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capnhue
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Metformin
- Black Box: Lactic Acidosis
- Contra: Scr 1.4 Females / 1.5 males
- S/E: vitamin B12 deficiency
- Notes: hold prior to IV contrast dye and wait 48 hrs
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Sulonylureas
- MOA: stimulates insulin secretion from pancreatic beta cells
- glipizide - glucotrol
- glimepiride - amaryl
- glyburide - diabeta/micronase
- chlorpropamide - diabinese
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Sulonylureas
- glyburide - Contra: CrCl - <50ml/min
- S/E: hypoglycemia, weight gain
- Notes: after 3 yrs efficacy decreases
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Meglitinides
- Repaglinide - Prandin
- Nateglinide - Starlix
- Similar MOA to sulonylureas - Do NOT use with sulonylureas
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Thiazolidinediones (TZDs)
- MOA: PPARy (peroxisome proliferator-activated receptor gamma) agonists increase peripheral insulin sensitivity
- pioglitazone - Actos
- rosiglitazone - Avandia
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TZDs adverse effects
- Black Box: may cause Heart Failure, Do NOT use in NYHA class III/IV heart failure
- Warnings: bladder cancer
- S/E: peripheral edema, weight gain, URTIs
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Alpha Glucosidase Inhibitors
- acarbose - Precose
- miglitol - Glyset
- Contra: IBD, intestinal obstruction
- S/E: GI
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DPP-4 Inhibitors
- MOA: Prevents DPP-4 enzyme from breaking down incretin hormones, GLP-1 and GIP. Increasing these hormones
- sitagliptin - Januvia
- metformin/sitagliptin - Janumet
- saxagliptin - Onglyza
- linagliptin - tradjenta
- aloglipitin - Nesina
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DPP-4 Inhibitors
- S/E: nasopharyngitis, URTIs, UTIs, hypoglycemia
- Notes: weight neutral
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Medications that can cause hypoglycemia?
- sulonylureas
- meglitinides
- DPP-4 inhibitors
- SGLT2 inhibitor (canagliflozin)
- GLP-1 agonists
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SGLT2 Inhibitor (Sodium Glucose Co-Transporter-2)
- MOA: in the proximal renal tubules inhibits the reabsorption of glucose, increases glucose excretion
- canagliflozin - Invokana
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canagliflozin - Invokana
- Contra: CrCl - <30ml/min, ESRD / dialysis
- S/E: female genital mycotic infections, UTIs, hyperkalemia, increase urination, hypoglycemia
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GLP-1 (Glucagon-like peptide-1) agonists
- MOA: analogs of glucagon-like peptide-1, increases insulin secretion and decreases glucagon secretion
- exenatide - Byetta
- exenatide ER - Bydureon
- liraglutide - Victoza
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GLP-1 adverse effects
- Black Box: Thyroid C-cell carcinomas
- Warnings: pancreatitis, gallstones, avoid in CrCl < 30ml/min
- S/E: weight loss, hypoglycemia
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Rapid-acting insulins
- lispro - Humalog
- aspart - Novolog
- glulisine - Apidra
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Regular or "short-acting" insulin
- Regular Insulins
- Humulin R
- Novolin R
- OTC
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Long-Acting Insulin
- detemir - Levemir
- glargine - Lantus
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Insulin Dosing
- Typical starting dose: 0.6units/kg/day
- basal-bonus insulin: 50% of TDD for basal insulin. 50% for bolus divided among 3 meals
- NPH-regular insulin: 2/3 for NPH dose and 1/3 for regular insulin dosed BID
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Rule 500 rapid, rule 450 regular
- 500 / TDD = gms of carb covered by 1 unit of rapid insulin (what are your rapid insulins)
- 450 / TDD = gms of carb covered by 1 unit of regular insulin (what are your regular insulins)
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Correction Factor dosing
- 1800 rule: 1800 / TDD = correction factor for 1 unit of rapid acting insulin
- 1500 rule: 1500 / TDD = correction factor for 1 unit of regular insulin
- Correction dose: (blood glucose now - target blood glucose) / correction factor
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