This powerpoint is enclosed with information on Diabetes and Skin care as well as how sleep affects skin care. Diabetes is one of the most common medical conditions patients have. The risk factors of diabetes are family history, ethnicity (asian, hispanic, african american), obesity, lifestyle factors (exercise, smoking, diet, alcohol). The skin related hormones are HLA, melatonin, prolactin, estrogen, testosterone, and thyroid hormones. Some complications of diabetes are macrovascular and microvascular complications. The microvascular complications are retinopathy, nephropathy and neuropathy. Neuropathy is when there is a loss of function in your lower extremities due to the complication of the diseased state, which in this case is diabetes. To prevent complications of diabetic neuropathy, it requires taking great care of your feet. Some measures patients can take to make sure to wash their feet everyday, check the feet everyday to ensure there aren't any cuts or infections. Patients should also trim their nails to keep their feet clean. Along with doing all these things at home, patients are also advised to visit the podiatrist once a year for a regular physical foot exam to see if there is any loss of sensation on their feet.
Other skin complications of diabetes are diabetic dermopathy, diabetic blisters, digital sclerosis, etc. Diabetic dermopathy is when patients have dark brown scaly patches, which occurs from the changes in small blood vessels due to the diabetes itself. However, they are not harmful and no treatment is needed for this condition. Digital sclerosis is when patients develop thick waxy skin on the back of their hands. This happens due to the uncontrolled blood sugar levels and the only treatment for this condition is to bring down the sugar levels within range. Some ways to take care of your skin when you have diabetes is avoid very hot showers or baths. Make sure to keep the skin dry and clean. Dry skin can lead to itching which can cause scraping and cause infections. Therefore keep the skin moisturized. These are some ways to prevent skin complications, however, if these methods aren’t working, make sure to contact your doctor to get help.
References:
Diabetes and Your Feet. (2019, December 4). Retrieved from https://www.cdc.gov/diabetes/library/features/healthy-feet.html
Skin Complications. https://www.diabetes.org/diabetes/complications/skin-complications.
Diabetes Treatment – Non-Insulin Part 2
SGLT2 inhibitors work by inhibiting SGLT2 which is a transporter. “These transporters are an ideal target for the treatment of diabetes because they are responsible for roughly 90% of filtered glucose reabsorption. The normal renal threshold for reabsorption of glucose corresponds to a serum glucose concentration of 180 mg/dL. In patients with type 2 diabetes, this threshold can increase and the expression of the SGLT2 can be up-regulated causing a maladaptive response that worsens hyperglycemia” (NIH). The mechanism of SGLT2 inhibitors promotes glucose excretion through urine and decreases blood glucose concentrations leading to improved glycemic control and cardiovascular and renal protection.
Examples of SGLT 2 inhibiters are canagliflozin, dapagliflozin, empagliflozin, bexagliflozin, and ertugliflozin. These drugs all end with the suffix -gliflozin. They have showed benefits in patients with heart failure, CKD, and ASCVD. SGLT2 inhibitors are recommended for patients who have theses comorbidities. Some warnings associated with SGLT2 inhibitors is that they can cause ketoacidosis, genital mycotic infections, UTIs, and hypotension. The reason for increased risk of UTI and genital infections is the increased glucose excretion, which can lead to these side effects. With canagliflozin and bexagliflozin specifically, there is an increased risk of foot and leg amputations. Some side effects of SGLT2 inhibitors is that they cause increased urination and thirst. There is also a hyperkalemia risk with canagliflozin.
Sulfonylureas are insulin secretagogues which means they work by stimulating insulin secretion from the pancreatic beta cells to decrease postprandial blood glucose. Older first-generation sulfonylureas include drugs like chlorpropamide, tolazamide, and tolbutamide. These drugs have prolonged duration of action and have a higher risk of hypoglycemia, therefore they are not to be used. The sulfonylureas that can be used today are glipizide, glimepiride, and glyburide. These drugs all start with a G and end with and -ide. A contraindication to sulfonylureas is a sulfa allergy. Some warnings and sides effects of sulfonylureas are hypoglycemia, weight fain, and nausea. IT can be expected that sulfonylureas decreased A1C by 1-2%. Glipizide IR is to be taken 30 minutes before a meal and doses may need to be help if the patient is NPO. Glimepiride and glyburide are not recommended in elderly patients according to the Beer’s criteria.
Meglitinides are another class of drugs that also act as insulin secretagogues. They differ from sulfonylureas in that that have a faster onset (15-60 minutes) and a shorter duration of action. Examples of metglinides are repaglinide and nateglinide. Warmings and side effects of metglinides are hypoglycemia and weight gain. It is also advised that if a meal is skipped the dose should also be skipped. Repaglinide interacted with clopidogrel and is contraindicated with gemfibrozil.
DPP-4 inhibitors “prevent the enzyme DPP 4 from breaking down incretin hormones, glucagon-like peptide 1 and glucose insulinotropic polypeptide (GIP) which enhances the effects of these incretins” (UWorld RxPrep). This helps with glucose regulation because they increase glucose dependent insulin secretion and decrease glucagon secretion. Examples of DPP 4 inhibitors are sitagliptin, linagliptin, saxagliptin, and alogliptin. These drugs in the suffix -gliptan. DPP 4 inhibitors have a a warning of pancreatitis, severe arthralgia, acute renal failure, and risk of heart failure is seen in saxagliptin and alogliptin. DPP 4 inhibitors are not to be used with GLP 1 agonists because they have overlapping mechanisms.
UWorld RxPrep NAPLEX Review 2025 Chapter 44 Diabetes Page 584