Current Issues in Diabetes Management Flashcards
(25 cards)
Metformin
- Use in Type 1 Diabetes
- Reduces insulin requirement
- Reduces/Maintains weight
- Reduces A1c if started at diagnosis (Mixed effects otherwise)
AE: GI side effects
Metformin
- When to use
Can help lower insulin use and decrease weight gain in overweight patients
Can help lower insulin use and help with weight in pediatrics
- Stronger efficacy in reducing A1c in younger patients
SGLT2i
- Use in Type 1 Diabetes
- Weight loss
- Better glycemic control
- Reduction of insulin dose
AE: Diabetic Ketoacidosis
- Ensure to select patient carefully to assess risk factors and provide monitoring techniques
SGLT2i
- Diabetic Ketoacidosis Symptoms
High blood sugar
Thirst
Nausea
Vomiting
Abdominal Pain
Confusion
SGLT2i
- Who is affected by Diabetic Ketoacidosis
More common in Type 1
Can occur even in euglycemic patients
SGLT2i
- Limiting Factor
Risk of DKA is the reason why SGLT2i have not been approved for Type 1 diabetes
- Is not the primary cause, just exacerbates other conditions/patient factors
GLP-1 Receptor Agonists
- Use in Type 1 Diabetes
- Reduce insulin need
- Improve glycemic control
- Reduces weight
- Variable effectiveness in patients
AE:
- Diabetic Ketoacidosis (Less than SGLT2i)
- Nausea
- Hypoglycemia (When used with insulin)
GLP-1 Receptor Agonists
- When to use
Most effective with overweight patients with detectable C-peptide levels
- Early initiation produces great results and can even eliminate insulin dependency later
Low Carbohydrate Diet
- Effects of nutrition therapy
Switching to low glycemic index carbohydrates
- Can reduce A1c by 1.0 - 2.0%
Low Carbohydrate Diet
- Calorie Intake
For people that are obese or overweight
- Reduce calorie intake to maintain healthier body to reach treatment goal
Low Carbohydrate Diet
- Consistiency
Spacing meal consumption and carbohydrate intake can help control blood glucose and weight
Low Carbohydrate Diet
- Registered Dietician
People with diabetes should get nutrition counseling
Low Carbohydrate Diet
- Patient decision
In the end patient should decide the dietary plan best suited to them
Low Carbohydrate Diet
- Recommendations
Less than 45% of daily energy from carbs
Low Carbohydrate Diet effect on Diabetes Management
Increased risk of Hypoglycemia if used with Insulin, sulfonylyrea, megltinides
- Have to decrease dose
Increased risk of DKA if used with SGLT2i
- Usually stop in community setting
Need to weight benefits and risks:
- Metformin, GLP1ra, DPP4i, acarbose
Need constant blood glucose monitoring
Deprescribing
- Indications
Risk of hypoglycemia
Risk of other antihyperglycemic adverse effects
Renal clearance decreases
Harm is more likely than benefit
- Frail, dementia, limited life expectancy
Deprescribing
- Medications with risk of hypoglycemia
Insulin (NPH and Regular have highest risk)
Sulfonylurea (Glyburide has highest risk, gliclazide has lower risk)
Meglitinides (Low risk)
Deprescribing
- Medications that are renally cleared
Metformin
Sulfonylurea
Insulin
Deprescribing
- Medications with other potential adverse effects
SGLT2i can cause DKA
Drug-Disease Interactions
- Cancer
- Metformin: Lower risk
- Insulin: Long acting analogue has risk
- Pioglitazone: Bladder cancer
Drug-Disease Interactions
- Drugs that cause diabetes
- Atypical Antipsychotics
- Antidepressants
Drug-Disease Interactions
- Drugs that increase blood glucose
Beta Adrenergic Agonists (Decongestants)
Glucocorticoids (Prednisone)
Protease Inhibitors (Ritonavir)
Calcineurin Inhibitors (Cyclosporine)
Thiazide Diuretics ()
Drug-Disease Interactions
- Beta Blockers
Medication Induced Hyperglycemia
- Blocking of epinephrine prevents release of insulin
Can exacerbate hypoglycemia
- Inhibits hepatic glucose production
- Masks symptoms of hypoglycemia (tremors, palpitations, tachycardia)
- Patient will still sweat
Emerging Treatments for Type 2 Diabetes
Tirzepatide
- Both GLP1ra and GIP
Insulin Icodec
- Once weekly insulin formulation, similar efficacy to daily insulin
Generic DPP4i and SGLT2i
Biosimilar Insulin
