Download Diabetes Cheat Sheet HANDOUT

Diabetes Cheat Sheet
HANDOUT
Rich Siegel, M.D., co-director, Tufts Medical Center's Diabetes Clinic
Types of Diabetes
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Type 1 diabetes – autoimmune destruction of pancreatic beta cells
Type 2 diabetes - combination of insulin resistance and relative insulin deficiency with dysfunction of multiple
organs including liver, fat, muscle, endocrine pancreas, kidney; most common type of diabetes
Gestational Diabetes - diabetes which occurs during a pregnancy and resolves with delivery; very high risk for
future type 2 diabetes
Maturity Onset Diabetes of Youth (MODY) – diabetes caused by a single gene defect, presenting usually under
the age of 40 in multiple generations
Diagnosis of Diabetes
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Fasting blood glucose (FBS) greater than or equal to 126 mg/dl
Hemoglobin A1C (HbA1C) greater than or equal to 6.5%
2 hour blood glucose greater than or equal to 200 mg/dl after a 75 gram glucose challenge (oral glucose
tolerance test)
Casual blood glucose greater than or equal to 200 mg/dl with symptoms
All tests should be confirmed by the same or a different test
“At risk for diabetes”
o Impaired fasting glucose - FBS 100-125 mg/dl
o Impaired glucose tolerance – 2 hour blood glucose 140-200 mg/dl after glucose challenge
o HbA1C 5.7-6.4%
Medications for Diabetes
Insulins
 Basal (background) insulins – keeps glucose levels down between meals and overnight
o NPH insulin (Humulin or Novolin N)
o Insulin Glargine (Lantus)
o Insulin Detemir (Levemir)
 Bolus (mealtime) insulins – keeps glucose levels down after meals
o Regular insulin (Humulin or Novolin R)
o Insulin Lispro (Humalog)
o Insulin Aspart (Novolog)
o Insulin Glulisine (Apidra)
 Premixed insulins – combination of basal and bolus insulins
o Humulin or Novolin 70/30 – 70% NPH and 30% Regular
o Humalog 75/25 – 75% Long acting Lispro and 25% Lispro
o Humalog 50/50 - 50% Long acting Lispro and 50% Lispro
o Novolog 70/30 - 75% Long acting Aspart and 25% Aspart
Non-insulin medications
 Insulin secretagogues – oral meds increasing insulin secretion from pancreatic beta cells
o Glyburide, Glipizide, Glimepiride (all generic) – once or twice daily
o Repaglinide (Prandin), Nateglinide (Starlix) – dosed at each meal
o Risk for hypoglycemia and weight gain
 Biguanide – oral medication which reduces glucose production at the liver
o Metformin (Glucophage and generic) as the only drug in the class
o First line medication indicated with lifestyle in guidelines for type 2 diabetes
o Weight neutral to minimal weight loss
o No hypoglycemia risk by itself or with medications other than insulin or insulin secretagogues
o ? Cardiovascular benefit, ? Benefit in selected cancers
 Thiazolidinediones (TZDs) – oral medication which improves insulin resistance at fat and muscle
o Pioglitazone (Actos and generic)
o Rosiglitazone (Avandia) - very restricted access making it effectively off the market; possible increased
cardiovascular risk
o Pioglitazone showed CV event benefit as secondary outcome in PROACTIVE trial
o May lead to weight gain, especially together with insulin
o Contraindicated in mid to late stage heart failure
o Risk for bone loss; ? risk for bladder cancer (taken off the market in France and Germany)
 Incretin related agents – on the market only since 2005; awaiting cardiovascular outcome trials
Page 2, “Diabetes Cheat Sheet” Handout
GLP-1 agonists – injectable medications which increase insulin release but only when sugars are high, slows
stomach emptying and inhibit appetite working at endocrine pancreas, GI tract and brain
 Exenatide (Byetta twice daily, Bydureon once weekly)
 Liraglutide (Victoza)
 Reduce glucose and weight
 Expensive at $200-300 per month
 Possible risk for pancreatitis, ? pancreatic cancer
 DPP-IV inhibitors – oral medications increase insulin release but only when sugars are high
 Sitagliptin (Januvia)
 Saxagliptin (Onglyza)
 Linagliptin (Tradjenta)
 Alogliptin (Nesina)
 Expensive at $200 per month
 Minimal side effects but also possible pancreatitis risk
Other medication classes
o Alpha glucosidase inhibitors – reduce postmeal glucose working in the intestines
 Acarbose (Precose), Miglitol (Glyset)
 Bile acid sequestrant – unknown mechanism of action
 Colesevelam (Welchol) – primary effect is to lower LDL cholesterol
 Amylin mimetic – reduce postmeal glucose by inhibiting glucagon, slowing gastric emptying
 Pramlintide (Symlin)
 Dopamine agonist – action in the brain though mechanism to lower glucose is not entirely clear
 Bromocriptine mesylate (Cycloset)
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From: http://healthjournalism.org/resources-tips-details.php?id=645#.VfNmqO9RFLA, accessed 9-11-15