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12 Cards in this Set
- Front
- Back
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T1DM Bolus Therapy |
Rapid-acting w meals, promote glu utilization/uptake post-meals, control post-prandial levels. 1) Rapid Analogues (dispart, lispro, glulisine) --> 10-15min onset, 1-2hr peak, short duration 2) Short acting (Humilin R, novolin Toronto) --> 30 min onset, 2-3hr peak, 6-7hr duration. LONGER than rapid. |
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T1DM Basal Therapy |
Long-acting at night, prevent hepatic glu production w fasting, control fasting glu levels. 1) Intermediate (Humulin/novolin NPH) --> 1-3hr onset, 5-8hr peak, 10-18hr duration; proteinacious, cloudy, variable dosing, unreliable. 2) Long-acting analogues (detemir, U100/300 glargine) --> 90min onset, 6-8hr peak, 24hr duration; ++$ |
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Metformin |
Safe, cheap, effective. WL. Combo with insulin. GI SFX. INSULIN SENSITIZER. NO HYPOGLYCEMIA. Biguanide (phenformin has ++SFX). Mediated by AMP kinase. 1.5-5hr half life. Careful with CKD/hypoxia/hepatic failure dt excreted unchanged by kidney so w no O2 --> lactate --> problems. Reduce hepatic glu production, increase intestinal absorption, increase peripheral uptake. Targets liver and skeletal muscle. |
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Secretagogues |
Sulphonylureas and meglitinides. Stimulate insulin secretion in pancreas by blocking K+ channel. Safe-ish, cheap, effective, combo with insulin, HYPOGLYCEMIA, weight gain, less durable glu reduction. 1) Glyburide (hypoglycemia) 2) Gliclazide (best) 3) Glimepiride 4) Repaglinide (meals) |
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a-glucosidase inhibitors (ACARBOSE) |
Slows digestion of oligosaccharides to monosaccharides (starch digestion), converts high to low glycemic index, slows delivery of glu to circulation. Prevent post-prandial hyperglycemia. Reduce CV. Safe, NO HYPOGLYCEMIA, modest reduction in A1c, poorly tolerated (++gas dt acting on intestines in anaerobic enviro). |
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TZD |
INSULIN SENSITIZER (decrease resistance), NO HYPOGLYCEMIA, DON'T COMBINE W INSULIN. Decrease BP, ++$, effective, weight gain. Fluid retention --> CHF, edema, dilutional anemia, fractures. Alters metabolism in adipose tissue. |
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INCRETINS (GLP-1R agonist) |
Increase glu-dependent insulin secretion (b-cells), decrease post-prandial glucagon secretion (a-cells) --> decrease hepatic glu output (liver), regulate gastric emptying, WL. Analogue resistant to DPP4 (usually breaks down GLP-1 hormone). Promotes satiety and decreases appetite (hypothalamus). Injected. |
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DPP4 inhibitors |
Decrease breakdown of endogenous GLP-1 and GIP. Prolong action of GLP-1R agonists. Increase insulin, decrease glucagon. NO WL. Tablet. (Less intense than GLP-1R). |
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SGLT2 inhibitors |
Decrease glu by blocking Na-glu transporter in kidney --> glucose excretion in urine. Decrease A1c, rare hypoglycemia, WL, UTI, genital infections ,hyperlipidemia, decrease BP, increase LDL. Need functional kidneys. Decrease glu reabsorption in proximal tubule --> glu loss --> osmotic diuresis and caloric loss. Reduce CV mortality. |
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T2DM Basal 1x/d |
When? +OHA max dosing, +high HbA1c, +Fasting hyperglycemia. 10u (or 0.1u/kg/day) 1x/day. Monitor/increase until ideal. Don't increase if nocturnal hypoglycemia or if >2 lows/wk. Reduce if fasting is <5.5. |
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T2DM Pre-mixed insulin 2x/d |
Either use Regular/NPH mix or rapid analogue mix. 2x/day, can mix and match. |
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T2DM mealtime insulin |
Choose a meal and start with 4 units. Check BG before next meal and modify by 1 unit until pre-meal is bw 4-7mmol/L. |
