Term
What is the MoA of Metformin?
What is the min/max dose? |
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Definition
- Insulin sensitizer - does not work in beta cells. Also decreases hepatic glucose production, GI absorption, and increases peripheral uptake.
Min: 500 mg po BID AC
MAX: 2.5 grams/day
Oral only, take with food, avoid alcohol. 3 week onset, ~70 mg/dl decr in BG, 1.5-2% decr in A1C |
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Term
| What are the side effects of metformin? |
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Definition
- GI: diarrhea, flatulence, GI upset. Goes away with time
- Vit B12 deficiency - megaloblastic anemia
- Lactic acidosis - can be serious
- Low risk of hypoglycemia
Do not use in liver disease, CrCl < 30, CHF stage 3, dehydration, recent MI, contrast dye, alcoholism, metabolic acidosis
- Monitor - LFTs, Scr, A1C, BGs, CBC (for anemia.
- Interacts: Tagament, Fluoroquinolones |
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Term
What is the MoA of Sulfonylureas?
Efficacy? |
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Definition
Increased insulin secretion INdependent of glucose levels
40-70 decr in FBG, 1-2% decr in A1C |
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Term
| What are the doses for glipizide, glyburide, and glimepiride? |
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Definition
Glipizide - 5-40 mg QD to BID
Glyburide - 5-10 mg QD, 10-20 mg BID
Glimepiride - 1-8 mg QD |
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Term
| What are side effects, contraindications, and monitoring for SUs? |
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Definition
- AE: HYPOGLYCEMIA, weight GAIN, rash, GI
- Contra: Sulfa, glipizide preferred in ELDERLY, only Glyburide safe in PREGNANCY
- Monitor LFTs, Scr, A1c
- Effects incr by warfarin, salicylates, Tagamet, ETOH. Decr by Rifampin
- Avoid ETOH, don't skip meals, watch hypoglycemia |
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Term
| What are the MoA, doses, and benefits of Actos/pioglitazone? |
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Definition
- 15-45 mg QD, increases insulin sensitivity. May preserve beta cells.
Lowers FBG by 30-60, A1C by 1.5
MAJOR AE: edema, Incr LDL, fractures, bladder cancer, CHF |
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Term
| What are the doses for the GLP1 agonists? |
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Definition
- Byetta/Exenatide - 5-10 mcg SQ BID
- Victoza/Liraglutide - 0.8-1.6 mg SQ QD
- Bydureon/Exenatide ER - 2 mg SQ
- Decreases glucagon release, gastric emptying, increases insulin secretion. |
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Term
| What are the AEs and monitoring for GLP1 agonists? |
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Definition
AE: NAUSEA, less with Victoza. Rare hypoglycemia. Pancreatitis.
Monitor A1C and S/S of pancreatitis
PRESERVES BETA CELLS |
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Term
| What is the MoA and doses for DPP4 agents? |
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Definition
- inhibits the enzyme DPP4, which breaks down GLP1
- Sitagliptin/Januvia - 50-100 mg QD
- Saxagliptin/Onglyza - 2.5-5 mg QD
- AE: HA, UTI
Lower efficacy, no weight gain. Very well tolerated. Lower dose in renal pts. |
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Term
| What are glycemic goals in diabetic patients? |
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Definition
A1c < 7%
Premeal glucose 90-130
Post-meal glucose <180 |
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Term
| When is monotherapy with basal insulin an option? |
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Definition
Only with Type 2 patients, not preferred for type 1 patients
Conventional: Dosed BID, requires consistent carb intake and activity
0.5-1 unit/kg/day --> 2/3 am and 1/3 pm. 1/3 regular, 2/3 NPH |
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Term
| When and how is sliding scale insulin used? |
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Definition
(BG-100)/insulin sensitivity factor. only use regular or rapid insulin
AE: hypoglycemia, weight incr. Site reactions
Do not use long term, eat 30 min before regular insulin, 0-15 min before rapid. Do not skip meals w/ BID dosing. |
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Term
| When should a patient be placed on insulin therapy? |
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Definition
| When their FBS > 350 or A1C > 10 |
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Term
| What are the steps for insulin adjustment? |
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Definition
- review records for hypoglycemia
- Identify which time is farthest from goal
- Determine which insulin type is affecting that time of day
- Determine what the goal is. |
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Term
| What meal times do regular and NPH insulin cover for BID dosing? |
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Definition
Regular - lunch (morning dose) and evening snack (PM dose)
NPH - supper (morning dose) and breakfast (PM dose) |
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Term
| What are signs and symptoms of hypoglycemia? |
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Definition
<70. If repetitively low, can lead to hypoglycemia unawareness
Tremor, HA, confusion, anxiety, agitation, tachycardia, sweating, an SNS surge
Severe - seizures |
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Term
| How are dextrose, glucose, and sucrose used? |
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Definition
| In both type 1 and 2 diabetes to increase blood glucose. Dextrose IV, Glucose and Sucrose PO. Can cause hyperglycemia |
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Term
| When should glucagon be used? |
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Definition
When patient is unconscious
30-40 -- tablets followed by a high carb meal
40-60 -- OJ or soda followed by a high carb meal |
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Term
| How does exercise work in diabetes? |
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Definition
0-20 min - muscle and glycogen stores
> 20 min - burn fat
24-48 hours after exercise, glycogen stores are replenished. Hypoglycemia still a risk
All hormones are increased except insulin is decreased --> increased BG and FFA --> increased lipolysis, glycolysis |
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Term
| What are the benefits of exercise in DM2? |
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Definition
- Type 1 - decrease CAD risk, does not decr A1C
- DM2 - Incr CV fxn, strength, insulin sensitivity, fibrinolysis. Decr LDL, BP, Weight, A1C, and stress. |
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Term
| What are the risks of exercise in DM2? |
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Definition
- Hypoglycemia
- Exacerbation of CAD
- Worsening retinopathy, nephropathy, neuropathy |
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Term
| How can hypoglycemia be prevented? |
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Definition
- Change insulin as needed
- Change injection sites to body part not involved in exercise
- check BG before and after exercise
- increase CHO for unplanned exercise |
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Term
| What is the first line for diabetic therapy? When do you go to second line? |
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Definition
Metformin! Second line if A1C not < 7 --> add SU, TZD, DPP4, GLP1, or insulin
After 3 months, may try 3 drugs. most doctors add insulin. |
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Term
| Which macronutrient does the majority of energy come from? |
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Definition
Carbohydrates - 4 kcal/gm. Simple = complex sugar
then fat
then protein |
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Term
| What is the CHO restriction for a DM2 patient? |
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Definition
45-60 gm for women
60-75 gm for men
15-30 gm for a snack |
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Term
| When should bolus insulin be administered? |
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Definition
Before meals
Regular insulin |
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Term
| Which insulin is used for basal insulin replacement? |
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Definition
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