Criteria for Dx and Drugs- DM Flashcards by Kim Grace

FPG ≥ ____________ (7.0) mg/dL (7.0 mmol/L)

126

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2-h PG ≥ _________ (11.1) mg/dL; using a glucose load containing _______g anhydrous glucose dissolved in water

200; 75

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A1C ≥ ________% (________ mmol/mol)

6.5%; 48

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In a patient with classic symptoms of hyperglycemia or
hyperglycemic crisis, a random plasma glucose ≥ _________ mg/dL (11.1 mmol/L).

200 mg/dl

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3 month average of the glucose level

A1C

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n the absence of unequivocal hyperglycemia,
diagnosis requires ____________ abnormal test results from the
same sample or in _______ separate test samples

two; two

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High-risk ethnicity

○ African Americans
○ Latino
○ Native Americans
○ Asian Americans
○ Pacific Islander

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Women who delivered a baby weighing __________ can be considered asymptomatic

≥ 9 lbs.

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Asymptomatic px:
Hypertension: __________ mmHg
HDL Level: __________mg/dL
TG level: ___________ mg/dL
Women with ________

≥140/90 mmgHg
<35 mg/dL
>250 mg/dL
PCOS

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Lipid levels + Inflammatory molecules =

atherosclerosis

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It could lead to Cataract and Glaucoma

RETINOPATHY

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It could lead to Diabetic Foot

NEUROPATHY

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Patients not meeting goals generally should be seen at
least every _________ months as long as progress is being
made

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Drug of choice for T1

INSULIN

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Insulin may be used in combination with

Amylin

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Insulin stimulates ___________ synthesis, increase ________ synthesis and faciliates _________ synthesis and storage by adipocytes

hepatic glycogen, protein, triglycerides

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Insulin inhibits _________

lipolysis

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Stimulates peripheral uptake of glucose

Insulin

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Humalog or Lispro
Novolog or Aspart
Apidra or Glulisine

Rapid-Acting

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Inject 10-15 minutes before mealtime

Rapid-Acting insulin

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Injected at
least 20-30
mins before
mealtime

Short-Acting

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Regular humulin, Actrapid or Novolin, Velosulin

Short acting insulins

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Commonly
used twice
daily. Often
combined with
rapid- or short
acting insulin.

INTERMEDIATE-ACTING INSULIN

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NPH (N) /
Isophane
Lente (L)

INTERMEDIATE-ACTING INSULIN

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Covers insulin needs for 24 hrs. If needed, often combined with rapid or short acting insulin.

LONG-ACTING INSULIN

Ultralente (U) Lantus or Glargine Levemir or Detemir

LONG-ACTING INSULIN

Long acting insulins that do not have any peaks.

Lantus or glargine

Combination of intermediate and short acting insulin. Commonly used twice daily before mealtime.

PRE-MIXED INSULIN

Insulin levels is plateau in px with

Type 1 dm

Pramlintide

Amylin

Enhance post-prandial control in individual with T1DM and T2DM

AMYLIN (Pramlintide)

CI: Gastric motility disorder

AMYLIN (Pramlintide)

AMYLIN (Pramlintide): slows down ____________ decreases ______________ suppresses _________

slows down gastric emptying time decreases post prandial glucagon secretion suppresses appetite

Exenatide, Liraglutide, -glutides

INCRETIN MIMETICS (GLP-1 AGONISTS)

Management of T2DM

INCRETIN MIMETICS (GLP-1 AGONISTS)

CI: Severe GI motility, pancreatitis, renal or hepatic impairment

INCRETIN MIMETICS (GLP-1 AGONISTS)

INCRETIN MIMETICS (GLP-1 AGONISTS): ○ Increase _______________ secretion, ○ Decrease ______________ output ○ Increase _______________ growth and replication ○ Slow gastric emptying time ○ Enhance satiety or feeling of fullness to suppress appetite

○ Increase glucose-dependent insulin secretion, ○ Decrease hepatic glucose output ○ Increase beta cell growth and replication ○ Slow gastric emptying time ○ Enhance satiety or feeling of fullness to suppress appetite

Sitagliptin, Saxagliptin, Linagliptin

DIPEPTIDYL PEPTIDASE IV (DPP IV) INHIBITORS

Patients with T2DM with normal or impaired hepatic and renal function

DIPEPTIDYL PEPTIDASE IV (DPP IV) INHIBITORS

CI: Pancreatitis

DIPEPTIDYL PEPTIDASE IV (DPP IV) INHIBITORS

DIPEPTIDYL PEPTIDASE IV (DPP IV) INHIBITORS: ○ Prevents the ____________ of incretin hormones by the enzyme DPP IV during hyperglycemia ○ Inhibits the _______________ allowing _______ insulin secretion and _______ hepatic glucose production

inactivation; breakdown of GLP-1; increased; decrease

INSULIN SECRETAGOGUES

SULFONYLUREAS

Targets fasting blood glucose level

SULFONYLUREAS

Binds to and inhibits the ATP-sensitive potassium channels to increase the beta cell sensitivity to glucose and stimulate the secretion of insulin

SULFONYLUREAS

T/F: SULFONYLUREAS are protein-bound and are prone to drug-drug interaction

True

SULFONYLUREAS: Associated with thrombocytopenia, agranulocytosis, hemolytic anemia, hyponatremia, SIADH

1ST GENERATION

Tolbutamide, Tolazamide, Chlorpropamide

1ST GENERATION

Glyburide, Glipizide, Glimepiride

2ND GENERATION

Repaglinide

Meglitinide

Nateglinide

Phenylalanine derivatives

Binds to ATP-sensitive potassium channel to stimulate secretion of insulin from **pancreatic Beta cell**, reduces hepatic glucose output

MEGLITINIDE AND PHENYLALANINE DERIVATIVES

T/F: Meglitinide and phenylalaninen derivatives are Used in caution in elderly due to increased risk of fall

True

MEGLITINIDE AND PHENYLALANINE DERIVATIVES are used for

T2DM, postprandial glucose control

Metformin

BIGUANIDES

Used for the glycemic control for management of T1DM and T2DM

BIGUANIDES

Inhibits hepatic glucose output, thus exerting beneficial effects on **fasting** blood glucose level

BIGUANIDES

Promotes glucose uptake by fat and muscles, improving insulin sensitivity

BIGUANIDES

Minor role in decreasing intestinal absorption of glucose

BIGUANIDES

Pioglitazone, Rosiglitazone

THIAZOLIDINEDIONES (TZDs)

Glycemic control in T2DM and primarily affects fasting blood glucose level

THIAZOLIDINEDIONES (TZDs)

Promote glucose uptake by** fat and muscle **and inhibit hepatic glucose output by stimulation of peroxisome proliferator-activated receptor-gamma **(PPAR–gamma)**

THIAZOLIDINEDIONES (TZDs)

ALPHA-GLUCOSIDASE INHIBITORS

Acarbose, Miglitol

Management of **post-prandial** blood glucose

ALPHA-GLUCOSIDASE INHIBITORS

Competitive **inhibition of alpha-glucosidase** in the intestinal brush border, which leads to **slower** absorption of complex carbohydrates

ALPHA-GLUCOSIDASE INHIBITORS

New class of oral hypoglycemic agent

SODIUM-GLUCOSE COTRANSPORTER INHIBITORS

Selectively and reversibly inhibits the sodium-glucose cotransporter which is selectively expressed in the proximal renal tubule

SODIUM-GLUCOSE COTRANSPORTER INHIBITORS

Canagliflozin, Dapagliflozin, and Empagliflozin

SODIUM-GLUCOSE COTRANSPORTER INHIBITORS

**T2** DM + ATHEROSCLEROTIC CARDIOVASCULAR DISEASE (**ASCVD**)

Monotherapy of GLP-1RA or SGL2

For: T2 DM + ATHEROSCLEROTIC CARDIOVASCULAR DISEASE (ASCVD) If: A1C above target

Thiazolidinediones

For: T2 DM + HEART FAILURE

SGL2

For: T2 DM + CHRONIC KIDNEY DISEASE (CKD)

SGL2 or GLP-1

For: T2 DM + CHRONIC KIDNEY DISEASE (CKD) If: A1C above target

SGL2I and GLP-1 RA

Preferred in GLYCEMIC CONTROL

Metformin

Blood glucose less than 13 mmol/L (or less than 230 mg/dL)

continue with current dosage

Blood glucose 13-22 mmol/L (or 230 to 390 mg/dL

patient should increase his insulin by 2 units per injection, even if unable to eat

Blood glucose greater than 22 mmol/L (or 390 mg/dL)

patient should increase his insulin by 4 units per injection, even if unable to eat

Criteria for Dx and Drugs- DM Flashcards

(76 cards)