12 Diabetes Treatment

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A1C

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• A1C < 9 or 10

Biguanides

_Aka metformin.,

_Oral therapy..

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• decrease liver gluconeogenesis

• decrease free FA, triglycerides for gluconeogenesis

• decrease glucose absorption in GI

• increase insulin sensitivity.,

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Biguanides (metformin) repress hepatic gluconeogenesis and increase peripheral insulin sensitivity and utilization of glucose. (Although unclear, the proposed mechanism of biguanides (metformin) is that they activate AMP-activated protein kinase (AMPK), which increase expression of a small heterodimer partner (SHP). SHP inhibits expression of liver phosphoenolpyruvate carboxykinase (PEPCK) and glucose-6-phosphatase, thus repressing hepatic gluconeogenesis).

• Mail box: increased insulin effect. AMPKinase in liver bag..

_Advantages:

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• Other drugs can have weight gain

• Other drugs that causes more insulin secretion won't work in advanced patients

• Skinny kid:

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• from reduced glucose absorption

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• Green face, milk container, renal insufficiency:

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• Lactic acidosis:

• Not given to patients with renal failure, in hopsital, or using CT contrast..

Sulfonylureas

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• 1st gen: mide > maid

• 2nd gen: ride > riding on back

• 3rd gen: zide > Z

_SE

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• chlorpropamide 1st generation

• Disulfiram for alcohol abuse

• hypoglycemia candy and old fat lady; Do not drink:

Meglitinides

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• glinides: gliding goose

Thiazolidinediones

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• Glitter in the zone

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• Binds PPAR-gamma

• End result is increase Glut-4, adiponectin, decrease TNF-alpha

• Intracellular PPAR:

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• Binding of PPAR-gamma receptor leads to:

• puts lipid and FA into adipocytes. Adipocyte enlargement

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• Glut 4 mail box and turtle neck

• Eats more FA

_SE

• weight gain

• hepatotoxicity

• edema.,

• adipocytes have highest PPAR receptors

• Big pants edema, heart failure, bone fracture, fat kid

Glucosidase Inhibitors

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• A-carb

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• a-glucosidase hydrolyzes 1-4 bonds

• only monosaccharides can be absorbed in intestines

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.,

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• from glucose excretion, like lactose intolerance

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Amylin Analogs

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• glucagon wrappers, stomach sealed

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[_](Amylin analogs given how, when, and why it's special)

• injected

• 1 and 2 fingers

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• glucagon and low insulin can cause hypoglycemia

• falling sugar balls

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Incretins

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Reason why oral glucose metabolized faster than IV glucose.,

_Includes:

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• glucagon on floor. Sealed stomach

GLP-1 Analogs

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• Tide and Gulp

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• pancreatitis

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stimulates insulin release because GLP

DPP-4 Inhibitors

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• may interfere with immune sys

• Gliptin on nose

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• Gliptin clips

SGLT2 Inhibitors

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• Pro cart track: PCT

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• flossing

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• new and expensive

• weight loss from excreting glucose/calories

• osmotic diuretics: helps with heart failure

• candidiasis/UTI: glucose in urine = food

• renal disease: more work on kidney

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• Pts with renal, heart, liver failure are ok with insulin