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77 Cards in this Set
- Front
- Back
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DM is the leading cause of blindness in...
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20-74 yo
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what is resposible for 75% of deaths in ppl with DM?
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cardiac event
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risk fators for developing diabetes?
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fam hx, obesity (BMI >27), physical inactivity, race, ethnicity, HTN (>140/90), TG (>250), HDL <35, hx of gestational dm, polycystic ovary dz
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LADA
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latent onset autoimmune diabetes in adults.
happens in 15-20% of ppl with type 2. initially do not require insulin, not overweight, no metabolic syndrome, decreased glucose absorption and production, pt not usually insulin resistant |
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metabolic syndrome
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HTN >130/85, TG >150, waist size >35f, >40m, FBS >110, HDL <40m, <50w
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poor dm managment can lead to?
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nephropathy, retinopathy, neuropathy
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drugs that can cause hyperglycemia?
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b blocker, diuretics, glucocorticoids, oral cotraceptives, phenytoin
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drugs that cause hypoglycemia?
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ethanol, pentamine, insulin, sulfonylurea
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types of insulin
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fast acting/short: lispro, aspart, glulisine, regular
intermediate; NPH long: Glargine, determir |
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Humulin, humalog, novolog?
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humulin: lipro protamine and lispro
humalog: NPH and regular novolog: aspart protamine and aspart |
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How do the long acting insulins work?
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glargine: forms a precipatate in subcutaneous tissue which slowly dissolves
determir: binds to albumin |
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when does each insulin start working and peak?
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fast acting onset: 15 min or fewer, peaks: 1-2 hrs
regular onset: 30-60 min, peaks: 2-4 hrs NPH onset: 1-2 hrs, Peak: 6-14 hrs long acting: onset: 1-2 hrs no peak |
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Insulin dosing?
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0.5-0.6 for type 1
0.5 - 2.5 for type II |
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how many carbs can 1 g of insulin take care of?
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Type 1 10-15
type II 5 |
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most common regimen?
what was the standard of care? |
3 regular (rapid acting becoming more prevelant), 1 determir
2 NPH, 2 fast acting/regular |
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common injectio site for insulin?
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abdomen, upper arm, thigh, buttock.
abdomen and upper arm get best absorption rotate sites in a linear fashion 1 inch apart |
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can you mix fast acting and intermediate acting insulins?
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yes
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syringe size for 30 units, 50, 50-100, >100?
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3/10, 1/2, 1, 2 (mL)
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glycemic goals for dm?
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before meals: 80-120
post prandial 120-180 before bed 100-140 |
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factors that effect absorption of insulin?
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not rolling insulin, exercise, lipohypertrophy
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how long is insulin good for?
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until exp date if unopened and refrigerated, 28 days once open
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if my daily dose of insulin is 46 units how far will that lower my BS?
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1700/46 = 36.9 points
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oral agents for Type 2 dm?
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sulfonylureas, short acting secretegogues, biguaides, alpha glucosidase inhibitors, thiazolidinediones, DPP4 inhibitors, incretin mimetics, amylin mimetic
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how do sulfonylureas work?
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stimulate pancreas B cells to release insulin
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types of sulfonylureas?
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1st gen: chlorpropramide, tolazamide (not used clinically)
2nd gen: glimepride (renal/hepatic issue), glipizide, gluburide |
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how far do sulfonylureas low ha1c?
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1.5-2%
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Adverse effects of sulfonylureas:
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teratogenic, hypoglycemia, weight gain, hyponatremia, skin rash, GI discomfort
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Drug interaction of 1st gen?
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alcohol = disulfiram rxn
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Sulfonylurea drug interactions?
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increase hypoglycemic effect: nsaids, sulfonamides, alcohol, ranitidine, cimetidine
decrease hypoglycemic effect: steroids, diuretics, thyroid hormone |
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types of short acting secretagogues (meglitinides)
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prandin, starlix
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MOA of meglitinides
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stimulate insulin release from pancreas
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how far does meglitinides low ha1c?
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0.8%
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meglitinides are dose dependent on?
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glucose
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why are they better than sulfonylureas?
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the produce more of a physiological insulin effect
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how the metabolized?
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cyp 450
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types of bigaunides?
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metformin
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MOA of metformin?
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decreases hepatic glucose production and increases utilization in the muscle.
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how far does it lower ha1c?
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1.5-2%
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benefits of metformin?
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doesn't cause hypoglycemia, no weight gain, lower ldl chol, lower MI risk, improves ovary function in insulin resistant women w/ polycystic
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what is metformin usually combined with?
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sulfonylurea
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adverse effects of metformin?
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N/V/diarrhea, decreases absorption of b12 and folic acid
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increases the concenration of metformin?
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cimetidine, digoxin, quinidine, procainamide
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Pt who should not recieve metformin?
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renal insufficiency, liver dz, shock, excess alcohol, dehydration, metabolic acidosis
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when should you hold metfomin for 48 hrs?
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when using contrast dye
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what does metformin inhibit?
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oxidation of lactic acid. happen in ppl with renal failure and who are hemodynamically compromised (hypoxia, dehydration)
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how should you monitor metformin?
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yrly LFTs and creatinine levels
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types of alpha glucosidase inhibitors
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acarbase, miglitol
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MOA of AGi?
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delay absorption of carbs, typically weak agents
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how far do AGi's lower ha1c?
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.3-1%
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benefit of AGi are?
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doesn't cause hypoglycemia and can be combined with insulin and sulfonylureas.
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adverse effects of AGi?
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cramps, abdominal distention, flatulence, diarrhea (all from unabsrobed carbs that are fermented by bacteria)
decrease iron absorption |
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types of glitazones?
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troglitazone (withdrawn), rosiglitazone (restricted), pioglitazone
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MOA of glitazones?
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improve insulin sensitivity. they require that insulin secretion is functioning
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down side to glitazones?
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they take 2-3 months to take effect
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benefits?
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improves endothelial function, dyslipidemia, BP, microalbuminuria, decreases fat distribution, and c reactive protein function, increases HDL, decreases tg
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adverse effects of glitazones?
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edema/weight gain, increases LDL, liver toxicity
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how far does glitazones lower ha1c
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1.5%
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what is needed before you start glitazones?
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baseline ALT/AST and the retest every 2 months. stop if 3x norm, don't start if 2.5 x norm
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s/s that indicate to stop glitazones?
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liver injury, N/V, ab pain, fatigue, anorexia, jaundice, dark urine
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types of incretin hormones?
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exanatide (long acting), sitagliptin
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MOA of incretin (GLP-1)?
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enhance glucose stimulation of insulin, suppress glucagon, decrease gastric emptying, maintain postprandial glucose homeostasis, self regulate glucose control, increase insulin in presence of glucose, control satiety and reduce weight
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Januvia?
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DDP IV breaks down GLP-1, this is a DDP IV inhibitor.
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symlin(pramlinitide)
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amylin like substance that is used if BG control is poor with insulin
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Benefits of symlin?
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slows gastric emptying, decreases postprandial glucose conc, regulates apetite
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adverse effects?
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nausea, hypoglycemia
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problems with starting insulin too soon before a meal?
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hypoglycemia, weight gain, hyperinsulinemia
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problems with starting it to late?
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not sufficient glycemic control
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meds to use to lower fasting blood glucose?
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metformin, glitazones, sulfonylurea, basal insulin, meglitinides (replaginide)
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meds to lower post prandial blood glucose?
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incretin mimetics, meglitinides (nateglinide), prandial insulin, AGi
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meds that work in pancreas?
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sulfonylurea, meglitinides,
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meds that work in the gut?
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AGi, incretin hormones, symlin,
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meds that work in the muscles?
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glitazones, bigaunides
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how should you tx severe hypoglycemia?
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glucagon (SE N/V)
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Dawn phenomenon?
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increase in BG early in the morning. caused by an increase in counter-reg hormones. Depends on stress, illness, menses
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Somogyi effect:
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rebound hyperglycemia after hypoglycemia. 2-3 am dx
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Initial therapy for DM II?
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metformin
combo with metformin sulfonylurea or insulin TZD if none of the above are working Meglitinides incretin therapy last resort |
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what oral medication can be used in type I and type II?
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symlin
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