Pharm2 1 T2DM Agents pt1 Flashcards
(37 cards)
What is LADA? & its pathophysiology?
Type 1.5: latent autoimmune diabetes of adulthood
Beta cell function and insulin resistance(LADA)
prototypical patient is 25-30 year old and is thin.
What’s the prototypical patient/frequent mistake made? with LADA?
It’s often dx as T2DM based on their age and not on their symptoms.
Which type of DM?: autoimmune, presents at a young age. 6 months-11 year old. They present with weight loss, polyuria, polydipsia, they get an altered mental status
Type 1
DKA is the severe result of uncontrolled
Type 1 DM
Which type of DM?: obese (central adiposity), polyuria, polydipsia, vision changes, multiple fungal infections, hypertension, dyslipidemia especially hypertrygliceridemia.
Type 2 DM
With Gestational Diabetes: women gain lots of weight during pregnancy, develop diabetes, and have ___ birth weight babies.
large birth weight babies
mom had gest dm, but always controlled it
How does insulin work?
Insulin is a co-mediator of the Na-K pump to drag glucose across the membrane so it can be utilized. Otherwise glucose sits in serum where it can’t do anything of use.
How long does a typical Diabetic patient actually have diabetes before they manifest symptoms?
~10 years
Diff btwn DM and Prediabetes
Fasting glucose >126 = Diabetes. 2 separate reading on 2 separate days
Fasting glucose btwn 106-126: Prediabetes.
Why is the Oral glucose tolerance test done less often than Fasting glucose or HbA1C?
What’s an upside of doing this test though?
bc it’s time consuming, despite being more sensitive.
HbA1C is a ____ hemoglobin.
What does it really measure?
glycosylated hemoglobin
Glucose in bloodstream over 3 months. The higher your blood sugar levels, the more hemoglobin you’ll have with sugar attached (mayoclinic).
HbA1C > __: Diabetes
HbA1C > __: Prediabetes
DM: >6.5
PreDM: 5.7-6.4
How to dx DM with Random Glucose test
> 200 + DM symptoms
PreDM, from a physiologic standpoint:
they lose some of the ability to drag the sugar across membranes after they eat – higher postprandial glucose levels.
T2DM Oral Medications
Seven classes of oral agents, one SQ class, all FDA-approved for T2DM:
Biguanides PO Thiazolidinediones (TZDs) PO Sulfonylureas PO (SUs) DPP-4 inhibitors PO Meglitinides PO (rarely, if ever, used) Incretin-mimetics SQ SGLT-2s: (brand new class of drugs)
2 classes of Insulin sensitizers & their Route of Admin.
How do they work? (don’t over-think this)
Biguanides PO
Thiazolidinediones (TZDs) PO
make individual cells more sensitive to insulin…
4 classes of Insulin secreatogues & their route of admin
How do they work?
Sulfonylureas PO (SUs)
DPP-4 inhibitors PO
Meglitinides PO (rarely, if ever, used)
Incretin-mimetics SQ
squeezes insulin out of your pancreas
__: the oldest class of diabetic medication, since the 1950’s.
Sulfonylureas
Both guidelines discussed in class say start with ___ unless it is CI
Metformin
Metformin’s dual mechanism of action
sensitizes the body to insulin. Reduces Glucagon from causing gluconeogenesis in the liver.
the most commonly prescribed and first-line therapy for type 2 diabetes
Biguanides (Metformin)
Metformin takes how long to have its full effect?
Work slowly (~ 4 weeks) – full effect
Can Biguanides may cause hypoglycemia. Why?
No (almost), Can aide in weight loss, lower cholesterol
B/c it does not promote insulin secretion. Hypoglycemia may only occur if caloric intake is not adequate or exercise is not compensated for calorically.
____ is the only currently available biguanide:
Metformin
