Type 2 Diabetes Management and Medications
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Type 2 Diabetes Management and Medications

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Questions and Answers

Which pharmacologic class is considered the first choice for patients with new and uncomplicated type 2 diabetes?

  • Biguanides (correct)
  • Alpha-glucosidase inhibitors
  • Meglitinides
  • Thiazolidinediones

    • What is a common adverse effect of insulin therapy?

  • Nausea
  • Hypoglycemia (correct)
  • Weight gain
  • Kidney damage

    • Which of the following is NOT a known cause of dysglycemia?

  • Biguanides (correct)
  • Beta-blockers
  • Corticosteroids
  • Thiazide diuretics

    • What is a primary mechanism of action for sodium-glucose cotransporter 2 (SGLT2) inhibitors like Canagliflozin?

    <p>Reduce glucose reabsorption in the kidneys</p> Signup and view all the answers

    Which adverse effect is commonly associated with the use of thiazolidinediones?

    <p>Fluid retention</p> Signup and view all the answers

    What is the primary mechanism of action of alpha-glucosidase inhibitors like acarbose?

    <p>Inhibit intestinal alpha-glucosidases</p> Signup and view all the answers

    What is the effect of meglitinides like Repaglinide compared to sulfonylureas?

    <p>Lower overall risk of hypoglycemia</p> Signup and view all the answers

    Which of the following therapies is associated with a risk of lactic acidosis?

    <p>Metformin</p> Signup and view all the answers

    How do thiazolidinediones primarily affect glucose metabolism?

    <p>Enhance insulin sensitivity of fat cells</p> Signup and view all the answers

    What is the effect of acarbose on HbA1c levels?

    <p>1% or less</p> Signup and view all the answers

    Which of the following statements about metformin is TRUE?

    <p>It is usually the first line for type 2 diabetes.</p> Signup and view all the answers

    Which group of medications requires sufficient kidney function to maintain their antihyperglycemic effects?

    <p>SGLT2 inhibitors</p> Signup and view all the answers

    How do rapid onset insulin preparations function in diabetes management?

    <p>For postprandial insulin injections</p> Signup and view all the answers

    Which of the following is a unique risk associated with SGLT2 inhibitors?

    <p>Genitourinary infections</p> Signup and view all the answers

    What cardiovascular effect have SGLT2 inhibitors been shown to provide?

    <p>Reduced cardiovascular mortality</p> Signup and view all the answers

    Which side effect is commonly caused by alpha-glucosidase inhibitors?

    <p>Flatulence</p> Signup and view all the answers

    What caution is associated with the use of loop diuretics alongside specific diabetes medications?

    <p>Increased risk of hypotension</p> Signup and view all the answers

    What is a significant benefit of nonpharmacologic interventions in diabetes management?

    <p>Complement pharmacologic treatments</p> Signup and view all the answers

    Which of the following statements about dipeptidyl peptidase-4 inhibitors is true?

    <p>They do not alter cardiovascular risk.</p> Signup and view all the answers

    What is a potential adverse effect associated with glucagon-like peptide-1 receptor agonists?

    <p>Nausea upon initiation.</p> Signup and view all the answers

    In what way do sulfonylureas primarily function?

    <p>They stimulate insulin release from the pancreas.</p> Signup and view all the answers

    What is a characteristic effect of glucagon-like peptide-1 receptor agonists on body weight?

    <p>They induce weight loss.</p> Signup and view all the answers

    Which of the following is true regarding the safety profile of sitagliptin?

    <p>It rarely causes hypoglycemia.</p> Signup and view all the answers

    Which condition is a contraindication for the use of glucagon-like peptide-1 receptor agonists?

    <p>Severe renal impairment.</p> Signup and view all the answers

    What is the typical effect on HbA1c observed with most sulfonylureas?

    <p>It decreases by 1% to 1.5%.</p> Signup and view all the answers

    What is the primary mechanism of action for dipeptidyl peptidase-4 inhibitors?

    <p>Inhibit the enzyme responsible for the degradation of GLP-1.</p> Signup and view all the answers

    Study Notes

    Introduction

    • Focus is on type 2 diabetes (T2D)
    • Key element: insulin resistance leading to insulin deficiency and hyperglycemia

    Drugs causing dysglycemia

    • Beta-blockers (drugs ending in –olol)
    • Corticosteroids (prednisone)
    • HMG-CoA Reductase Inhibitors (drugs ending in statin)
    • Thiazide or loop diuretics (hydrochlorothiazide, furosemide)
    • Protease antiviral medications
    • Second-generation antipsychotics (olanzapine, quetiapine)

    Goals of therapy

    • Control symptoms
    • Maintain glycemic control
    • Prevent complications
    • Manage risk factors (hypertension, obesity, dyslipidemia)

    Pharmacologic choices

    • Nonpharmacologic interventions (diet, exercise) are essential
    • Self-monitoring is important

    Insulin

    • Human insulin and insulin analogues are preferred
    • Classified by onset and duration of action
    • Rapid-acting for postprandial injections or insulin pump use
    • Long-acting for basal infusion

    Insulin adverse effects

    • Hypoglycemia is the most common
    • Localized fat hypertrophy
    • Allergic reactions

    Biguanides

    • Metformin is generally the first choice for new and uncomplicated T2D
    • Decreases hepatic glucose production
    • Does not cause weight gain
    • Lowers HbA1c by 1-1.5%

    Biguanides adverse effects

    • Gastrointestinal side effects (nausea, diarrhea, discomfort)
    • Lactic acidosis risk in those with hepatic/renal disease
    • Vitamin B12 deficiency with long-term use
    • Low risk of hypoglycemia as monotherapy

    Alpha-glucosidase inhibitors

    • Acarbose inhibits intestinal alpha-glucosidases
    • Delays starch and disaccharide digestion, reducing postprandial glucose
    • Does not significantly affect lactase

    Acarbose

    • Requires TID dosing
    • Effective only with meals
    • Lowers HbA1c by 1% or less
    • Glucose, not sucrose, should be used for hypoglycemia treatment
    • Does not cause weight gain

    Acarbose adverse effects

    • Gastrointestinal side effects (flatulence, diarrhea, pain, cramps)
    • May reduce metformin bioavailability
    • Contraindicated in irritable bowel disorders

    Dipeptidyl Peptidase-4 Inhibitors

    • Generic ending: -gliptin
    • Sitagliptin is an example
    • Inhibit enzyme responsible for GLP-1 degradation
    • Indirectly act as incretin mimetics

    Dipeptidyl Peptidase-4 Inhibitors

    • Do not seem to alter cardiovascular risk
    • Lower HbA1c by 1% or less
    • Weight neutral

    Dipeptidyl Peptidase-4 Inhibitors adverse effects

    • Nasopharyngitis, hypersensitivity reactions
    • Rare pancreatitis and joint pain
    • Low interaction potential due to minimal cytochrome P450 inhibition
    • Low risk of hypoglycemia

    Glucagon-like Peptide-1 Receptor Agonists

    • Semaglutide and liraglutide are examples
    • Direct incretin mimetics by acting on GLP-1 receptors
    • Increase insulin secretion, suppress glucagon, slow gastric emptying, increase satiety

    Glucagon-like Peptide-1 Receptor Agonists

    • Usually subcutaneous injection, but oral semaglutide exists
    • Decrease HbA1c by 1-1.5%
    • Cause weight loss
    • Evidence suggests cardiovascular event prevention in both primary and secondary prevention

    Glucagon-like Peptide-1 Receptor Agonists adverse effects

    • Common GI side effects, especially nausea initially
    • Injection site reactions
    • Rare pancreatitis
    • Caution in heart rhythm disturbances and severe renal impairment
    • Contraindicated in pregnancy and those with medullary thyroid carcinoma or MEN type 2

    Sulfonylureas

    • Glyburide is an example
    • Generic names often begin with gly or gli
    • Insulin secretagogues, stimulating both basal and meal-stimulated insulin release
    • Generally add-on therapy to metformin, not monotherapy

    Sulfonylureas

    • Lower HbA1c by 1-1.5%
    • Variation within the class regarding effectiveness, hypoglycemia risk, and weight gain
    • Glyburide has higher hypoglycemia and weight gain risks
    • Cardiovascular event reduction unclear due to lack of evidence

    Sulfonylureas adverse effects

    • Weight gain
    • Prolonged hypoglycemia, especially in elderly or those with renal impairment
    • Beta-blockers can mask hypoglycemic symptoms

    Meglitinides

    • Repaglinide is an example
    • Another class of insulin secretagogues
    • Shorter duration of action than sulfonylureas
    • Similar effects and adverse effects as sulfonylureas
    • Lower hypoglycemia risk if meals are missed
    • More extensive metabolic drug interactions

    Sodium-Glucose Cotransporter 2 Inhibitors

    • Canagliflozin is an example
    • Prevent glucose reabsorption in the kidneys, leading to enhanced excretion
    • Do not cause weight gain (cause weight loss)
    • Lower HbA1c by 1% or less

    Sodium-Glucose Cotransporter 2 Inhibitors

    • Reduce cardiovascular mortality, adverse cardiovascular events, and hospitalization due to heart failure
    • Small blood pressure decrease
    • Require sufficient kidney function
    • Slow progression of nephropathy

    Sodium-Glucose Cotransporter 2 Inhibitors adverse effects

    • Increased risk of urinary tract infections
    • Hypotension due to reduced intravascular volume
    • Hyperkalemia
    • Diabetic ketoacidosis risk
    • Increased hypotension risk when used with loop diuretics

    Thiazolidinediones

    • Pioglitazone is an example
    • Agonists at PPARG receptors in the nucleus (particularly in adipose tissue)
    • Influence gene expression, upregulating GLUT4 transporters and lipoprotein lipase
    • Enhance glucose reabsorption and triglyceride hydrolysis
    • Exact mechanism not fully understood

    Thiazolidinediones

    • Increase peripheral glucose uptake
    • Enhance fat cell insulin sensitivity
    • Decrease hepatic glucose output
    • Reduce HbA1c by 1-1.5%
    • Associated with weight gain

    Thiazolidinediones adverse effects

    • Increased heart failure risk due to fluid retention and edema
    • Fractures (hip and wrist)
    • Worsened macular edema
    • Health Canada mandates patient counseling and written consent for rosiglitazone

    Sample question

    • Metformin is generally considered first-line therapy for most patients with type 2 diabetes.

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    Related Documents

    Pharmacology: Diabetes Lecture - PDF

    Description

    This quiz covers essential topics related to Type 2 diabetes (T2D), focusing on insulin resistance, pharmacologic therapies, and the various medications that can affect glycemic control. You'll learn about the goals of diabetes therapy, nonpharmacologic interventions, and the adverse effects of insulin. Test your knowledge on managing symptoms and preventing complications related to T2D.

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