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diabetes diagnosis medications algorithm endocrinology pharmacology diabetic differential drugs hypoglycemia management neuropathy pathophysiology primarycare targets causes ckd classification ddxof dm2
Mechanism of Action for Common Diabetes Medications • SGLT2i (Dapagliflozin) • TZD (Pioglitazone) • Biguanides (Metformin)
Mechanism of Action for Common Diabetes Medications • SGLT2i (Dapagliflozin) • TZD (Pioglitazone) • Biguanides (Metformin) • α-Glucosidase (Acarbose) • Biguanides (Metformin) • Sulfonylureas / Meglitinides • GLP-1 Receptor Agonists • DPP4i / Gliptins By Sarah Lyon @sarahthelyon #Diabetes #Medications #pharmacology #pathophysiology #endocrinology
Drugs causing hyperkalemia • Impaired release of renin: NSAIDs, Beta blockers, Cyclosporine, tacrolimus, Diabetes, Elderly •
Drugs causing hyperkalemia • Impaired release of renin: NSAIDs, Beta blockers, Cyclosporine, tacrolimus, Diabetes, Elderly • Angiotensin-converting enzyme inhibitors • Angiotensin receptor blockers • Impaired aldosterone mechanism: Adrenal disease, Heparin, Ketoconazole • Sodium Channel Blockers: Triamterene, Trimethoprim, Pentamidine • Aldosterone Receptor Blockers: Spironolactone, Eplerenone, Drospirenone #Drugs #hyperkalemia #medications #causes #differential #diagnosis
Diabetic Foot Guidelines: Test patients w diabetes for peripheral neuropathy using the Semmes-Weinstein test JAMA. 2017;318(14):1387-1388. doi:10.1001/jama.2017.11700 #Diagnosis
Diabetic Foot Guidelines: Test patients w diabetes for peripheral neuropathy using the Semmes-Weinstein test JAMA. 2017;318(14):1387-1388. doi:10.1001/jama.2017.11700 #Diagnosis #PrimaryCare #Diabetic #Neuropathy #Monofilament #Testing #Locations
Diabetic Peripheral Neuropathy - Pharmacotherapy Peripheral neuropathy is a common microvascular complication of diabetes. In clinic patients
Diabetic Peripheral Neuropathy - Pharmacotherapy Peripheral neuropathy is a common microvascular complication of diabetes. In clinic patients should receive an annual monofilament foot exam to screen for peripheral neuropathy. The ADA recommends duloxetine, gabapentin, or pregabalin as treatment options for peripheral neuropathy. Other options include venlafaxine or TCA's. Jarred Prudencio, PharmD - https://www.instagram.com/ambcarerx #Peripheral #Neuropathy #Diabetes #Pharmacology #Management #Medications
Diabetes Pathophysiology and Medication Targets The ominous octet is one concept that summarizes the different pathophysiologic pathways
Diabetes Pathophysiology and Medication Targets The ominous octet is one concept that summarizes the different pathophysiologic pathways that lead to hyperglycemia in type 2 diabetes. I've previously posted about it, but this post includes a reference of each of the commonly used diabetes medications and what part of the ominous octet it works on. Jarred Prudencio, PharmD - https://www.instagram.com/ambcarerx #Diabetes #Pathophysiology #Medication #Targets #Drug #Endocrinology
Type 2 Diabetes - Screening, Diagnosis and Management Algorithm Lifestyle Modifications (Diet and Exercise) -> Start
Type 2 Diabetes - Screening, Diagnosis and Management Algorithm Lifestyle Modifications (Diet and Exercise) -> Start Oral Hypoglycemic (First Line: Metformin) -> Start Second Oral Hypoglycemic -> Start Basal Insulin qhs (D/C Secretagogues after starting insulin) -> Start PostPrandial Insulin A1c Targets: • 7.1 – 8.5 % - Recurrent severe hypoglycemia, Limited life expectancy, Frail elderly ± with dementia • 7.1 – 8.0 % - Functionally dependent • ≤ 7.0 % - Most adults • ≤ 6.5 % - Reduces Risk of Complications Risk Factors: • Age >= 40 • 1st degree relative with DM2 • High risk population (Aboriginal, Asian, South Asian, African, Hispanic) • History IFG, IGT • Presence of complications associated with DM • Presence of vascular risk factors (Dyslipidemia, Hypertension, Overweight, Abdominal obesity) • Gestational Diabetes OR macrosomic infant • Secondary Causes: Endocrinopathies (Cushing Syndrome, PCOS), Pancreatic Disease (CF, pancreatitis), Infections (CMV, Rubella) • Medications (Glucocorticoids, Atypical antipsychotics, HAART) - Amy Chung, MD, MSc @AmyChung #Diabetes #Screening #Targets #Management #algorithm #DM2 #DMII #Classification #primarycare
Hypoglycemia - Evaluation Algorithm Interpreting Hypoglycemia Labs - the patient must be hypoglycemic at the time of
Hypoglycemia - Evaluation Algorithm Interpreting Hypoglycemia Labs - the patient must be hypoglycemic at the time of testing Beta-Hydroxybutyrate - Is there an insulin-like substance? → Non-insulin/lGF-mediated Insulin - Is it insulin? → IGF-2 - Malignancy (islet cell tumor, paraneoplastic) C-Peptide, Proinsulin - Is it endogenous? → Exogenous Insulin Oral Hypoglycemic Screen - Is there a sulfonylurea? → Oral Hypoglycemic Insulinoma, NIPHS, Post-Gastric Bypass - BWH Medicine Chiefs @BrighamChiefs #Hypoglycemia #Evaluation #Algorithm #workup #diagnosis #endocrinology
Summary of dosing recommendations in renal impairment of commonly used hypoglycaemic agents #Diabetes #Diabetic #Medications #Pharmacology #Dosing
Summary of dosing recommendations in renal impairment of commonly used hypoglycaemic agents #Diabetes #Diabetic #Medications #Pharmacology #Dosing #Dosing #Renal #Impairment #CKD #Table #GFR #Hypoglycemics
Differential Diagnosis of Hypoglycemia Evaluation of Hypoglycemia Patients with known diabetes who are not systemically ill and can
Differential Diagnosis of Hypoglycemia Evaluation of Hypoglycemia Patients with known diabetes who are not systemically ill and can identify a clear precipitant, no extensive workup is required. In severely ill patients, consider: - BMP - LFT - EtOH - Infectious workup: CXR, UA, urine and blood cultures - ECG, troponin - Other studies: insulin, C-peptide, pro-insulin, glucagon, growth hormone, cortisol, B-OH, insulin antibodies #Diagnosis #EM #IM #Hypoglycemia #Differential #Algorithm #Drugs #Malignancy #Exogenous #Hypoglycemic #Ddxof
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