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50 Cards in this Set

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Describe Type I Diabetes
Insulin dependent
Faulty Beta cells
Affect mostly children
25% of diabetics
Describe Type II Diabetes
defective insulin secretion and insulin resistance or reduced insulin sensitivity
Mostly affects adults
75% of diabetics
Genetic
Name other types of diabetes
Gestational
Drugs and chemicals
Pancreatic disease
Cystic fibrosis
Hyperthyroidism
Cushings syndrome
what are the symptoms of DM?
polyuria
Polydipsia
Polyphagia
Blurred vision
how do you Dx DM?
Random glucose >200 c Sx
Fasting glucose > 126
Glucose Tolerance Test(GTT)- p 2 hr >200
what are risk factors for type II DM?
>45 y/o
BMI > 25-obesity
First degree relative
what is the initial tx of Type II?
Diet- decrease carbs
Exercise
Weight loss
These hypoglycemics act by increasing insulin release from the beta cells in the pancreas and limit glucose production in the liver
Sulfonylureas
what is HbA1c test?
used primarily to identify the mean plasma glucose concentration over 3 months
what are the side effects of sulfonylureas?
HIGH

Hypoglycemia
Increase LFTs
GI
Hematologic-agranulocytosis
an HbA1c of 6 correlates to?
135mg/dl mean plasma glucose; normal is 4-6
In which type of DM are sulfonylureas used with?
with type II because you need the Beta cells to be working so they can be stimulated
what is the normal HbA1c level?
6.5

you want to keep diabetics below 7
you have a pt whom you might think is allergic to sulfa, would you put him on a sulfonylurea?
yes
which sulfonylureas have active metabolites?
First generation:

ACT

Acetohexamide
Chlorpropamide
Tolazamide
what is the recommended startin dose of Glyburide?
2.5mg BID
which sulfonylurea has a duration of 60 hrs
Chlorpropamide
what is the duration for all the sulfonylureas?
12-24 hrs
what are the effects of Metformin?
> insulin sensitivity
< hepatic glucose
< intestinal glucose absorp

< TG
> HDL
Weight loss
what is the dose of Metformin?
500mg PO BID
Max dose is 850mgx3=2500 daily

>2500 can cause lactic acidosis
what are the adverse side effects of metformin?
AND

Anorexia
Nausea
Diarrhea #1 side effect
which drug would be used in combo with metformin?
mostly glyburide
You have a male pt and his SCr is >1.4, should you give Metformin?
No, because of > risk of lactic acidosis

For females is >1.5
Your patient is having a contrast CT done and is on metformin, what do you do?
hold the meformin a day of and the day after the study. In emergent situations give acetylcysteine 600mg PO BID to prevent renal complications
What is the MOA of Alpha-Glucosidase inhibitors?
delays breakdown of sugars to glucose; these need to be taken with meals
Name 2 Alpha-Glucosidase Inhibitors and their dose
Acarbose 25mg with meals
Miglitol 25mg with meals
what are the adverse effects of AGI's(Alpha Glycoside Inhibitors)?
GI symptoms:

Diarrhea
Gas
what are the C.I. of AGI's?
IBS
Chronic ulcers
partial obstructions
which drug has no effect on insulin secretion but increases insulin sensitivity?
Thiazolidinedione (TZD)
Name 2 TZD's
Rosiglitazone
Pioglitazone
what do you worry about with TZDs?
Hepatotoxcicities(get LFTs)
Edema
Anemia
what are the C.I of TZDs
Acute CHF-edema
Severe hepatic impairment
Increase in LFTs
what drug can you give to resume ovulation?
TZD
what are the drug interactions of TZDs?
Birth control pills; reduces estrogen levels
which drug reduces absorption of TZD?
Cholestyramine; it is a drug binder
what is the MOA of Meglitinides?
Stimulates insulin secretion from Beta cells
Name 2 meglitinides
Prandin
Starlix
what is the dosing for prandin?
If no h/o A1c >8, then 0.5mg before meals

If h/o A1c >8, then 1-2mg before meals

Max is 16mg/day
which drugs interact with meglitinides?
Cyp 450 3A4 inducers
Name the rapid insulins
Lispro- humalog
Aspart- novolog
which insulin is the most similar to basal insulin?
Glargine (lantus)
what is the "Dawn effect"?
early-morning increase in glucose — usually between 4 a.m. and 8 a.m
what is the Symogi effect?
the tendency of blood sugar to rise as a result of low blood sugar. Low blood sugar can trigger release of hormones such as glucagon that raise blood sugar
what is the initial dosing of insulin for Type I?
0.5 IU/kg/day
what type of insulin is used with a drip?
Regular
what is the initial dosing of insulin for Type II?
0.7 IU/kg/day
what is Byetta used for?
Type II DM
what is the MOA of Byetta and Symillin?
They're amylin peptides which enhance glucose-dependent insulin secretion
name the inhaled insulin
Exubera
what is a disadvantage of Exubera
We don't know its effects with COPD and pulmonary fibrosis patients. Therefore, pulmonary function tests and peak flow tests must be performed prior to starting this drug.