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Endocrine Lecture

Why is C-peptide found in amounts equal to insulin in diabetes? Because insulin and C-peptide are linked when first made by the pancreas. The level of C-peptide in the blood can show how much insulin is being made by the pancreas.
C-Peptide level in type 1 diabetes will be: low, because no insulin is being produced
C-peptide level in type-2 diabetes will be: normal or high
biguanide (Metformin) gold standard for type 2 diabetes
Metformin dosage 500mg qd to bid up to 2000mg/d
Metformin ADR GI upset, lactic acidosis, 2 week onset
Metformin Benefits decreases blood sugar, weight loss, decreased vascular issues
Sulfonylureas (insulin secretagogues) glipizide (Glucotrol), glyburide (Diabeta), glimerpiride (Amaryl)
Sulfonylureas effectiveness work good for awhile but then start to creep up again
Sulfonylureas dosage most are BID (Amaryl qd, diabenese qod), take 30 minutes before meal. Do not skip meals!!!
Sulfonylureas caution Sulfa allergy, hepatic/renal failure, weight gain, GI distress, malnutrition, eating d/o, adrenal insufficiency.
Sulfonylureas benefits Rapid onset, cheap (generic) effective
Meglitinides- Repaglinide (Prandin) Nateglinide (Starlix) Can skip meals, good for irregular eating habits
Thiazolidinediones (TZDS) Pioglitazone (actos), Rosiglitazone (Avandia)
Avoid Avandia in: CHF and CAD
Actos and Avandia major ADR fluid retention, may give diuretic to overcome
Sitagliptin (Januvia) and Sazgliptin (onglyza) works on carb absorption, increase satiety, slow gastric emptying (expensive)
Januvia 100 mg q day
Onglyza 5 mg q day
Fasting glucose should be? 90-130mg/dl
A1C should be <6.5-7
Created by: 1096147201