Glucose Control - Important Points

Question 1

Which class(es) of med stimulate insulin release from pancreatic Beta cells?

Answer 1

1. Sulfonylureas (“-amides) & Glipizide, Glyburide, etc
2. Meglitinides (“-glinides”)
3. DPP-4 inhibitors (“-gliptins”) + limit glucagon secretion; slows gastric emptying; promotes satiety
4. Incretin Mimetic - Amilyn + slow gastric emptying; increase beta cell growth

Question 2

How do Alpha Glucosidease inhibitors work? What are they (2)?

Answer 2

• Acarbose & Migitol

- decrease enzyme that breaks down complex carbs = < glucose in blood stream

Question 3

How do Meglitinides work? What are they (2)?

Answer 3

• “- glinides” - Repaglinide & Nateglinide
• increase insulin secretion from islet cells (like sulfonylureas)
• faster onset, shorter DOA, ONLY active in presence of glucose = decr. R/o hypoglycemia

Question 4

What is the negative effect of Meglitinides that decreases its use?

Answer 4

Weight gain

Question 5

Thiazolidinediones (TZD) - what are they? How do they work?

Answer 5

• (“- glitazone”) - Rosiglitazone & Pioglitazone
• all day basal med
• decreased insulin resistance & decrease hepatic glucose output

Question 6

Which class of med has many extreme side effects which limits its use?

Answer 6

Thiazolidinediones

- MI & CV death; CHF; bone fracture; edema; hepatotoxicity

Question 7

DPP-4 inhibitors - what are they? How do they work?

Answer 7

• “- gliptins” - stitagliptin; saxogliptin; lingagliptin; alogliptin
  1. Increase insulin secretion
  2. Limit glucagon secretion
  3. Slows gastric emptying
  4. Promotes satiety

Question 8

SLGT2 inhibitors - what are they? What do they do?

Answer 8

• “-gliflozins” - canagliflozin; dapagliflozin; empagliflozin
• “sodium glucose transporter type 2”
• increase urinary excretion of glucose (Na+-glucose transport mechanism in kidney)

Question 9

What is the main contraindication of SLGT2 Inhibitors?

Answer 9

Renal dysfunction

1. CrCl < 30
2. ESRD
3. HD

Question 10

What 2 groups of incretin mimetics are there? How do they work?

Answer 10

1. GLP-1 analogs (exanitide & liraglutide - “-tide”) - prolong gastric emptying & decr. Glucagon secretion
2. Amylin Analogs (Pramilinide) - protein of gilamonster spit - increase insulin secretion, slows gastric emptying, increase beta cell growth, gastroparesis

Incretin mimetics = “ide”

Question 11

Which med has a black box warning for hypoglycemia?

Answer 11

Incretin mimetic - Amilyn analog - Pramilinide

Question 12

What are Biguianides? How do they work?

Answer 12

• Glucophage (Metformin)
  1. Decrease hepatic glucose production
  2. Decrease glucose absorption in intestines
  3. Increase insulin sensitivity

Question 13

Which is the #1 med for type II DM on market?

Answer 13

Biguanides - (Glucophage) Metformin

Question 14

What do pts on Glucophage run r/o during surgery? What can be done to prevent this (2)?

Answer 14

• r/o lactic acidosis

- d/c med 48 prior to sx & avoid dehydration

Question 15

When should Glucophage NOT be restarted after sx?

Answer 15

If GFR < 30; restart whenever if GFR > 45

Question 16

Which class of meds has a new increase r/o toe amputation?

Answer 16

SLGT2 inhibitors (“-gliflozin”)

Question 17

What are “-amides”

Answer 17

Sulfonylureas first gen.

Question 18

What are “gl-…”

Answer 18

Sulfoylureas second gen

Question 19

What are acarbose & miglitol?

Answer 19

Alpha glucose inhibitors

Question 20

What are “-glinides”

Answer 20

Metglitinides

Question 21

What are “- glitazones”

Answer 21

Thiazolidinediones

Question 22

What are “-gliptins”

Answer 22

DPP-4 inhibitors

Question 23

What are “-gliflozins”

Answer 23

SLGT 2 inhibitors - “flo” = pee

Question 24

What are “-glutides”

Answer 24

Incretin mimetic - GLP-1 analogs

Question 25

What group is Amilyn in?

Answer 25

Incretin mimetic

Question 26

What class is metformin in?

Answer 26

Biguanides