MCPC Test 2

type 2 diabetes mellitus

diabetes in which either the body produces insufficient insulin or insulin resistance (a defective use of the insulin that is produced) occurs; the patient usually is not dependent on insulin for survival

T2DM is caused by a progressive loss of

beta-cell insulin secretion

clinical presentation of type 2 diabetes

often asymptomatic

polyuria

nocturia

polydipsia

hyperglycemia

lethargy

most are overweight or obese

type 2 diabetes screening

age 45 for individuals without risk factors

all adults who are overweight and have at least one risk factor

A1C levels for normal, prediabetes, and diabetes

normal: below >6.5%

prediabetes: 5.7-6.4%

normal:

Diagnostic criteria for diabetes

Diabetes

- A1C: >/= 6.5%

- FPG: >/= 126 on 2 occasions

- OGTT (2-hr BG): >/= 200

Prediabetes

- AIC: 5.7-6.4%

- FPG: 100-125

- OGTT: 140-199

how often should you collect A1c reading in those with diabetes

controlled: at least 2 times per year

uncontrolled: at least quarterly

goals in T2DM

A1c:

extra vaccine indicated in T2DM

PPSV23 indicated in age 2-64 with underlying condition (diabetes)

hypoglycemia

blood sugar

hyperosmolar hyperglycemic state (HHS)

hyperglycemic crisis that occurs in type 2 DM due to severe stress

BG>600

assessing nephropathy in T2DM patients

assess urinary albumin and eGFR in all patients

treatment of nephropathy in T2DM

SGLT2 inhibitor or GLP1 recommended

retinopathy screening in T2DM

initial exam at time of diagnosis and then every 1-2 years

neuropathy screening in T2DM

at diagnosis and then at least annually

treatment for neuropathy in T2DM

pregabalin, duloxetine, or gabapentin

metformin brand name

glucophage

metformin drug class

biguanide

metformin MOA

Insulin sensitizer. Inhibits hepatic glucose output and improves glucose uptake in insulin-sensitive tissues (e.g. muscles)

metformin AE

GI distress (diarrhea, nausea), lactic acidosis (rare but serious), vitamin B12 deficiency.

metformin kidney dosing

Do not initiate in people with eGFR

metformin BBW

lactic acidosis

metformin class effects

no hypoglycemia

weight loss

sulfonylureas

glipizide, glyburide, glimepiride

glipizide brand name

Glucotrol

glyburide brand name

Diabeta

glimepiride brand name

Amaryl

sulfonylureas MOA

Increase insulin secretion from pancreatic beta cells

sulfonylureas administration

30 min before meals

sulfonylureas AE

hypoglycemia

weight gain

rash

GI upset

sulfonylureas CI

type 1 DM, sulfa allergy, concurrent use with insulin

Thiazolidinediones (TZDs)

Pioglitazone

Rosiglitazone

pioglitazone brand name

actos

rosiglitazone brand name

Avandia

Thiazolidinediones (TZDs) MOA

PPAR-gamma agonists: increase insulin sensitivity in muscle and fat

Thiazolidinediones (TZDs) AE

edema

weight gain

heart failure exacerbation

pioglitazone increases risk for what type of cancer

bladder cancer

Thiazolidinediones (TZDs) CI

Class III/IV HF, hepatic impairment

GLP-1 receptor agonists

liraglutide

semaglutide

dulaglutide

liraglutide brand name

Victoza, Saxenda

semaglutide brand name

Ozempic, Rybelsus, Wegovy

dulaglutide brand name

Trulicity

dual GLP-1/GIP agonist

Tirzepatide (Mounjaro)

GLP-1 agonists MOA

Mimics incretin hormone to increase insulin secretion, slow gastric emptying, and reduce glucagon release

GLP-1 agonists AE

-n/v/d

-pancreatitis

-hypoglycemia (low risk)

GLP-1 agonists BBW

Thyroid C-cell tumors

LEADER trial

liraglutide had major benefits in CV outcomes

DPP-4 inhibitors

Linagliptin, saxagliptin, sitagliptin

Sitagliptin brand name

Januvia

linagliptin brand name

Tradjenta

saxagliptin brand name

Onglyza

DPP-4 inhibitors AE

Mild urinary or respiratory infections; weight neutral, pancreatitis

DPP-4 with no renal dosing adjustments

linagliptin (Tradjenta)

SGLT-2 inhibitors

Canagliflozin

Dapagliflozin

Empagliflozin

canagliflozin brand name

Invokana

empagliflozin brand name

Jardiance

dapagliflozin brand name

Farxiga

SGLT-2 inhibitors MOA

inhibits sodium and glucose co-transport in the proximal tubule, leading to increased glucose in the urine (increased glucose excretion)

SGLT-2 inhibitors AE

UTIs, yeast infection, dehydration, ketoacidosis

SGLT-2 inhibitors and kidney function

do not use in eGFR

gabapentinoids

Gabapentin (Neurontin)

Pregabalin (Lyrica)

gabapentinoids MOA

Blocks voltage-gated calcium channels in the CNS, slowing the release of excitatory neurotransmitters

gabapentinoids AE

dizziness

sedation

peripheral edema

gabapentinoids indication

diabetic neuropathy

Tricyclic Antidepressants (TCAs) in diabetic neuropathy

amitriptyline

nortriptyline

Tricyclic Antidepressants (TCAs) MOA

block the reuptake of norepinephrine and serotonin into nerves

Tricyclic Antidepressants (TCAs) AE

Anticholinergic effects (dry mouth, constipation), sedation, weight gain.

SNRIs

Venlafaxine (Effexor)

Duloxetine (Cymbalta)

SNRIs MOA

Blocks reuptake of serotonin (5-HT) and norepinephrine (NE)

SNRIs AE

Nausea, sexual dysfunction, somnolence

Capsaicin MOA

depletes substance P

lidocaine MOA

sodium channel blocker

agents preferred in HTN/T2DM

ACEi/ARB

treatment for vulvovaginal candidiasis

Fluconazole

Nystatin

Terconazole

Miconazole (OTC)

Clotrimazole (OTC)

SUSTAIN trial

semaglutide and improved CV outcomes

SURPASS trial

safety and efficacy of tirzepatide

EMPA-REG trial

empaglifozlin superior to placebo in CV outcomes

treatment in T2DM with HF

SGLT2 inhibitor

treatment in T2DM with CKD

SGLT2 inhibitor, GLP1 agonist

treatment in T2DM and advanced CKD

GLP1

when to start insulin in T2DM

A1c>10 or blood glucose >300

after failure of GLP1

diabetic neuropathy treatment

SNRIs, TCAs, or gabapentinoids

FDA approved for diabetic neuropathy

duloxetine, pregabaline, tapentadol

add on to ACEi/ARB in diabetes

CCB or diuretic

bolus insulin

released at mealtimes to react with glucose entering the body from food intake

basal insulin

Insulin needed for 24 hour coverage. No relationship to intake of meals

types of basal insulin

insulin detemir

insulin glargine

insulin NPH

insulin degludec

Insulin Detemir brand name

Levemir

insulin glargine brand name

U100: Lantus, Basaglar, Semglee

U300: Toujeo

ultra long acting insulin

Insulin degludec - Tresiba

Insulin glargine - Toujeo

insulin NPH brand name

Humulin N, Novolin N

bolus insulin products

insulin glulisine

insulin lispro

insulin aspart

insulin regular

regular insulin brand name

Humulin R, Novolin R

insulin lispro brand name

Humalog, Admelog

insulin aspart brand name

Novolog, Fiasp

insulin that acts as basal and bolus

insulin regular U-500

Insulin 70/30

70% NPH, 30% regular

goal target % in target range for CGM

at least 70% of time

ADA vs AACE goal for A1c

ADA:

what is preferred before insulin in patients with type 2 DM?

GLP-1 agonists