management Diabetes > Flashcards

W1L9 Management Diabetes Flashcards

1
Q

Goal of ttt?

A
  • Eliminate overt cli mani
  • Prevent Acute dia comp
  • Prevent & ttt hypoglycemia
  • Maintain high lvl phy fit
  • Normal growth include timing puberty
  • Encourage pt all acti suit for age
  • Educate pt & fam w diabetic process
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2
Q

Specific Goals in Management of Diabetes?

A
  • Fasting <100 mg/dL
  • Post-meal <140 mg/dL
  • A1C <7%
  • Blood Pressure <130/80
  • LDL <100 mg/dL, HDL >45 mg/dL
  • Triglycerides <150 mg/dL
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3
Q

Treatment of diabetes mellitus

A
  • Education
  • Diet
  • Physical exercise
  • Peroral antidiabetic drugs
  • Insulin
  • Islet call transplantation
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4
Q

Education

A
  • Nature & emergencies Diabetes
  • Diet, drug therapy
  • follow up
  • ABC diabetes
    • A1C, aspirin
    • Bp
    • Cholesterol
    • Dia edu & foot exam
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5
Q

Non-pharmacological Management of T2DM (Lifestyle interventions)

A
  1. Diet:
    - Decrease fat content & total calories
    - Decrease saturated fat
    - Decrease salt(htn)
    - Individualized diet
    - Weight reduce(obese)
  2. Exercise:
    - Reduce cardiovascular risk factors
  3. Smoking cessation
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6
Q

oral antidiabetics

A
  • Sulfonylureas
  • Thiazolidinediones
  • Biguanides
  • Alpha-glucosidase inhibitors
  • D-phenylalinine derivatives
  • Incretin based therapies
  • SGLT-2 Inhibitors
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7
Q

5 principles in selecting Antihyperglycemic interventions

A
  1. Efficacy
  2. Hypoglycemia
  3. Weight
  4. Side effects
  5. Cost
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8
Q

Actions Sulphonylureas

A

Promote release insulin from β - cells

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9
Q

Classi su

A

1st gen:
Tolbutamide(st act)(.5-2g)
Acetohexamide(mid)(.25-1.5g)
Chlorporpamide(long act)(.5g)

2nd gen:
Glipizide(6)(2.5-30mg)
Gliclazide(12)(40-320mg)
Gliclazide MR(24)(120mg) 
Glibenclamide(12-24)(2.5-15mg)
Glimepride(24)(1-8mg)
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10
Q

Attributes of Sulphonylureas

A
  1. Mecha
    -Stimulate insulin secretion
  2. Efficacy
    -high
  3. Adverse
    -Hypoglycemia -Weight gain
    -B Cell Exhaustion
    -Chloretic jaundice
    -Hypersensitivity react
  4. Adv
    -Extensive experience
    -
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11
Q

Drug Interactions with sulphonylurea

A
  1. Increased Hypoglycemia:
    - Anticoagulants -Salicylates -Sulfonamides -MAO Inhibitors
    - Tricyclic antidepressants
    - Azole antifungals
  2. Decreased Action :
    - Beta Blockers, Diuretics
    - Corticosteroids
    - Estrogens, Thyroid Hormones
    - Sympathomimetics -Phenothiazines
    - Isoniazid, Phenytoin -Nicotinic Acid
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12
Q

Biguandies

A
  1. Actions
    - ↓ hepatic gluc product
    - ↑anaerobic glycolysis
    - ↑ sensitivity of insulin receptor
    - ↓ appetite & gluc abs from the gut
    - Beneficial effect on lipid profile.
  2. Indications
    - Use alone obese type 2 DM
    - Combine w other oral antidiabetic/insulin to achieve control
  3. Preparation & dosage:
    - Metformin: 500 mg t.d.s after meal up to 2-3gm/d
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13
Q

Attributes of Metformin

A
  1. Mecha
    - Decreases hepatic gluc output
    - Increase gluc uptake from peripheral tissue & liver
    - Lower fasting glycaemia
  2. Efficacy
    - high
  3. Adverse
    - GI s/e(reduce by low dose & gradually titrating)
    - Lactic acidosis(extremely rare)
    - Ci CKD & HF
  4. Adv
    - Extensive experience
    - No weight gain
    - No hypoglycemia
    - Likely ↓ CVD events (UKPDS)
    - Low cost
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14
Q

Attributes of TZDs

A
  1. Mecha
    - Insulin sensitizers(increase peripheral Insulin action on Skeletal Muscle)
    - Decrease hepatic Glucose production
  2. Efficacy
    - high
  3. Adverse
    - Edema
    - Weight Gain
    - Increases risk of CHF
    - Bone fracture
  4. Adv
    - No hypoglycemia
    - Durability
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15
Q

Attributes of Alpha Glucosidase Inhibitors

A
  1. Mecha
    - Inhibits intestinal enz= reduced abs starch & sugars.
  2. Efficacy
    - modest
  3. Adverse
    - GIT upset
  4. Adv
    - No weight gain
    - No hypoglycemia
    - ↓Post-prandial glucose
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16
Q

Attributes of GLP-1 analogues

A
  1. Mecha
    - Activates GLP-1 receptor
    - ↑Insulin, ↓glucagon
    - ↓gastric emptying
    - ↑satiety
  2. Efficacy
    - high
  3. Adverse
    - GI
    - Sometimes ↑ Pancreatitis
    - Injectable
    - High cost
  4. Adv
    - Weight loss
    - Low risk hypoglycemia higher than DPP-4 inhibitors
    - Preserve Beta cell mass
    - Cardiovascular protection
17
Q

Attributes of DPP-4 inhibitors

A
  1. Mecha
    - Inhibits DPP-4
    - Increases GLP-1, GIP
  2. Efficacy
    - moderate-hugh
  3. Adverse
    - Pancreatitis
    - High cost
  4. Adv
    - no hypoglycemia
    - well tolerated

IM (17 decks)

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