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Clin Med- P > Type 2 DM > Flashcards

Type 2 DM Flashcards

1
Q

around 1995 there were only ____ classes of drugs besides insulin: _____ and _______. now there are about __ with more on the horizon

A

1995: 2: metformin and sulfonyureas
now: 9

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2
Q

certain companies are now classifying the “cure” for DM as an A1C < ___ for __ years …. however the real cure may be a possibility for the future

A

<6.4 for 2 years

NOT IN NOTES, HADLEY MADE A POINT OF IN LECTURE

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3
Q

Txt: increases in insulin should be by ____ at a time

A

5%

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4
Q

At what age and frequency are average people (no obesity of complications) checked for DM ? and if there are risk factors (aka preDM or suspiscion of preDM)?..

A

45 years old, every 3 years.

risk factors? every 1 year

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5
Q

what must you have before you can actually Dx someone with type 2 DM?

A

two abnormal test results

can use the same sample for two separate tests, so that you dont have to re-stick pt

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6
Q

what are way to test for DM?

A

fasting blood glucose (FBG)
glucose tolerance test
A1C

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7
Q

for those with preDM, _________ can reduce risk of developing typ 2DM by ____. The goal is to get __% loss of INITIAL body weight.

A

intensive behavioral interventions, dec. by 50%

want 7% dec initial body weight

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8
Q

alcohol for DM pts?

A

yes its ok! (if moderate)
< 1/day for women
<2 /day for men

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9
Q

what do we use to check for glycemic target?

A 
assessment of glycemic control: 
use A1C (not FBG or glucose tolerance)
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10
Q

if were testing for glycemic control and they have good control, we will then re-test ____ time a year. if not good control then re-test ____ a year.

A

good control: 2x year

not good control:4x year

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11
Q

DM txt: sliding scale or no?

A

NO SLIDING SCALE

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12
Q

general approach to DM treatment

A
  • diet, exercise, pt education
  • metformin to start
  • maybe add on other meds
  • txt comorbid conditions
  • (consider txt pre-DM with meds, diet/exercise)
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13
Q

the average decrease in A1C from drugs? but a higher starting A1C means what?

A

1%

higher starting A1C, usually >1% decrease from drugs (higher starting A1C = bigger response to drugs)

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14
Q

first line oral antiDM drug? what is the starting dose?

A

biguanides (metformin)

starting dose: 500mg at night for two weeks

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15
Q

why dont you want to increase metformin dosage too quickly?

A

people will become intolerant (bad GI ADRs more likely)

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16
Q

metformin: restrictions of txt with specific GFR levels, what about if the pt is going to receive contrast for imaging?

A

cant have if GFR <30
dose adjust GFR 30 to 45 (no current kidney failure: therapy initiated at half initial dose, if GFR falls into this range DURING therapy: drop dose by half)

must stop before having IV contrast

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17
Q

when dosing for metformin, always use _____.

A

feedback- A1C levels

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18
Q

metformin max dose. why is this good to know?

A

2500 mg/day

max out on metformin THEN try something else

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19
Q

ADR of alpha glucosidase inhibitors?

A

GI issues- flatulence/diarrhea, fecal incontinence

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20
Q

which anti-DM drugs have a first phase insulin response? which dont? this first phase is good but with what risk? …

A

first phase: meglitinides and incretins
(insulin and amylin as well)
(produce insulin at the time of the meal to counter that initial glucose spike.. but leads to hypoglycemia risk if no carbs are in the meal)
no first phase: sulfonyureas

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21
Q

which anti-DM drug increases sensitivity?

A

TZDs (“glitazones”)

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22
Q

the remaining “ok” TZD/glitazone without CVD risk and beneficial effects on lipids

A

pioglitazone

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23
Q

which type of anti-DM drug is byetta(exantide)?

what are two major added benefits of it?

A

incretin: aka GLP1 agonist or “mimic”

weight loss, decreased CVD risk (moderately)

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24
Q

do incretins increase pancreatitis risk?

A

according to hadley, no, DM is what increases the risk

25
Q

amylin has what added benefit (same as GLP1s)

A

weight loss

26
Q

which anti-DM drug decreass CVD and CHF risk and lowers BP?

A

SGLT2 inhibitors

27
Q

GLP-1 vs DPPIV drug administration

A

GLP 1- subQ

DPP IV- oral

28
Q

which anti-DM drug decreases insulin resistance?

A

SGLT-2 inhibitors (do so while paradoxically increasing glucagon and endogenous glucose production)

29
Q

the impact on cardiovascular outcomes is positive with this drug..

A

SGLT2-Is (empagliflozin specifically)

30
Q

drug considerations for txt: start ____ and go _____ to minimize ADRs. especially with _____ and _____.
start _____ early.
what is always an option?

A

start low and go slow
Alpha glucosidase-Is and lipase inhibitors (drugs for weight loss)
-start combo therapy early
-insulin is ALWAYS an option to get sugars down

31
Q

for DM txt STRATEGIES, always consider ____ ____ ____.

A

global cardiovascular risk

32
Q

we see DM treatments that provide good lab outcomes (aka______) but dont consider what?

A
  • good lab values aka “surrogate endpoints”

- good outcomes that matter to the pt ( quality of life, risks etc)

33
Q

why do we want to minimize insulin use?

A

can increase CVD risk

34
Q

Txt that affect the Mechanisms of DM ______ are high priority targets

A

earlier in the cascade

- (obesity, insulin resistance and reduced gut peptide function are the root of DM, these should be addressed FIRST)

35
Q

what two drug options will be look to add-on for decreased CVD risk

A

liraglutide (a GLP-1)

any SGLT2

36
Q

what two drug classes would be good add-ons to decrease renal risk?

A

GLPs and SGLT2s

37
Q

if there is no risk for renal or CVD, what three things will we take into consideration when deciding on an add-on drug for DM?

A

weight loss/minimize weight gain (any except sulfonyurea)
minimize hypoGlycemia risk (SGLT2 or GLP1)
cost (Sulfonyurea) or TZD)

38
Q

what to do if a pt has hypoglycemia from med?

A

oral glucose, wait 15min, then give more if it hasnt come up

39
Q

what two drugs can cause weight gain ?

A

sulfonyureas and insulin

40
Q

what txt method is best for type 1 DM?

A

basal-bolus

41
Q

do we take someone off metformin?

A

no (unless their GFR<30)

..only add-on (again… no sliding scale)

42
Q

what to monitor if someones on metformin?

A

B12 levels

43
Q

high TriGs? what is the txt strategy?

A

lifestyle and glycemic control! almost never txt with meds just for this… unless its really bad.

44
Q

what to do for DM retinopathy? different approach for type 1 and type 2?

A

optimize BP and sugar control
type 2: assume its been going on a while.. txt right away
type 1: maybe txt 5 years from Dx

45
Q

for older Pts… err on the side of _____

A

hyperglycemia.. targets should be slightly higher for their A1C b/c its worse for them to by hypoglycemic than hyperglycemic

46
Q

in Type 2 DM glucagon is ____ likely due to what?

A

elevated inappropriately

  • dysregulation of gut peptide interactions
  • ->drives hepatic glucose output despite high serum glucose levels
47
Q

Kidney works hard to reclaim glucose in the _______, even when blood glucose is high, but cannot keep up with amounts over _____

A

ultrafiltrate

150 mg/dL

48
Q

why do we treat DM?

A

acute symptoms and longterm complications

49
Q

hyperglycemia in type 1 vs type 2

A

type 1: DKA

type 2: HHNK (no ketones, much higher glucose >600mg/dL)

50
Q

why do we want a SLOW correction of HHNK?

A

prevent brain swelling from rehydration of brain cells

51
Q

why is insulin “not essential” for HHNK?

A

dont really need it for txt (focus on rehydration) PLUS it can cause worse hypoKalemia

52
Q

what is insulin resistance?

A

hyperinsulemia (high insulin levels) with insulin resistance to maintain glucose levels
(path is broken somewhere between where the insulin binds on target cell and where glucose is supposed to come into target cells)

53
Q

how can you tell someone has DM when looking at first and second phase response ?

A

1st: normal person will have insulin spike from glucose spike (from meal) . DM will not have insulin spike (decreased spike)
2nd: somewhat equal DM and non DM

54
Q

impaired fasting glucose vs type 2 DM (in regards to insulin resistance, production and fasting plasma glucose? )

A

IFG: insulin resistance just outweighs insulin production, fasting plasma glucose low
DM type 2: insulin resistance HIGH, insulin production LOW (drops), fasting plasma glucose higher.

55
Q

dont just treat sugar levels, treat ______

A

insulin resistance! supranormal insulin levels are harmful!

56
Q

most sensitive detector to indicate when complications will start from DM: lab and symptom?

A

FPG >126

Retinopathy

57
Q

UKPDS: txt _____ for microvascular problems, ______ for macrovascular problems

A

insulin- micro

metformin- macro

58
Q

what meds do you have to monitor A1C levels for?

A

those with hypoglycemia risk (ex/ yes insulin , dont need to for metformin)

Clin Med- P (124 decks)

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