Diabetes Pharmacology Quiz

Pharmacology of Diabetes Mellitus

• Diabetes Mellitus (DM) is a metabolic disorder characterized by hyperglycemia resulting from anomalies in insulin secretion or action, or both.

• In the US, 34.2 million people have DM, and 88 million have prediabetes.

• Type 2 diabetes can be delayed or prevented in patients with prediabetes.

• Hormones like GLP-1, GIP, and DPP-4 inhibitors play a role in regulating blood glucose levels.

• Type 1 DM affects 5-10% of the diabetic population and is associated with autoimmune processes, while type 2 DM affects 90% of the diabetic population and is caused by insulin resistance and defects in insulin secretion.

• Glycated Hemoglobin A1C is used to estimate average plasma glucose levels, and glycemic goals involve maintaining A1C levels below 7%.

• Insulin therapy involves different formulations of insulin with varying onset and duration of action.

• Premeal insulin requirements are estimated using the "500 rule," and the "1700 rule" determines correction factor for additional insulin required to lower blood glucose levels.

• Hypoglycemia is a common complication of insulin therapy and can be treated with rapidly absorbed carbohydrates.

• Symptoms of hypoglycemia include blurred vision, sweating, and tremulousness, and patients may become combative or experience nightmares during nocturnal hypoglycemia.

• The treatment of unconscious patients with hypoglycemia involves administering glucagon or intravenous glucose.

• Patients with DM are at risk of developing microvascular complications like retinopathy, nephropathy, and neuropathy, and macrovascular complications like peripheral vascular disease, CVD, and stroke.Overview of Medications for Diabetes Management

• Glucagon can be administered intranasal, subcutaneously, intramuscularly, or intravenously, with a mean response time of 6.5 minutes for outpatient settings.

• Amylin is a hormone that complements the glucose-regulatory actions of insulin, and pramlintide is a stable analog of human amylin that suppresses glucagon release, slows gastric emptying, and increases satiety.

• Gestational diabetes mellitus (GDM) is caused by placental hormones that increase insulin resistance during pregnancy, and insulin is the main treatment for GDM, with dosing ranging from 0.7 to 1.2 units/kg/day depending on the trimester.

• Sulfonylureas and glinides bind to ATP-sensitive potassium channels on pancreatic beta cells, causing membrane depolarization and calcium influx, which leads to insulin secretion.

• Thiazolidinediones bind to PPAR-gamma receptors in muscles, adipose tissue, and the liver, increasing insulin sensitivity and glucose uptake and decreasing glucose production in the liver.

• GLP-1 receptor agonists bind and activate GLP-1 receptors, increasing insulin secretion, decreasing glucagon secretion, and slowing gastric emptying, which results in weight loss.

• DPP-4 inhibitors inhibit the DPP-4 enzyme, preventing it from breaking down incretin hormones and glucagon-like peptide 1 (GLP-1), allowing them to regulate glucose by increasing insulin release and decreasing glucagon secretion.

• SGLT-2 inhibitors inhibit sodium-glucose co-transporter-2 proteins in the proximal convoluted tubules of the kidney, decreasing glucose reabsorption and increasing glucose excretion in urine.

• Alpha-glucosidase inhibitors delay intestinal carbohydrate digestion and absorption, reducing postprandial hyperglycemia, but have modest efficacy and can cause gastrointestinal side effects.

• Meglitinides increase insulin secretion by binding to a different location on the sulfonylurea receptor, but they can cause hypoglycemia, weight gain, and frequent dosing schedules.

• Common side effects of diabetes medications include nausea, vomiting, anorexia, diarrhea, flatulence, abdominal cramping, headaches, dizziness, and fatigue.

• Patients should be advised to take medications with food, rotate injection sites, monitor glucose levels frequently, report symptoms of hypoglycemia and pancreatitis, and avoid medications in certain conditions, such as renal impairment, liver disease, and pregnancy.

• Beers Criteria should be considered when prescribing diabetes medications to elderly patients, and drug interactions should be monitored, especially with medications that induce or inhibit CYP enzymes.Diabetes Management Cases and Questions

• Case 1: A patient is switched to Metformin ER and key counseling points include observing an empty shell in stool, monitoring for low blood sugar, and avoiding alcohol.

• Case 2: A patient with type 1 diabetes presents with tachycardia and trembling, but POC blood glucose levels are 84 mg/dL. The question asks whether the patient is experiencing hypoglycemia, and the correct answer is that the patient's glucose is >70 mg/dL and his levels at home are very high, putting him at little to no risk of hypoglycemia from insulin.

• Case 3: A patient with symptoms of polydipsia, polyuria, weight loss, and irritability is diagnosed with type 1 diabetes. The question asks which long-acting insulin to recommend, and the correct answer is insulin glargine.

• Case 4: The question asks about the mechanism of action of Ozempic, and the correct answer is that it mimics incretin hormone to activate GLPI receptors, increasing insulin secretion, decreasing glucagon secretion, and slowing gastric emptying.

• Case 5: A patient with uncontrolled diabetes and comorbidities is taking Metformin, Furosemide, Valsartan, and metoprolol succinate. The question asks which additional medication to recommend, and the correct answer is Dapagliflozin 10 mg.