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9 Cards in this Set
- Front
- Back
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DM II Progressive Care Approach (4 steps)
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Step 1: nutrion, exercise, lifestyle
Step 2: oral agents (mono & early combo) Step 3: Add basal insulin Step 4: Intensify insulin |
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Thiazolidinediones (TZDs)
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Rosiglitazone, Pioglitazone
*put on your glita to go to the PPARty Insulin sensitizers making more favorable fat cells & raising adiponectin levels, shifts toward subcut fat from visceral fat AE: Fluid retention (no CHF), Weight gain (largest complaint) |
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Metformin
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biguanide drug
MOA: activates AMP kinase to alter glucose and lipid metabolism --> decr hepatic glucose, enhances insulin sensitivity (not as robust as TZDs) AE: renal insufficiency --> lactic acidosis |
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α-glucosidase inhibitors
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Acarbose, Miglitol
MOA: delay post-prandial glucose in blood modest decrease in HbA1c AE: flatulence, diarrhea, n/v |
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Secretagogues
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MOA: increase insulin secretion by binding to K-ATP channel in β-cells
Sulfonylureas (long acting) Meglitinides (Short acting) Do not improve insulin resistance Glimepride - reduces hypoG episodes, limits weight gain, no dose adjust for renal pts AE: hypoG risk, weight gain, loss of β-cell responsiveness in 30% of pts |
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GLP-1 Agonist
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Exenatide
Gila monster saliva (obviously) binds GLP-1 receptors but resistant to DPP-4 degradation Subcutaneous injection MOA: stimulates insulin secretion, inhibits glucagon secretion, slows gastric emptying AE: n/v, weight loss |
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DPP-4 Inhibitor
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Sitagliptin
MOA: Increase GLP-1 and GIP levels stimulates insulin secretion, inhibits glucagon secretion, slows gastric emptying AE: netural effect on body weight |
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Amylin Analog therapy
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Pramlintide
MOA: inhibits glucagon secretion from α-cells, reduces hepatic glucose production, slows gastric emptying, post-prandial glucose control |
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Algorithm for glucose control
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continue until HbA1c<7%
Lifestyle intervention ->metformin PO -->other drugs one by one* --->continue to increase doses ---->add intensive insulin other drugs: *basal insulin SC (most effective) *sulfonylureas PO (least expensive) *glitazone SC (no hypoglycemia) |
