Diabetes - Therapeutics

Front 1

Goal A1C

Back 1

<7% or <6.5%

Front 2

Goal FPG

Back 2

70-130 or <110

Front 3

2-hr Post Prandial Glucose

Back 3

<180 or <140

Front 4

Microalbuminuria

Back 4

30-299 mg/dl

Front 5

Macroalbuminuria

Back 5

300+

Front 6

Total Cholesterol

Back 6

<200

Front 7

Triglycerides

Back 7

<150

Front 8

LDL

Back 8

<100 or <70

Front 9

HDL

Back 9

>45

Front 10

Blood Pressure

Back 10

<130/80

Front 11

Step 1 (Tier 1)

Back 11

Lifestyle Modification
+
Metformin

Hint 11

Reduces A1C by 2-4%

Front 12

Step 2 (Tier 1)

Back 12

Addition of:
Basal insulin
OR
Sulfonylurea (glip, glim, gly)

Hint 12

Reduces A1c by 2.5-5.5%

Front 13

Step 3 (Tier 1)

Back 13

Addition of:
Intensive insulin

Front 14

Metformin
---
Glucophage

Back 14

↑ peripheral glucose uptake (sensitizer)
↓ hepatic glucose production

Hint 14

Biguanide
↓ 1-2% A1C

Front 15

Pioglitazone
---
Actos

Back 15

↑ uptake of glucose (sensitizer)
↓ hepatic glucose production

Hint 15

Thiazolidinedione (Glitazone)
↓ 0.5-1.4% A1C

Front 16

Rosiglitazone
---
Avandia

Back 16

↑ uptake of glucose (sensitizer)
↓ hepatic glucose production

Hint 16

Thiazolidinedione (Glitazone)
↓ 0.5-1.4% A1C

Front 17

Nateglinide
---
Starlix

Back 17

↑ insulin secretion (rapid/short) in presence of glucose

Hint 17

Meglitinide
↓ 0.5-1.5% A1C

Front 18

Rapaglinide
---
Prandin

Back 18

↑ insulin secretion (rapid/short) in presence of glucose

Hint 18

Meglitinide
↓ 0.5-1.5% A1C

Front 19

Exenatide
---
Byetta

Back 19

↑ glucose-dependent insulin secretion
↓ food intake (wt loss)
↓ glucagon secretion

Hint 19

GLP-1 Analog (Incretin Mimetic)
↓ 0.5-1% A1C

Front 20

Liraglutide
---
Victoza

Back 20

↑ glucose-dependent insulin secretion
↓ food intake (wt loss)
↓ glucagon secretion

Hint 20

GLP-1 Analog (Incretin Mimetic)
↓ 1-1.5% A1C

Front 21

Glyburide
---
Diabeta

Back 21

↑ insulin secretion
+
other effects

Hint 21

Sulfonylurea
↓ 1-2% A1C

Front 22

Glipizide
---
Glucotrol

Back 22

↑ insulin secretion
+
other effects

Hint 22

Sulfonylurea
↓ 1-2% A1C

Front 23

Glimperide
---
Amaryl

Back 23

↑ insulin secretion
+
other effects

Hint 23

Sulfonylurea
↓ 1-2% A1C

Front 24

Saxagliptin
---
Onglyza

Back 24

↑ incretin secretion

Hint 24

DPP-4 inhibitors
↓ 0.5-0.9% A1C

Front 25

Sitagliptin
---
Januvia

Back 25

↑ incretin secretion

Hint 25

DPP-4 inhibitors
↓ 0.5-0.9% A1C

Front 26

Vildagliptin
---
Galvus

Back 26

↑ incretin secretion

Hint 26

DPP-4 inhibitors
↓ 0.5-0.9% A1C

Front 27

Acarbose
---
Precose

Back 27

Block the enzymes that digest starch in the small intestines

Hint 27

α-glucosidase inhibitor
↓ 0.5-0.8% A1C

Front 28

Voglibose
---
Voglib

Back 28

Block the enzymes that digest starch in the small intestines

Hint 28

α-glucosidase inhibitor
↓ 0.5-0.8% A1C

Front 29

Pramlintide
---
Symlin

Back 29

↓ glucagon secretion PP
↓ hepatic glucose production
↓ gastric emptying

Hint 29

Amylin Analog (Amylin Mimetic)
↓ 0.5-1% A1C

Front 30

DKA

Diabetic Ketoacidosis

Back 30

Hyperglycemia
Ketosis
Acidosis

Hint 30

Intensive fluids, immediate insulin, potassium replacement, treatment of underlying disease state

Front 31

HHS

Hyperosmolar Hypergylcemic State

Back 31

severe hyperglycemia
dehydration
serum osmolarity
Normal anion gap
Presence of insulin!

Hint 31

Fluid replacement, treat DM with PO agents or insulin

Front 32

HYPOglycemia

Back 32

<50-60

Cold sweats, faintness, dizziness, HA, tachycardia, nervousness, blurred vision, hunger, personality changes

Hint 32

15 g glucose, wait 15 mins, repeat if necessary

Glucagon injection (if pt unresponsive)

Front 33

Macrovascular Complications

Back 33

IDH/CAD
CVD
PVD

Hint 33

Achieve A1C <7 or <6.5,
Lipid goals,
BP,
ASA (if M50+/F60+ w. 1+ risk factor)
Quit Smoking

Front 34

MICROvascular complications

Back 34

Retinopathy
Nephropathy
Neuropathy

Hint 34

A1C control, BP control, ACEI in T1/2D with microalbuminuria, ACEI/ARB in T2D with macroalbuminuria