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:
.
- 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
.
- Green face, milk container, renal insufficiency:
- Lactic acidosis:
- Not given to patients with renal failure, in hopsital, or using CT contrast..
Sulfonylureas
.
- 1st gen: mide > maid
- 2nd gen: ride > riding on back
- 3rd gen: zide > Z
SE
.
- chlorpropamide 1st generation
- Disulfiram for alcohol abuse
- hypoglycemia candy and old fat lady; Do not drink:
Meglitinides
.
.
- glinides: gliding goose
Thiazolidinediones
.
- Glitter in the zone
.
- 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
.
- A-carb
- a-glucosidase hydrolyzes 1-4 bonds
- only monosaccharides can be absorbed in intestines
.
- 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:
.
- glucagon on floor. Sealed stomach
GLP-1 Analogs
.
- Tide and Gulp
- pancreatitis
.
stimulates insulin release because GLP
DPP-4 Inhibitors
.
- may interfere with immune sys
- Gliptin on nose
.
- Gliptin clips
SGLT2 Inhibitors
.
- Pro cart track: PCT
.
- flossing
.
- 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