--results from insulin resistance and progressives tp beta cell failure

--Starts as hyperinsulinemia

relative lack of insulin

-seen more in >60yoa

-american indians>black>mexicans> white

Metabolic Syndrome

(and components)

--Caused by obesity,physical inactivity and genetics

3 of the 5 components:

1. FBG>110
2. serum triglycerides >150
3. HDL < 40
4. BP >130/85
5. waiste >102cm men

Screening Recomendations for DM type 2

(ADA recommendations)

--at 45 years old and then every 3 years after

1. Improve quality of life
2. keep patient assymptomatic
3. reduce micro and macro vascular DZ risks
4. agressive management of CV risk factors

Maintainance numbers for Euglycemia

1. Hemoglobin A1C
2. preprandial plasma glucose
3. postprandial plasma glucose

1. <7%
2. 90-130 mg/dL
3. <180 mg/dL

MOA--stimulates insulin release from beta cells

(decrease glucagon release/increase insulin receptor binding affinity)

--adjuct to diet and exercise

--used with other combo's

--decreased FBG by 50-70 mg/dL

--reduce HgB A1C 1.5%

Sulfonylureas

(medication examples)

Glimepiride

Glipizide

Glyburide

--monitor CrCl

--Precaution--sulfa allergy

--all besides glipizide can be given with first meal

Sulfonlureas

(caution patients)

1. elderly
2. hepatic/renal dysfunction
3. Irregular diet
4. Alcoholism
5. concomitant hypoglycemic agents

Sulfonylureas

(Adverse reactions)

1. Hypoglycemia
2. weight gain

MOA--stimulate insulin release from beta cells in response to a glucose load

--used in combo therapy with other meds

--decrease FBG 40-60mg/dL

reduce HgB A1C 1-1.5%

Meglitinides

(medications)

1. repaglinide
2. nateglinide

Meglitinides

(specifications)

• take 15-30 min. prior to each meal (skip meal skip dose)
• HgB A1C <8% (0.5 mg repaglinide or 60 mg nateglinide)
• double dose if above 8%

MOA--reduce hepative glucose production by increasing hepatic sensitivity to insulin  (also enhance glucose uptake and utilization)

--Monotherapy and used in combinations

*therapy of choice in overweight and obese*

--decrease FBG 50-70

--reduce Hgb A1C 1.5 %

Biguanide

(meds)

--Metformin

--class-biguanide--reduces hepatic glucose production

**contraindicated if Scr is >1.5 men or >1.4 women

--500mg BID

not effective above 2000mg/day

Metformin

(advantages)

--less hypoglycemic risk

--favorable lipid effects

--no weight gain

Metformin

(adverse reactions)

--GI

--HA

--metallic taste

Metformin

(contraindications)

--Lactic Acidosis(tissue hypoperfusion and hypoxia)

--should be discontinued  at the time of or prior to precedures using iodinated contrast material

MOA--improve tissue sensitivity to insulin in muscles  (also suppress hepatic glucose production)

 --mono or combo therapy(sulfonylurea)

--decrease FBG 30-40 mg/dL

--reduce Hbg A1C .5-1.4%

Glitazones

(medications)

1. Rosiglitazone
2. Pioglitazone

--may take several wks for onset and several months for peak

--titrate every 12 wks

--pioglitazone helps the lipid improvement more

Glitazones

(adverse reactions)

--minimal hypoglycemic risk

--macular edema

--fluid retention/edema

--potential liver toxicity

--CHF possible with NYHA class 3 and 4

MOA--delays glucose absorption and lowers prostprandial hyperglycemia

--Does NOT decrease FBG

--Decrease post-PG 40-50 mg/dL

--reduce Hgb A1C .5-.8%

Alpha-glucosidase inhibitors

(meds)

1. Acarbose
2. Miglitol

**titrate dose to decrease GI effects**

Alpha-glucosidase inhibitors

(contraindications and advers reactions)

--Contraindications:

   --maj. GI disorders

--Adverse reactions:

   --GI intolerance

**hypoglycemia must be treated with oral glucose or gels when on this**

• Glucocorticoids
• Nicotinic Acid
• Pentamidine
• Clozapine
• olanzapine

**all increase glucose**

ABC of diabetes care

(A-K)

A--A1C

B--blood pressure

C--cholesterol

D--dental and diet

E--education/exercise/eye exams

F--foot exam

G--glucose monitoring

H--heart health

I--indications for specialties

K--kidney

0.7-1.5 units/kg/day