Diabetes Management: Acarbose and Amylin Analogs

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Questions and Answers

What is the primary effect of long-acting GLP1-RAs compared to short-acting agents?

  • They have a greater effect on fasting plasma glucose (FPG) than on postprandial glucose (PPG). (correct)
  • They only lower fasting plasma glucose (FPG).
  • They lower both fasting plasma glucose (FPG) and postprandial glucose (PPG) with a larger effect on PPG.
  • They predominantly lower postprandial glucose (PPG) levels.

Which side effects are associated with GLP1-RAs?

  • Hypoglycemia and constipation.
  • Fatigue and abdominal pain.
  • Headaches and dizziness.
  • Nausea, vomiting, and diarrhea. (correct)

When should dose titration of GLP1-RAs be considered?

  • Because side effects are dose-related. (correct)
  • When hypoglycemia occurs.
  • When patients have uncontrolled blood sugar levels.
  • When the patient shows severe allergic reactions.

In which scenario can GLP1-RAs be used as monotherapy?

<p>Only for those who cannot tolerate first-line therapy. (D)</p> Signup and view all the answers

Which combination of medications poses a risk of hypoglycemia when using GLP1-RAs?

<p>GLP1-RAs and sulfonylureas. (C)</p> Signup and view all the answers

What is the primary mechanism by which acarbose and miglitol lower post-prandial glucose levels?

<p>They inhibit α-glucosidase. (D)</p> Signup and view all the answers

In which patients are acarbose and miglitol most appropriately prescribed?

<p>Patients with high post-prandial glucose levels and near-target A1C. (A)</p> Signup and view all the answers

What is a common side effect of using pramlintide in diabetes management?

<p>Nausea and vomiting. (A)</p> Signup and view all the answers

What key action does GLP-1 receptor agonists perform in the management of type 2 diabetes?

<p>They suppress glucagon secretion and stimulate insulin release. (D)</p> Signup and view all the answers

What starting dosage of pramlintide is recommended for type 2 diabetes before meals?

<p>60 mcg SC. (D)</p> Signup and view all the answers

Flashcards

What are Alpha-Glucosidase Inhibitors?

Acarbose and Miglitol are medications used to treat type 2 diabetes by delaying carbohydrate absorption from the intestines. This slows the rise in blood sugar levels after meals.

How do Alpha-Glucosidase Inhibitors affect blood sugar?

Alpha-Glucosidase inhibitors primarily reduce postprandial glucose levels (PPG) - the blood sugar spike after meals - while having less effect on fasting blood glucose (FBG).

What is Pramlintide?

Pramlintide is a synthetic analog of amylin, a hormone produced by the pancreas. It helps manage blood sugar levels by reducing glucagon, slowing gastric emptying, and increasing feelings of fullness.

Why is Pramlintide often used in type 1 diabetes?

Pramlintide is particularly beneficial for type 1 diabetes patients who struggle to achieve good blood sugar control despite maximizing mealtime insulin doses.

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What are GLP-1 Receptor Agonists?

GLP-1 Receptor Agonists are a class of medications that mimic the actions of the hormone glucagon-like peptide 1 (GLP-1). They help manage type 2 diabetes by stimulating insulin release, suppressing glucagon, and decreasing liver glucose production.

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What are GLP-1 Receptor Agonists (GLP-1 RAs)?

GLP-1 Receptor Agonists (GLP-1 RAs) are medications that mimic the actions of the hormone GLP-1, which is naturally produced in the body. They work by enhancing insulin secretion, suppressing glucagon (another hormone), and slowing down the stomach's emptying rate.

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Why are GLP-1 RAs used in type 2 diabetes?

GLP-1 RAs are often used in type 2 diabetes because they can help improve blood sugar control by increasing insulin production, reducing glucagon, and slowing down glucose absorption.

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How do short-acting and long-acting GLP-1 RAs differ?

Short-acting GLP-1 RAs, such as exenatide and lixisenatide, are most effective at reducing postprandial glucose (PPG) levels, meaning the blood sugar spike after meals. Long-acting agents, like dulaglutide, liraglutide, and semaglutide, have a greater impact on lowering both fasting and postprandial glucose levels.

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What are some potential side effects of GLP-1 RAs ?

GLP-1 RAs can cause side effects such as nausea, vomiting, and diarrhea. These usually happen early in treatment, are mild, and tend to go away. However, if severely uncomfortable, the dose may need to be adjusted or the medication stopped.

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Can GLP-1 RAs cause hypoglycemia (low blood sugar)?

Since GLP-1 RAs increase insulin secretion, they don't usually cause low blood sugar when taken with metformin or TZDs. However, the risk of hypoglycemia is higher if combined with sulfonylureas or insulin.

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Study Notes

Acarbose and Miglitol

  • Used for type-2 diabetes mellitus (DM)
  • Inhibit α-glucosidase enzymes, delaying carbohydrate absorption
  • Lower postprandial glucose (PPG) levels (40-50 mg/dL)
  • Modest A1C reduction (0.3%–1%)
  • Beneficial for patients with near-target A1C and normal fasting blood glucose (FBG), but high PPG
  • Common side effects: flatulence, abdominal pain, diarrhea; titration can reduce these
  • Contraindicated in specific conditions: cirrhosis, colonic ulcers, intestinal disease, inflammatory bowel disease, diabetic ketoacidosis

Amylin Analogs (Pramlintide)

  • Synthetic amylin analog (e.g., Symlin)
  • Actions: reduce glucagon secretion, slow gastric emptying, increase satiety.
  • Lower both PPG and A1C levels.
  • A1C reduction: ~0.6% in type-2 DM, 0.4%-0.5% (5-6 mmol/mol Hb) in type-1 DM
  • Primarily used as adjunctive therapy in type-1 DM for patients who do not achieve PPG goals with maximizing mealtime insulin.
  • May also aid weight loss and facilitate lower mealtime insulin doses.
  • Common side effects: nausea, vomiting, anorexia.
  • Hypoglycemia risk exists when combined with insulin, but not with pramlintide alone.
  • Dosage in type-2 DM: starts at 60 mcg SC before meals, titrating to 120 mcg as tolerated and indicated by PPG
  • Dosage in type-1 DM: starts at 15 mcg SC before meals, titrating to 60 mcg as tolerated, in increments of 15mcg

Glucagon-like Peptide 1 Receptor Agonists (GLP1-RAs)

  • Incretin hormone: GLP-1
  • Used for type-2 DM
  • Examples: Dulaglutide, Exenatide, Exenatide XR, Lixisenatide, Liraglutide, Semaglutide
  • Actions: stimulate insulin secretion, suppress postprandial glucagon secretion, decrease hepatic glucose output, slow gastric emptying, increase satiety, cause weight loss (1-3 kg avg)
  • Short-acting agents (e.g., exenatide, lixisenatide): predominantly lower PPG
  • Long-acting agents (e.g., dulaglutide, liraglutide, exenatide XR, semaglutide): lower both FPG and PPG, with substantial effect on FPG
  • Common side effects: nausea, vomiting, diarrhea, dose-related; effects usually transient and mild, but discontinuation may be needed.
  • Eating slowly and stopping when satiated can lessen effects.
  • Injection site reactions and hypersensitivity are possible (anaphylaxis and angioedema)
  • Combine with metformin or thiazolidinediones (TZDs) to lower hypoglycemia risk
  • Avoid using with sulfonylureas or insulin as they can increase hypoglycemia risk.
  • 2nd line agent for patients with established atherosclerosis, CKD and those wanting to avoid hypoglycemia or weight gain/induce weight loss

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