Oral anti-hypoglycemic agents
Medication that binds to the peroxisome proliferator activated receptor gamma (PPAR-y), upregulates multiple genes, and culminates in decreased insulin resistance
What is pioglitazone ?
Also accept: rosiglitazone, thiazolidinediones
Note: the thiazolidinediones reduce insulin resistance by binding to the peroxisome proliferator activator receptor (PPAR - Y). This receptor is found int he highest level in the adipocyte. Agonists of PPAR-y regular gene transcription promoting adipocyte differentiation, reduced hepatic fat accumulation and promote fatty acid storage. Circulating insulin levels decrease with use of thiazolidinediones indicated a reduction of insulin resistance.
Substance that enhances lipoprotein lipase activity and can correct triglyceride levels, when dangerously elevated, to safe levels within 3 - 5 days
What is insulin ?
Major side effect of metformin
What is lactic acidosis ?
Also accept: GI upset: nausea, vomiting, diarrhea, abdominal pain; B12 deficiency
Electrolyte abnormality precipitated by insulin infusion
What is hypokalemia ?
Most worrisome side effect of sulfonylurea medications
What is hypoglycemia ?
Current guidelines recommend that all patients with diabetes mellitus should be started on a statin for primary prevention of atherosclerotic cardiovascular disease if greater than this age
What is 40 years old ?
Two preferred insulins for prandial coverage
What is aspart, glulisine, and lispro insulins ?
Also accept: regular
Note: insulin regimens should contain a long acting insulin (NPH, glargine, or detemir) to supply basal insulin. Regular, aspart, glulisine, or lispro insulin provides prandial coverage. Short acting insulin analogues are given just before or just after meals
FDA recommends measurement of liver function tests prior to initiating this oral anti-hypoglycemic and LFT testing at regular intervals every 2 months for the first year
What is thiazolidinediones ?
also accept: rosiglitazone, pioglitazone.
Note: troglitazone was the prototypical thiazolidinedione but it was removed from the market after reports of hepatotoxicity and idiosyncratic liver reactions would lead to liver failure. Other side effects of these medications include CHF, peripheral edema, and weight gain.
Two preferred insulins for basal coverage
What is detemir, glargine, and NPH insulins ?
Note: insulin regimens should contain a long actin insulin (NPH, glargine, or detemir) to supply basal insulin. Regular, aspart, glulisine, or lispro insulin provides prandial coverage. Short acting insulin analogues are given just before or just after meals
In general, the best initial medication for type 2 diabetics
What is metformin ?
Note: it is thought reasonable that initial therapy for type 2 DM to be metformin because of its efficacy, known side effect profile, and low cost. Metformin promotes mild weight loss, lowers insulin levels, and improves the lipid profile slightly. It is associated with lactic acidosis, GI upset, and B12 deficiency
Names of two medications that stimulate insulin secretion by interacting with the ATP sensitive potassium channel on the beta cell
What is glipizide and glimepiride ?
Also accept: glyburide, chlorpropamide, tolbutamide, repaglinide, and nateglinide.
Note: Sulfonlyurea medications stimulate insulin secretion by interacting with the ATP sensitive potassium channel on the beta cell. They are most effective in new onset type 2 DM (patients with residual endogenous insulin production). 'Newer' sulfonylureas include: glipizide, glyburide, & glimepiride. Older agents include chlorpropamide & tolbutamide. The meglitinides are repaglinide and nateglinide - they are not sulfonylureas but interact with the same ATP sensitive K+ channel on the beta cells
Agent that amplifies glucose-stimulated insulin secretion by acting as a glucagon-like peptide 1 agonist or enhancing endogenous glucagon-like peptide 1 activity
What is exanatide ?
Also accept: liraglutide
Note: both liraglutide and exantide are incretins that stimulate glucose stimulated insulin secretion, suppress glucagon, and slow gastric emptying. Major side effects are pancreatitis, nausea, vomiting and diarrhea. Liraglutide increases risk of thyroid C cell tumors in rodents and is contraindicated in MEN/MTC. These medications should not be used in those taking insulin.
Medications that inhibit dipeptidyl peptidase 4 thereby increasing the amount of glucagon like peptide 1
What is saxagliptin ?
Also accept sitagliptin, vildagliptin
Note: Glucagon - like peptide 1 increases insulin secretion and decreases glucagon secretion. Dipeptidyl peptidase degrades GLP-1. By inhibiting DPP4, GLP1 levels are increased, thereby leading to increased insulin secretion.
Amylin agonist that slows gastric emptying and decreases glucagon levels
What is pramlintide ?
Medications that inhibit the brush border enzyme responsible for breaking down oligosaccharides into monosaccharides thereby leading to decreased postprandial carbohydrate absorption
What is acarbose ?
Also accept: miglitol, alpha-glucosidase inhibitors
Note: the alpha glucosidase inhibitors act to inhibit alpha glucosidase. This enzyme is present in the brush border of the small intestine and is responsible for breaking down oligosaccarides and disaccharides into monosaccharides. By inhibiting this enzyme, absorption of postprandial carbohydrates is decreased and postprandial glucose levels are lowered.
Name of medication that decreases tubular reabsorption of glucose by inhibiting the sodium glucose co-transporter in the proximal tubules
What is canagliflozin ?
Also accept: dapagliflozin
Patients with an HbA1c of this percentage or greater should be highly considered for insulin therapy, even on initial diagnosis
What is 10% ?
Class of medications associated with euglycemic diabetic ketoacidosis, UTIs, and genital candidiasis
what is the SGLT2 inhibitors ?
Morning hyperglycemia attributed to declining serum levels of insulin and the release of growth hormone
What is the Dawn phenomenon ?
Laboratory parameters in surreptitious sulfonylurea use (comment on proinsulin, insulin, c peptide, glucose, oral hypoglycemic screen)
What is increased proinsulin, insulin, C peptide and decrease glucose, positive oral hypoglycemic screen ?
Drug class in which metformin belongs
What is the biguanides ?
Note: metformin is a biguanide that reduces fasting plasma glucose and insulin levels, improves the lipid profile and promotes modest weight loss. It works in the liver to decrease hepatic gluconeogenesis and decreased serum glucose levels. It also may decrease absorption of glucose from the GI tract and increase peripheral utilization of glucose by adipose tissue and skeletal muscle.
Phenomenon by which morning hyperglycemia occurs as a response to nocturnal hypoglycemia and release of counter regulatory hormones, often in the setting of too high an evening dose of insulin
What is the Somogyi effect ?
First generation sulfonylurea associated with SIADH
What is Chlorpropamide ?
Laboratory parameters in surreptitious insulin use (Comment on proinsulin, insulin, C peptide, glucose level, oral hypoglycemic screen)
What is decreased / normal proinsulin, increased insulin, normal / decreased C peptide, decreased glucose, negative oral hypoglycemia screen.
Thiazolidinedione removed from the market due to cases of fatal hepatotoxicity
What is troglitazone ?