2-6: 5/23: Dm Management Ii

Front 1

Nutrition Recommendations

Back 1

Fat <30%
(Not commercially prepared fish, but have fish 2x week)
Protein: 15-20%

Front 2

Exercise Effects

Back 2

Increases mvmt of GLUT 4 to cell surface, improves insulin sensitivity

(IMPOSSIBLE TO LOSE WEIGHT WITHOUT CALORIE RESTRICTION)

Front 3

Exercise Risks

Back 3

Hyperglycemia if exercise when have high glucose (insufficient insulin)

Hypoglycemia: consume carbs pre-exercise (exercise makes you insulin insensitive)

CV Risk

Front 4

Avoid vigorous exercise in presence of advanced ______.

Back 4

Retinopathy

Front 5

Consider non-weight bearing exercise in presence of __________.

Back 5

Neuropathy

Front 6

UPDS study determined ________.

Back 6

Progressive deterioration beta-cell function over time

Front 7

Sulfonylureas:
Mechanism
Side Effects
2nd Generation Examples

Back 7

Sulfonylureas bind K-ATP channels, close channel, cells depol, Ca2+ in, insulin out

Restores 25% beta cell function, but only temporarily

AE's:
Hypoglycemia (glyburide causes the most!)
Weight gain

Second Gens:
Glyburide
Glipizide
Glimepiride

Front 8

Chlorpropapmide:
Class
Side Effects

Back 8

First Gen Sulfonylurea

AE:
SIADH
Disulfram-like reaction

Front 9

Glyburide:
Class
Side Effects

Back 9

Second Generation Sulfonylureas
More hypoglycemia in older patients or pts with renal insufficiency (accumulation of glyburide due to decreased clearance; may cause CV effects bc can bind K-ATP channels of heart)

Front 10

Netaglinide:
Class
Mechanism

Back 10

Short-Acting Insulin Secretagogue
Bind Sulfonylurea binding site, act same way

Lower postmeal glucose excursions

AE's:
Hypoglycemia, weight gain

Front 11

Repaglinide:
Class
Mechanism

Back 11

Short-Acting Insulin Secretagogue
Bind Sulfonylurea binding site, act same way

Lower postmeal glucose excursions

AE's:
Hypoglycemia, weight gain

Front 12

Metformin:
Class
Mechanism
Side Effects

Back 12

Biguanide

Increases insulin insensitivity in liver (suppresses hepatic gluconeogenesis)

Lowers glucose without raising insulin, thus NO WEIGHT GAIN, NO HYPOGLYCEMIA

GI Distress (minimize by slow titration of dose and administer with food)
Some interference with B12 absorption

Risk for lactic acidosis increases with renal dyfn and advanced age (probably because metformin is unmetabolized by kidneys, and not excreted. BUILD UP)

Front 13

Phenformin:
Class
Side Affects

Back 13

Biguanide
LACTIC ACIDOSIS

(not a huge risk for metformin, also a biguanide)

Front 14

Under what conditions should metformin be avoided?

Back 14

Renal Dysfn
Uncompensated CHF
Use of iodinated contrast materials

Can build up and get lactic acidosis

Front 15

UKPDS: effects of intensive metformin treatment

Back 15

Tight Control with Metformin reduces CV mortality (MI)

Front 16

Metformin: Other uses

Back 16

Polycystic ovary syndrome

Decreases risk of progression of prediabetes to diabetes

Front 17

Thiazolidinedione:
Mechanism
Site of Action
Examples

Back 17

Binds PPAR-gamma
Which binds RXR
Which binds DNA, transcribes insulin-sensitive genes

Primarily work in adipose and skeletal muscle (concentration of PPAR-gamma is high in adipose but low in skeletal muscle)

Ex: -glitazones

Front 18

Thiazolidinedione:
Side Effects

Back 18

Fluid retention/edema
Weight Gain (may be due to fluid retention)
CHF
MI (rosiglitazone)
Hepatotoxicity (troglitazone)
Fracture Risk

NO HYPOGLYCEMIA

Front 19

Thiazolidinedione: Other uses

Back 19

PCOS, Prediabetes-->Diabetes prevention (LESS SO THAN METFORMIN)

Front 20

Alpha-glucosidase Inhibitors:
Mechanism
Side Effects

Back 20

Competitively inhibit alpha-glucosidase in small intestine, and pancreatic alpha-amylase

Delays breakdown of oligosaccharides to monosaccharides

Delayed glucose absorption results in lower postprandial hyperglycemia

AE's:
Undigested carbs metabolized by bacteria-->FLATULENCE

No weight gain
No hypoglycemia

Front 21

Incretin Effect

Back 21

If you give a glucose load in a normal person, glucose and insulin go up, then go down

If give glucose IV, insulin response is a third of the response (INCRETIN EFFECT)--must be some signal from GI input!

Front 22

Effects of GLP-1

Back 22

Inhibits alpha cell secretion
Stimulate beta cell secretion

Super short half-life because of DPP IV

Front 23

Sitagliptin:
Mechanism
Examples
Side Effects

Back 23

Inhibits DPP IV to prevent breakdown of GLP-1

Ex: -gliptins

AE's:
Upper respiratory tract infections (also causes changes in cytokines, and other small molecules)

NO weight gain (insulin secretion dependent on ambient glucose levels)

Front 24

Colesevelam:
Mechanism
Side Effects

Back 24

Bile-acid-binding resin: binds bile acids in GI tract, body can't reabsorb them, thus body must make new bile acids (needs to utilize cholesterol stores)
Bile acids may affect glucose somehow (complicated)

Lowers LDL

GI Side Effects
May rise TG's
Interfere with fatty soluble vitamin absorption

Front 25

This drug was discovered from research in hibernating animals.

Back 25

Bromocriptine

Front 26

Bromocriptine:
Mechanism in DM
Side Effects

Back 26

Quick release: pulse of DA agonist to brain centers; reduces postprandial glucose without increasing insulin

CV FRIENDLY

AE's
Potential to exacerbate psychosis