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    Type 2 DM

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    disgurlistaken
    This document discusses different agents for managing type 2 diabetes mellitus. It describes glucose-lowering medications that work by increasing insulin secretion, decreasing glucose production, increasing glucose sensitivity, enhancing GLP-1 action, and promoting urinary glucose excretion. The major classes of agents covered are biguanides, sulfonylureas, GLP-1 receptor agonists, alpha-glucosidase inhibitors, thiazolidinediones, SGLT2 inhibitors, and insulin. Guidelines for initial therapy and combination therapy based on degree of hyperglycemia are provided. Potential adverse effects are also mentioned.

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    Type 2 DM

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    disgurlistaken
    3 views27 pages
    This document discusses different agents for managing type 2 diabetes mellitus. It describes glucose-lowering medications that work by increasing insulin secretion, decreasing glucose production, increasing glucose sensitivity, enhancing GLP-1 action, and promoting urinary glucose excretion. The major classes of agents covered are biguanides, sulfonylureas, GLP-1 receptor agonists, alpha-glucosidase inhibitors, thiazolidinediones, SGLT2 inhibitors, and insulin. Guidelines for initial therapy and combination therapy based on degree of hyperglycemia are provided. Potential adverse effects are also mentioned.

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    This document discusses different agents for managing type 2 diabetes mellitus. It describes glucose-lowering medications that work by increasing insulin secretion, decreasing glucose production, increasing glucose sensitivity, enhancing GLP-1 action, and promoting urinary glucose excretion. The major classes of agents covered are biguanides, sulfonylureas, GLP-1 receptor agonists, alpha-glucosidase inhibitors, thiazolidinediones, SGLT2 inhibitors, and insulin. Guidelines for initial therapy and combination therapy based on degree of hyperglycemia are provided. Potential adverse effects are also mentioned.

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    3 views27 pages

    Type 2 DM

    Uploaded by

    disgurlistaken
    This document discusses different agents for managing type 2 diabetes mellitus. It describes glucose-lowering medications that work by increasing insulin secretion, decreasing glucose production, increasing glucose sensitivity, enhancing GLP-1 action, and promoting urinary glucose excretion. The major classes of agents covered are biguanides, sulfonylureas, GLP-1 receptor agonists, alpha-glucosidase inhibitors, thiazolidinediones, SGLT2 inhibitors, and insulin. Guidelines for initial therapy and combination therapy based on degree of hyperglycemia are provided. Potential adverse effects are also mentioned.

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    of 27

    TYPE 2 DIABETES

    MELLITUS
    MANAGEMENT
    GLUCOSE LOWERING AGENTS
    • Increased Insulin Secretion
    • Decreased Glucose Production
    • Increased glucose sensitivity
    • Enhance GLP1 Action
    • Promote Urinary Excretion of Glucose
    GLUCOSE LOWERING AGENTS
    • BIGUANIDES
    • INSULIN SECRETAGOGUES- THAT AFFECT POTASSIUM CHANNEL
    • INSULIN SECRETAGOGUES- ENHANCE GLP-1 RECEPTOR SIGNALING
    • ALPHA GLUCOSIDASE INHIBITORS
    • THIAZOLIDINEDIONES
    • SGLT2 INHIBITORS
    BIGUANIDES
    Metformin
    • Trade Names: Glucophage, Glucophage XR ®
    BIGUANIDES
    INSULIN SECRETAGOGUES
    (ATP-SENSITIVE K CHANNELS)
    FIRST GEN SULFONYLUREAS
    • Trade Names:
    • Tolbutamide (Orinase ®, Oramide ®)
    • Chlorpropamide (Diabinese ®)

    • SECOND GEN SULFONYLUREAS


    • Drugs & Trade Names:
    • Glimepiride (Amaryl ®)
    • Glipizide (Glucotrol ®, Glucotrol XL ®)
    • Glyburide (DiaBeta ®, Micronase ®)
    INSULIN SECRETAGOGUES
    (ENHANCE GLP1 SIGNALING)
    ALPHA GLUCOSIDASE INHIBITORS
    Acarbose
    • Trade Names: Precose ®
    Miglitol
    • Trade Names: Glyset ®
    THIAZOLIDINEDIONES
    THIAZOLIDINEDIONE
    Rosiglitazone
    • Trade Name: Avandia ®
    Pioglitazone
    • Trade Name: Actos ®
    SODIUM GLUCOSE COTRANSPORTER 2
    (SGLT2) INHIBITOR
    SODIUM GLUCOSE COTRANSPORTER 2
    (SGLT2) INHIBITOR
    Canagliflozin (Invokana ®)
    • Trade Names: Invokana ®
    INSULIN
    INITIAL THERAPY IN:
    • Lean individuals/severe weight loss
    • Individuals with hepatic/renal disease
    • Acutely ill patients/hospitalized patients

    • single dose of long-acting insulin (0.2–0.4 U/kg per day), given in the
    evening or just before bedtime (NPH, glargine, detemir, or degludec)
    CHOICE OF INITIAL GLUCOSE
    LOWERING AGENT
    MILD HYPERGLYCEMIA (<7.0–11.0 mmol/L [126–199 mg/dL])
    single, oral glucose-lowering agent

    MODERATE HYPERGLYCEMIA (FPG 11.1–13.9 mmol/L [200–250 mg/dL])


    require more than one oral agent or insulin.

    SEVERE HYPERGLYCEMIA(FPG >13.9 mmol/L [250 mg/dL])


    may respond partially but are unlikely to achieve normoglycemia with oral
    therapy. INSULIN MAY BE USED
    COMBINATION THERAPY
    • metformin + second oral agent
    • metformin + GLP-1 receptor agonist,
    • metformin + insulin,
    • combinations of a long-acting insulin + GLP-1 receptor agonist.
    ADVERSE EFFECTS OF
    THERAPY
    DIABETIC KETOACIDOSIS

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