Patho B3L7

what is the difference b/t type 1 and type 2 diabetes in terms of insulin?

T1: not enough or no insulin

T2: increased insulin at start, insulin resistance as disease progresses

what are the classes of meds for T2DM? (6)

biguanide

GLP-1TA

SGLT-2i

DPP-4i

TZD

Sulfonylureas

what do biguanides do? (5)

decreases gluconeogenesis by acting at liver

increases sensitivity of peripheral tissues to ins

increases glucose uptake by skeletal muscle

lowers A1C by 1-2%

DOES NOT stim ins secretin

what are most common side effects of biguanides (7)

nausea, vomiting, loss of appetite, diarrhea, flatulence, abdominal pain, vit B12 deficiency

what are contraindications of taking biguanides

do not take if pt has kidney failure as it could cause lactic acidosis

what does MALA stand for + what does it do

metformin associated lactic acidosis

altered lactate and hydrogen, pH < 7.35, lactate > 5mmol/L

what do sulfonylureas do? (4)

ACTS DIRECTLY ON BETA CELLS to stim release of insulin without requiring glucose or amino acids as stimulus

works by blocking K+ channel in cell membrane of beta cell

improves glucose uptake at insulin-dependent tissues-muscle

reduces A1C by 1-2%

what are primary adverse effects of sulfonylureas? (3)

hypoglycemia, GI upset, cardiac risk → may impact vascular tone + myocardial contractility

what do TZDs do? (6)

functions by improving ins sensitivity in muscle, liver, and adipose tissue

reduces A1C by 1-2%

found to decrease beta cell deterioration + protect against diabetes

reduces triglyceride lvels

increases HDL levels

improves blood pressure

how do TZDs work?

they bind to PPAR-gamma on intranuclear transcription factors → genes involved in regulating lipid metabolism + ins action are activated

what are primary adverse effects of TZDs? (4)

weight gain + fluid retention

reduced bone mass

associated with increased heart failure + MIs

liver toxicity

what do GLP-1RAs do? (5)

STIMS INS SECRETION FROM BETA CELLS

reduces gastric emptying

reduces appetite

inhibits glucagon release

reduces glucose output from liver

what do DPP-4is do? (3)

inhibits the key enzyme called DPP-4 that breaks down incretins

reduces A1C and fasting plasma glucose levels

improves glucose profile with metformin

what are primary adverse effects of DPP-4is? (1)

small increase in GI discomfort

generally well tolerated

what do amylin analogs do? (6)

DECREASES GLUCAGON SECRETION

decreases gastric emptying

decreases osteoclast activity

increases osteoblast activity and proliferation

increases vasodilation

increases renin activity

where is amylin stored and secreted?

it is co-stored and co-secreted with ins by beta cells

how and who is amylin given to?

subcutaneously to T1 and T2 DM Pts

can be given with ins to control post meal hyperglycemia

what are primary adverse effects of amylin (3)

nausea, vomiting, hypoglycemia when given with insulin

how does SGLT-2 drug work?

blocks reabsorption of glucose, leads to glucosuria

what does SGLT-2 drugs do?

allows for glucose reabsorption from glomerular filtrate to the plasma

what does the insulin drug do?

controls high blood sugar

cautions with ins drug (3)

do not use to treat DKA

do not use during low blood sugar

only taken once a day via subcutaneous injection

what are primary adverse effects of insulin (2)

hypoglycemia

can cause heart failure if taken with TZDs

what can cause hypoglycemia (4)

missing meals

changing carb content in meal

exercising

changes in insulin absorption rate

what is the hypoglycemia rule of 15? (3)

1. if blood glucose below 70, pt needs to eat 15g of carbs and recheck glucose in 15 min

2. if blood glucose still below 70, pt needs to eat another 15g of carbs and recheck glucose every 15 min

3. if level is still not above 70, consume another 15g of carbs, physician needs to be contacted