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30 Cards in this Set
- Front
- Back
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Diagnosing DM. A1C and BS
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A1C: normal 5, Pre-5.7-6.4, Diabetes >6.5
Fasting BS: Normal <100, Pre 100-125, Diabetes >125 Random: Normal <139, Pre 140-199, diabetes >199 |
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MOA sulfonylurea
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Stimulate insulin release
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Meglitinides MOA
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Prandin, starlix
Stimulate the release of insuline May cause wt. gain Helpful in post prandial control given before meals. Less hypoglycemia |
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Thiazolidinediones MOA
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Actos
Reduced insulin resistance and increase sensitivity in skeletal muscle Higher dose may decrease hepatic glucose production May cause peripheral edema |
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Biguanide
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Metformin
Inhibit hepatic glucose production and improves peripheral sensitivity to insulin Gluconeogenesis and glycogenolysis are inhibited NOT associated with hypoglycemia |
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Metformin A/E
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GI side effects.
contraindicated in: HF< RF< LF and advanced age |
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Alpha Glucose inhibitors
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Acarbose/Precose
Miglitol/glyset Blocks the breakdown of starches and certain sugars. |
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Alpha Glucose inhibitors
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Acarbose/Precose
GI gas, abd pain, diarrhea |
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Incretin
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Released when body senses hyperglycemia.
Simulates pancreatic alpha and beta cells to release insulin and to cease glucose production |
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Incretin mimetics
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Byetta
May have wt. loss Adjuvant therapy for pts failing metformin or combo NOT approved with insulin or TZDs |
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Amylinomimetics
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Pramlitide
May have wt. loss Post prandial glucose control. May delay gastric emptying |
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Sitagliptin(Januvia)
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DPP-4 inhibitor
Slows inactivation of incretin hormones Causes increased insulin release and decreased glucagon levels |
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Indications for Januvia
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Type II DM in combination with metformin or glitazones
Do NOT use in type I or DKA Dose adjustment for low renal function |
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DPP-4 inhibitor MOA
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Block DPP-4 which inactivates GLP-1.
GLP-1 along with incretin stimulates insulin release and inhibits glucagon release |
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Insulin: basal
Short Intermediate |
Levemir(detemir), Lantus (glargine)
Humalog(aspart, Novolog(lispro) human regular (humulin and novolin) Human NPH |
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Humalog, novolog, apidra onset, peak and duration
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15min
1-2 hours 4-6 hours |
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Human regular onset, peak and duration
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30-60min
2-4 hours 6-8 hours |
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Human NPH onset, peak and duration
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2-4 hours
4-10 hours 12-20 hours |
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levemir and lantus onset, peak and duration
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1-2 hours
flat 24 hours |
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What is the first line choice for monotherapy if a1c <7.5
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Meformin
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What should you consider as adjunc therapy for PPG and FPG elevations
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DPP4 (januvia) or
GLP-1 |
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For a1c 7.5-9, what therapy
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Dual with caution
Met+glp-1/dpp4 or TZD |
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For a1c >9, what therapy
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Drug naive: with symptoms us insulin + other agents
No symptoms-met +glp-1 or dpp4+SU Met+TZD+-SU Met+glp-1 or ddp-4+tzd |
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What is actos (thiazolidinediones) associated with?
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Edema and CHF
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Basal insulin requirements
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50% of daily requirements
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Prandial insulin
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50% of daily insulin
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Prandial insulins
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Lispro-humalog
Aspart-novolog Glulisine-apidra |
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Should you use glitazones in CHF patients
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NO
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Adjusting insulin therapy
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If >2 BSBG are <80 decrease by 20%
If>2bsbg are >180 increase by 10-20% |
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Transition from IV to SC insulin
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Continue IV at least 2 hours after first SC. longer if basal
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