Exerts its effects by binding to specific membrane-bound receptors on target tissues (liver, skeletal muscle, and adipose tissue), initiating a cascade of intracellular signaling pathways that regulate the metabolism of carbohydrates, proteins, and fats
Insulin
Symptoms of Hypoglycemia
Anxiety/irritability, dizziness, shakiness, headache, confusion, blurred vision, diaphoresis, hunger, nausea, ataxia, tremors, palpitations, tachycardia
A1c Threshold for Diagnosis
A1c ≥ 6.5% (≥ 48 mmol/mol)
Insulin
Weight gain, hypoglycemia, hypokalemia, lipoatrophy, lipohypertrophy
Lantus
Insulin Glargine
Decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization
Biguanide
Symptoms of Hyperglycemia
Polyuria, polydipsia, excessive hunger, extreme fatigue, blurry vision, dry mouth, fruity breath, slow healing bruises/cuts, tingling, pain, or numbness in hands and feet, erectile dysfunction, vaginal fungal infections
How much physical activity is recommended?
At least 150 minutes/week of moderate intensity physical activity
Thiazolidinediones
Peripheral edema, weight gain, upper respiratory infections, myalgia, bone fractures, heart failure (cause or worsen)
Jardiance
Farxiga
Jardiance = Empagliflozin
Farxiga = Dapagliflozin
Inhibit *** protein in the proximal renal tubule, reducing reabsorption of glucose and increasing urinary glucose excretion
SGLT2 Inhibitors
T2DM is due to both
insulin resistance and insulin deficiency
"Rule of 15"
1.Take 15-20 grams of glucose or fast-acting carbohydrates
2.Recheck blood glucose after 15 minutes
3.If hypoglycemia continues, repeat
4.Once blood glucose is normalized, eat a snack or small meal
SGLT2 Inhibitors
Trulicity
Ozempic
Trulicity = Dulaglutide
Ozempic = Semaglutide
Incretin hormone **** analogs, which increase glucose-dependent insulin secretion, decrease glucagon secretion, slows gastric emptying, and improves satiety
GLP-1 Agonists
Damaged pancreatic cells that produce insulin
𝛽−cells
Treatment Goals (A1c, fasting BG, and 2-hr post-prandial)
A1C < 7.0%
Fasting plasma glucose: 80–130 mg/dL
Peak post-prandial capillary plasma glucose: < 180 mg/dL
Sulfonylureas
Hypoglycemia, weight gain, nausea
Mounjaro
Mounjaro = Tirzepatide
Peroxisome proliferator-activated receptor gamma agonist that increases peripheral insulin sensitivity
Thiazolidinediones
Fruity breath, nausea, and acidosis indicate this crisis
Diabetic ketoacidosis (DKA)
Microvascular Complications
GLP-1 Agonists
Weight loss, nausea, vomiting, diarrhea
BBW: thyroid carcinoma
Januvia
Tradjenta
Januvia = Sitagliptin
Tradjenta = Linagliptin