MOA of Drug
This drug class decreases hepatic glucose output, decreases glucose absorption from the gut, and increases glucose uptake in muscle and adipose tissue.
What is Biguanides? (Metformin)
This class can be added on to Metformin and work by acting to increase the secretion of insulin from the pancreas
Sulfonyureas (glyburide, glipizide, glimepiride)
This type of insulin needs to be given with food in front of you because it acts within 4 minutes
What is ultra rapid-acting insulin?
Only one: Aspart (Fiasp)
SE of this class include: increased urination, frequent UTI's or yeast infections, as well as increased thirst, constipation, and nausea
What is the SGLT2 Inhibitors? The "flozins"
The starting dose of Metformin
What is 500 mg at bedtime for 7 days, then 500 mg BID for 7 days, then 1,000 mg BID thereafter?
This class causes the stimulation of glucose-dependent insulin secretion by the pancreas. It also causes decreased secretion of glucagon, slowed gastric emptying, increased satiety, and decreased food intake.
What is GLP1's? (Examples: Exenatide, Liraglutide, Dulaglutide, Lixisenatide, and semaglutide)
This class of oral medications should never be used alone, but rather in adjunct with metformin/diet/exercise and is a rather cheap for those w/o insurance or high copays
Thiazolidinediones (Pioglitazone, Rosiglitazone)
When do we consider using insulin as a part of the treatment regimen?
If their A1C is over 9.5
If there on 3 oral agents and still not close to target
Pregnancy
Hospitalized patient with hyperglycemia
SE of this class include: edema, and increased plasma volume. Hint: they should not be used in Heart Failure
What is the Thiazolidinediones? Pioglitazone and Rosiglitazone
Rosiglitazone: increased risk of cardiovascular events
Pioglitazone: increased risk of bladder cancer
Preventative measures or annual screenings a type 2 diabetic should have
what are yearly foot exams, dilated eye exams, and immunizations (Influenza, Pneumonia, Zoster, Covid, RSV)?
These drugs increase insulin sensitivity and decreased insulin resistance in Type 2 Diabetes
What is the Thiazolidinediones? (Pioglitazone, Rosiglitazone)
This class can be used alone or in combo with metformin but should not be combined with GLP1'S due to similar MOA- also good because they are safe for those who are renally impaired
DPP-4 Inhibitors (Sitagliptin/ Januvia, saxagliptin, linagliptin etc)
Name the rapid-acting insulins (Hint: there are 3 of them)
What is insulin lispro (Humalog, admelog), insulin aspart (novolog), and insulin glulisine (apidra)?
Metformin
Hypoglycemia rule
What is the Rule of 15? provide 15 grams of fast-acting carbs, wait 15 minutes to check blood sugar. If still low, repeat. If normal, eat a carb/protein snack
This class of drug works by inhibiting the alpha glucosidase enzyme, which decreases the rate of glucose absorption and post prandial blood concentrations
alpha glucosidase inhibitors, Acarbose and miglitol
This class of drugs is contraindicated if they are receiving hemodialysis or have severe renal dysfunction (GFR<30)
SGLT-2 inhibitors
ideal patient to use these in: those who are overweight, have HTN, and need additional glycemic control
Name the long-acting insulins
Glargine 100 u/ml (Lantus and Basaglar)
Glargine 300 u/ml (Toujeo)
Detemir (Levemir)
Degludec (Tresiba)
What are the A1C, BP, and lipid goals for type 2 diabetics?
BP- 140/90
Lipids- <70 in almost all cases
This medication should not be started in patients whose have an eGFR of between 30-45, and is absolutely contraindicated in those with one less than 30
Metformin
Which type of insulin should NEVER be given IV and why?
Variability with release of it
What is the Somogyi effect and the Dawn phenomenon?
Somogyi effect: in the middle of the night the patient becomes hypOglycemic due to medication and insulin effects
Dawn phenomenon: Hyperglycemia in the middle of the night due to insulin wearing off