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What should be the order of priority in managing DM pt's
- HTN
- Lipid
- Vasculopathic load
- Microalbuminemia
- Glucose
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What is the greatest cause of mortality in DM2 pt's
athersclerotic vascular dz
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DM have ___x greater risk for CVD
2-4
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DM pt's have ___x risk of stroke
3
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DM have increased risk of MI independent of prior MI. T/F
T
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3 ways of diagnosis
Sx of diabetes (polydipsia, polyuria, unexplained wt loss) plus:
- 1. fasting blood glucose >126
- 2. random blood glucose > 200
- 3. 2-hr OGTT glucose >200
- 4. HgbA1C > 6.5
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Definition of insulin resistance
Normal glucose and High insulin
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Name 2 drugs that act at GI tract
- Alpha glucosidase inhibitors
- Incretin mimetics
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Name 1 drug that act at adipose tissues
TZD's
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Name 4 drugs that act at pancreas
- Incretin mimetics
- DPP3 inhibitors
- Sulfonylurease
- Meglitinides
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Name 2 drugs that act at liver
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Name 2 drugs that act at muscle
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What does that ACCORD trial say about intensive glucose control
increases risk of death
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What does ADVANCE trial say about intense glucose control
works
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For pt's uncontrolled w/ metformin and lifestyle changes, what drugs should be used in next step
Insulin or Sulfonylurease
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Name two benefits of glargine compared w/ NPH
- 1. Less wt gain
- 2. Less nocturnal hypoglycemia
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Name 4 actions of mechanism of incretin
- 1. Increase insulin production
- 2. Decrease glucagon secretion
- 3. Delay gastric emptying
- 3. Increase satiety
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What is the goal of HTN for Diabetics
<130/80
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Name effects of Niacin on LDL, HDL, TG, HgbA1c
- Dec LDL
- Inc HDL
- Dec TG
- No effect on HgbA1c
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Can niacin be used in diabetics?
yes
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Diabetes is a CVD equivalent risk which means what %
20%
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Ramipiril has what other actions outside of lowering BP
anti-atherosclerotic, vasculoprotective effect
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What drugs in the PROGRESS trial was shown to reduce stroke by 43% in diabetic pt's
Perindopril and idipamide
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What are 3 benefits of ARB's in DM pt's
- 1. Reduce microalbuminuria
- 2. Reduce devel of diabetic nephropathy
- 3. reduce preogression to dialysis or transplant
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What drug is 1st line agent for pt's w/ DM who have HTN and renal dz
ACEI
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What drug may be useful in pt's who still have proteinuria after tx w/ ACEI
Spironolactonw
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What are current goals of DM: BP, A1C, LDL, urine albumin, TG
- BP < 130/80
- LDL < 100
- TG < 150
- A1c < 7
- Urine albumin < 30 mg/24hr
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What drug is almost solely used for DM1
Amylin analog
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alpha-glucose inhibitors
Mech of action
Advantages
SE
- Prevent carb breakdown
- Wt neutra; no hypoglycemia
- GI SE
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Metformin: what SE do you have to be really careful about? And how do you look out for this?
Lactic acidosis; so don't gave if Cr > 1.4 (F) and 1.5 (M)
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DDP4 inhibitors mech of action and contraindication
- Inhibits the enzyme which degrades incretin
- C/I in gastroparesis
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GLP1 agonist mech of action and advantage
- = incretin mimetic
- Stim pancreatic insulin synt
- Suppress glucagon secretion
- Slow gastric emptying
- Promote satiety
- Promote Bcell inc
- Advantage: wt loss
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Glitinides mech of action and SE
- stim pancreatic insulin secretion short term
- SE: wt gain
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Sulfonylureas mech of action and se's
- stimulate pancreatic insulin secretion
- Wt gain and hypoglycemia
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TZD's mec of action and SE
- Dec insulin resistance at peripheral tissue
- Fluid retention and wt gain so be cautious of CHF
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If a patient wants to lose weight what are 2 drugs?
- Byetta - incretin mimetic
- Metformin
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