Note - Endocrania
Note - Endocrania
DM:
Type 1:
Destruction of B-cell in pancreases that produce insulin
# C-peptide test to determine if there still insulin production or not
# if there is no sufficient amount of insulin to take glucose inside the cell to produce energy à the body will break the fat to
produce ketone body as an alternative source of energy
Type 2:
Insulin resistant and deficiency, decrease insulin sensitivity in body cells
Diagnosed of DM:
• A1C > 6.5
• FBG > 126
Medication:
A. Oral:
1. Biguanide (metformin):
# SE: lactic acidosis, Metallic taste, decrease Vit B2, GI upset (take it with food)
# Avoid: with Iodinated contrast 48 hours. # Drug interaction: topiramate
# off label use: gestational DM, decrease weight, Poly cystic ovarian syndrome (PCOS)
# CI: lactic acidosis, renal failure. > 80 y: metformin consider CI, bc. Kidney function will decrease
2. Meglitinides: (repaglinide, Nateglinide). # CI: T1DM, DKA, cause hypoglycemia
3. Sulfonylurea: (Glipizide, Glimepiride, Glyburide) # CI: T1DM, DKA, Sulfa allergy, cause hypoglycemia
4. Thiazolidinediones: (pioglitazone, Rosiglitazone) # CI: HF, Hepatic failure, edema
5. SGLT-2I: (canagliflozin, Dapagliflozin, Empagliflozin) # Monitor: renal
6. DPP-4I: (Sitagliptin, Sexagliptin, Linagliptin) # Cause: Pancreatitis
B. Injection:
1. GLP-1: (Exenatide, Liraglutide) # Have adverse effect on thyroid
# Liraglutide it an FDA approved to decrease weight
2. Insulin # High risk medication
- Rapid (lispro, Aspart)
- Short (regular) # use IV in DKA
- Intermediate (NPH) # cloudy and can be mix with other insulin
- Long (detemir, Glargine)
Insulin dose:
T1DM: 0.3-0.6 U/kg/day
T2DM: 0.1-0.2 U/kg/day
Vaccination with Diabetic patient:
Vaccine in diabetic foot: TD ONLY
Vaccine in DM: Pneumonia, HBV, influenza
Diabetic insipidus:
• Vasopressin
• Desmopressin
# desmopressin also used in nocturnal enuresis and urine incontinence (UI)
DM in pregnant:
1st: insulin # NOT cross placenta
2nd: metformin
3rd: Glyburide # NOT cross placenta
DM & weight:
Approved medication: liraglutide
Off-label use: Metformin
Obesity: Orlistat
NOTE on DM:
# Medication can exaggerate blood glucose and cause hyperglycemia: Thiazide diuretic & statin
# Medication can exaggerate insulin effect and cause hypoglycemia: linezolid
# Medication masking the symptoms of hypoglycemic: Beta-Blockers
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Thyroid:
Hypothyroidism:
Diagnosis:
Primary Hypothyroidism: low T4, High TSH
Secondary Hypothyroidism: low T4, Low TSH
Subclinical Hypothyroidism: Normal T4, High TSH
Treatment: Levothyroxine
# t1/2: 7 days
# take on empty stomach (morning)
# Safe for pregnant but we should increase dose by 30%-50% in pregnancy
# you will see the effect on patient energy & lab
Hyperthyroidism:
Treatment:
A. Antithyroid agents: Methimazole, Propylthiouracil (PTU)
# in pregnancy {1st trimester PTU, 2nd & 3rd trimesters use methimazole}
# SE: Agranulocytosis, PTU à Hepatotoxic
B. Iodides: Potassium iodide (KI), Saturated Solution of Potassium iodide (SSKI)
Adrenal hormones: