12 Diabetes Treatment

A1C

  • A1C < 9 or 10

Biguanides

Aka metformin.

Oral therapy..

  • decrease liver gluconeogenesis
  • decrease free FA, triglycerides for gluconeogenesis
  • decrease glucose absorption in GI
  • increase insulin sensitivity.

Biguanides (metformin) repress hepatic gluconeogenesis and increase peripheral insulin sensitivity and utilization of glucose.  (Although unclear, the proposed mechanism of biguanides (metformin) is that they activate AMP-activated protein kinase (AMPK), which increase expression of a small heterodimer partner (SHP). SHP inhibits expression of liver phosphoenolpyruvate carboxykinase (PEPCK) and glucose-6-phosphatase, thus repressing hepatic gluconeogenesis).

  • Mail box: increased insulin effect. AMPKinase in liver bag..

Advantages:

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  • Other drugs can have weight gain
  • Other drugs that causes more insulin secretion won't work in advanced patients
  • Skinny kid:

  • from reduced glucose absorption

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  • Green face, milk container, renal insufficiency:

  • Lactic acidosis:

  • Not given to patients with renal failure, in hopsital, or using CT contrast..

Sulfonylureas

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  • 1st gen: mide > maid
  • 2nd gen: ride > riding on back
  • 3rd gen: zide > Z

SE

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  • chlorpropamide 1st generation
  • Disulfiram for alcohol abuse
  • hypoglycemia candy and old fat lady; Do not drink:

Meglitinides

.

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  • glinides: gliding goose

Thiazolidinediones

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  • Glitter in the zone

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  • Binds PPAR-gamma

  • End result is increase Glut-4, adiponectin, decrease TNF-alpha
  • Intracellular PPAR:

  • Binding of PPAR-gamma receptor leads to:

  • puts lipid and FA into adipocytes. Adipocyte enlargement

.

  • Glut 4 mail box and turtle neck
  • Eats more FA

SE

  • weight gain
  • hepatotoxicity
  • edema.

  • adipocytes have highest PPAR receptors

  • Big pants edema, heart failure, bone fracture, fat kid

Glucosidase Inhibitors

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  • A-carb

  • a-glucosidase hydrolyzes 1-4 bonds
  • only monosaccharides can be absorbed in intestines

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  • from glucose excretion, like lactose intolerance

.

Amylin Analogs

  • glucagon wrappers, stomach sealed

.

  • injected
  • 1 and 2 fingers

.

  • glucagon and low insulin can cause hypoglycemia
  • falling sugar balls

.

Incretins

Reason why oral glucose metabolized faster than IV glucose.

Includes:

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  • glucagon on floor. Sealed stomach

GLP-1 Analogs

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  • Tide and Gulp

  • pancreatitis

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stimulates insulin release because GLP

DPP-4 Inhibitors

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  • may interfere with immune sys
  • Gliptin on nose

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  • Gliptin clips

SGLT2 Inhibitors

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  • Pro cart track: PCT

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  • flossing

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  • new and expensive
  • weight loss from excreting glucose/calories
  • osmotic diuretics: helps with heart failure
  • candidiasis/UTI: glucose in urine = food
  • renal disease: more work on kidney

  • Pts with renal, heart, liver failure are ok with insulin