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46 Cards in this Set
- Front
- Back
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Type 1 DM
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Autoimmune destruction of the beta cells of the pancreas
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Type 2 DM
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Combination of insulin resistance and relative insulin deficiency; progressively lower insulin secretion over time
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Risk factors for Type 2 DM
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1st degree relative w/ DM
Native American, African American, Asian, Hispanic, Pacific Islander Overweight Physical inactivity HTN HDL < 35 and/or TG > 250 Hx of CVF Polycystic ovarian syndrome |
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Microvascular complications
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Retinopathy
Nephropathy Peripheral neuropathy Autonomic neuropathy (ED, gastroparesis, loss of bladder control) |
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Macrovascular complications
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Coronary artery disease (HTN, MI, HF)
Cerebrovascular disease (TIA/stroke) Peripheral artery disease |
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DM lifestyle modifications
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Weight loss
Waist circumference < 35 in (female), < 40 in (male) Diet Monitor carb intake Limit saturated fat intake < 7% of total calories Minimize trans fat intake Exercise 30 min x 5 days Smoking cessation |
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Vaccinations required for diabetics
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Influenza
Hep B Pneumovax TdaP |
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Metformin
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Glucophage
Biguanide IR 500 mg QD-BID or 850 mg QD ER 500-1000 mg QD w/ dinner 1st line therapy for DM BLACK BOX --- lactic acidosis |
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Janumet
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Sitagliptin + Metformin
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Metformin Contraindications
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SCr > 1.4 (female) or > 1.5 (male)
CrCl < 60 mL/min Metabolic acidosis Temporary d/c w/ iodinated contrast media (resume after 48 hrs if renal function is normal) STOP in any case of hypoxia Hepatic impairment |
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Metformin Adverse Effects
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D/N/V/flatulence
Weight neutral |
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Metformin Interactions
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Alcohol, iodinated contrast dye - increase risk of lactic acidosis
Decreases Vitamin B12 absorption |
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Glipizide
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Glucotrol
Sulfonylurea IR 5-10 mg BID XL 5-10 mg QD, max 20 mg QD |
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Glimepiride
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Amaryl
Sulfonylurea 1-2 mg QD, max 8 mg QD |
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Glyburide
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DiaBeta
2.5-5 mg QD, max 20 mg/d Contraindicated in CrCl < 50 ml/min |
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Metformin MOA
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Decreases hepatic glucose production
Decreases intestinal absorption of glucose Improves insulin sensitivity |
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Sulfonylurea Info
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Stimulate insulin secretion from the pancreatic beta cells
SE - hypoglycemia, weight gain CYP 2C9 substrates Take w/ food |
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Sulfonylurea Contraindications
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Use w/ meglitinides
Sulfa allergy Glyburide --- CrCl < 50 mL/min |
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Meglitinide Info
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Stimulate insulin secretion from the pancreatic beta cells
SE - hypoglycemia, mild weight gain, upper respiratory tract infxn Repaglinide, nateglinide |
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Pioglitazone
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Actos
15-30 mg QD, max 45 mg QD Contra in active bladder cancer |
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Thiazolidinedione MOA
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Peroxisome proliferator-activated receptor gamma agonists
Increases uptake and utilization of glucose by the peripheral tissues |
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TZD Warnings and Side Effects
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BLACK BOX --- NYHA Class III/IV heart failure
Don't use pioglitazone in active bladder cancer CYP 2C8 substrates SE - peripheral edema, weight gain, UTRIs CHF, increased fracture risk, increased LFTs |
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Alpha Glucosidase Inhibitors
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Cause reversible inhibition of membrane-bound intestinal alpha-glucosidases which hydrolyze oligosaccharides and disaccharides to glucose
Delays glucose absorption Ex. Acarbose, Miglitol |
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Alpha-Glucosidase Inhibitor Warnings and Side Effects
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Contra in inflammatory bowel disease, colonic ulceration, partial or complete intestinal obstruction
SE - GI effects, weight neutral Take w/ full glass of water w/ 1st bite of food Treat hypoglycemia w/ glucose tablets or gel |
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Sitagliptin
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Januvia
DPP-4 Inhibitor 100 mg QD CrCl 30-49 --- 50 mg QD CrCl < 30 --- 25 mg QD |
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DPP-4 Inhibitors
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Prevent the enzyme DPP-4 from breaking down incretin hormones, GLP-1, and GIP
Increase insulin release from the pancreatic beta cells Decrease glucagon secretion from pancreatic alpha cells Ex. Sitagliptin, saxagliptin, linagliptin (no renal dose adjustment), alogliptin |
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DPP-4 Inhibitor Adverse Effects and Interactions
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Nasopharyngitis, Upper RTIs, UTIs, peripheral edema, rash, hypoglycemia
Weight neutral Saxagliptin --- CYP 3A4 substrate Linagliptin --- CYP 3A4 and P-glycoprotein substrate |
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Canagliflozin
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Invokana
SGLT2 Inhibitor 100 mg Qbreakfast (max 300 mg Qbreakfast) CrCl 45-60 - 100 mg max Contra in CrCl < 45 mL/min |
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SGLT2 Inhibitors
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Reduces reabsoprtion of filtered glucose and lowers renal threshold for glucose --- increases urinary glucose excretion
UGT substrate Ex. Canagliflozin |
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SGLT2 Inhibitor Side Effects and Misc.
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SE - female genital mycotic infxns, UTIs, hyperkalemia, increased urination, hypoglycemia
Contra - CrCl < 30 mL/min, ESRD, or on dialysis Increases AUC of digoxin |
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Exenatide
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Byetta, Bydureon (ER)
GLP-1 agonist IR --- 5 mcg SC BID x 1 month, then 10 mcg SC BID ER --- 2 mg SC q7 days |
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GLP-1 Agonists MOA
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Analogs of glucagon-like peptide-1
Increases insulin secretion Decreases glucagon secretion Slows gastric emptying and improves satiety Ex. Exenatide, liraglutide |
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GLP-1 Agonists Misc.
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BLACK BOX --- possible thyroid cancer
Contra - family hx of medullatry thyroid carcinoma, Multiple Endocrine Neoplasia syndrome type 2, CrCl < 30 mL/min, severe GI disease SE - nausea, V/D/C, weight loss, hypoglycemia Pancreatitis, caution in moderate renal impairment |
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Liraglutide
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Victoza
GLP-1 Agonist 0.6 mg SQ QD x 1 wk, then 1.2 mg SQ QD |
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Pramlintide
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Symlin
Analog of amylin Slows gastric emptying and increases satiety SE --- hypoglycemia, nausea, anorexia BLACK BOX - coadmin w/ insulin |
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Bromocriptine
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Cycloset
Dopamine agonist Works in the CNS to decrease insulin resistance Take w/ food |
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Rapid acting Insulin
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Aspart (Novolog), Glulisine (Apidra), Lispro (Humalog)
Last for a meal Dosed for amount of carbs in a meal or in fixed regimen Clear |
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Regular insulin
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Humulin R, Novolin R
Inject 30 min before meal Onset of action - 30 minutes, lasts 6-10 hours Clear |
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NPH insulin (Intermediate insulin)
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Humulin N, Novolin N
Onset is 1-2 hours, peak of 4-8 hours, duration of 24 hrs Cloudy |
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Long-acting insulin
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Detemir (Levemir), Glargine (Lantus)
Onset 1-2 hrs, duration ~24 hrs DO NOT PEAK Don 't mix w/ other insulins |
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Diabetes drugs that cause hypoglycemia
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Insulin
Sulfonylureas and meglitinides GLP-1 agonist, DPP-4 inhibitor, TZDs, Invokana Pramlintide (Symlin) |
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Symptoms of hypoglycemia
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Dizziness, HA
Anxiety, shakiness Sweating, excessive hunger Confusion, clumsy or jerky movements Tremors, palpitations, blurred vision |
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Diabetic ketoacidosis (DKA)
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Occurs when there is not enough insulin and the body breaks down fat to make energy
May be initial presentation of Type 1 DM or the result of patient stopping insulin therapy |
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DKA Symptoms
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Hyperglycemia
Polyuria, polyphagia, polydipsia Blurred vision Metabolic acidosis (fruity breath, dyspnea) Dehydration |
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DKA Lab Values
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Glucose > 300
Ketones (+) in urine and blood pH < 7.2 Bicarb < 15 WBC 15-40 |
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DKA Treatment
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IV fluids, electrolytes
Insulin |
