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
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
3
Q
Treatment of diabetes mellitus
A
- Education
- Diet
- Physical exercise
- Peroral antidiabetic drugs
- Insulin
- Islet call transplantation
4
Q
Education
A
- Nature & emergencies Diabetes
- Diet, drug therapy
- follow up
- ABC diabetes
- A1C, aspirin
- Bp
- Cholesterol
- Dia edu & foot exam
5
Q
Non-pharmacological Management of T2DM (Lifestyle interventions)
A
- Diet:
- Decrease fat content & total calories
- Decrease saturated fat
- Decrease salt(htn)
- Individualized diet
- Weight reduce(obese) - Exercise:
- Reduce cardiovascular risk factors - Smoking cessation
6
Q
oral antidiabetics
A
- Sulfonylureas
- Thiazolidinediones
- Biguanides
- Alpha-glucosidase inhibitors
- D-phenylalinine derivatives
- Incretin based therapies
- SGLT-2 Inhibitors
7
Q
5 principles in selecting Antihyperglycemic interventions
A
- Efficacy
- Hypoglycemia
- Weight
- Side effects
- Cost
8
Q
Actions Sulphonylureas
A
Promote release insulin from β - cells
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)
10
Q
Attributes of Sulphonylureas
A
- Mecha
-Stimulate insulin secretion - Efficacy
-high - Adverse
-Hypoglycemia -Weight gain
-B Cell Exhaustion
-Chloretic jaundice
-Hypersensitivity react - Adv
-Extensive experience
-
11
Q
Drug Interactions with sulphonylurea
A
- Increased Hypoglycemia:
- Anticoagulants -Salicylates -Sulfonamides -MAO Inhibitors
- Tricyclic antidepressants
- Azole antifungals - Decreased Action :
- Beta Blockers, Diuretics
- Corticosteroids
- Estrogens, Thyroid Hormones
- Sympathomimetics -Phenothiazines
- Isoniazid, Phenytoin -Nicotinic Acid
12
Q
Biguandies
A
- Actions
- ↓ hepatic gluc product
- ↑anaerobic glycolysis
- ↑ sensitivity of insulin receptor
- ↓ appetite & gluc abs from the gut
- Beneficial effect on lipid profile. - Indications
- Use alone obese type 2 DM
- Combine w other oral antidiabetic/insulin to achieve control - Preparation & dosage:
- Metformin: 500 mg t.d.s after meal up to 2-3gm/d
13
Q
Attributes of Metformin
A
- Mecha
- Decreases hepatic gluc output
- Increase gluc uptake from peripheral tissue & liver
- Lower fasting glycaemia - Efficacy
- high - Adverse
- GI s/e(reduce by low dose & gradually titrating)
- Lactic acidosis(extremely rare)
- Ci CKD & HF - Adv
- Extensive experience
- No weight gain
- No hypoglycemia
- Likely ↓ CVD events (UKPDS)
- Low cost
14
Q
Attributes of TZDs
A
- Mecha
- Insulin sensitizers(increase peripheral Insulin action on Skeletal Muscle)
- Decrease hepatic Glucose production - Efficacy
- high - Adverse
- Edema
- Weight Gain
- Increases risk of CHF
- Bone fracture - Adv
- No hypoglycemia
- Durability
15
Q
Attributes of Alpha Glucosidase Inhibitors
A
- Mecha
- Inhibits intestinal enz= reduced abs starch & sugars. - Efficacy
- modest - Adverse
- GIT upset - Adv
- No weight gain
- No hypoglycemia
- ↓Post-prandial glucose
