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type 2 pharm
Terms in this set (22)
Diagnostic Criteria for DM
A1c 5.7-6.5 = prediabetes
A1c 6.5 and over = diabetes
Random BG > 200 + symptoms
The bellow should be repeated to confirm diagnosis:
2 h post prandial BG > 200 (OGTT 75 g CHO)
Fasting BG > 126
Off label use for metformin// A1C <6.5, metformin
Weight loss and lifestyle mod
Case 1 65 yo W F with a h/o DM2, asthma and HTN sent for diabetes management.
Diagnosed with diabetes 4 years prior. No complications
Current therapy: NPH 35 units in the morning and 30 units in the pm, metformin 500 BID, and glyburide 2.5 mg BID.
On insulin for 2 years, frequent hypoglycemia that is causing significant distress, as low as 40 mg/dL. Taking a prednisone burst for her asthma.
how long have you had diabetes?
Lows-how often, how do you treat
Step 1: recommended changing to a basal/bolus insulin program, stopping NPH/glyburide. Continue metformin
2 months later: pt feeling much better, off stroids, and no hypoglycemia. Most BG levels in the 100s.
Step 2: stop meal insulin, start exenatide premeal Bid. Continue metformin
Next visit 2 months: feeling well, BG good, lantus decreased and exenatide increased.
Over time pt has had very well-controlled BG on metformin, glargine and exenatide
Case 2 CW is a 54 yr old gentleman originally from Jamaica employed as a construction worker.
history of diabetes about 15 years' duration, started on basal insulin about 8 years ago.
FH of DM mom, aunt, uncle
"Range of blood glucose 60-220.
Taking lantus 36 units plus glipizide and metformin
Forgot to bring in meter."
Cont current rx for now
Lantus 38 units at bedtime
glipizide 10mg twice daily
metformin 1g by mouth twice daily
starting Invokana 100mg subsequent noticed increased urination but no orthostasis or or UTIs or balanitis.
Biguinides function? Side effects?
Block hepatic glucose release
Improve muscle uptake of glucose
Diarrhea, gas, nausea are very common
GFR<45, no if 30
Metforimn and CT dye
stop metformin before contrast
Recheck creatinine before resarting 48 hrs later if renal function is normal
glibizide slifde 29
Pros of SU
long history of use
high efficacy, daily dosing, outcomes measurements.
Cons of SU
(CV effects, beta-cell decline?)
caution with renal and liver dysfunction.
Meglintinitdes slide 32
Fucntion of Meglinitides
Pros of MEglitinides
Cons of MEglinitides
SGLT-2 sodium glucose co transporter
Pros of SGLT-2
Cons of the SGLT-2
cardiac benefit form SGLT-2
Alpha glucosidase inhbitiors
Dose ranges, why indicated, why contraindicated. Safety. Casues low BS. Don't add medicice when something else is the problem "piece fo the puzzle". Metformin (250-2000) and insulin dosing questions.
Insulin defieicent-not making enough >35 but presents like type 1.not helpful to give metformin
Met + glipizide
Cheap and effective for new diagnosis and marked hyperglycemia if insulin is not used
Consider switching once under control, weight gain is a problem
Hypoglycemia on glip is a serious consideration - if you stay here, have regular discussions on how glip is being used
Met + gliptin (DPP4)
Very effective for early classical type 2 DM
No weight gain, maybe some loss
Met + GLP-1 (e.g. Victoza once daily)
Great for obese individuals who are motivated
Weight loss, highly effective in most patients
Met + gliptin + TZD
Two once daily pills make this relatively easy
Great for insulin resistant type 2s not needing insulin just yet
Avoid high dose TZD - do not go higher than Actos 30
Other cautions with TZD: heart failure, bone loss in at-risk women