Chapter 6: Endocrine: Type 2 Diabetes Flashcards
What is T2DM characterised by?
Insulin resistance
Also causing an increase in cardiovascular risk, what is T2DM associated with?
- Obesity
- Physical inactivity
- Raised blood pressure
- Dyslipidaemia
- Tendency to thrombosis
When does T2DM usually develop?
In later life
What is the first line intervention of T2DM?
Lifestyle measures
Which lifestyle measures can be used to manage T2DM? (3)
- Smoking cessation
- Weight loss
- Exercise
Metformin does not stimulate release of insulin, therefore it has no risk of causing which adverse event?
Hypoglycaemia
What is the starting dose of metformin?
500mg OD after one meal for 1 week
500mg BD after two meals for 1 week
500mg TDS with all three meals
Why is metformin titrated gradually?
To reduce gastro-intestinal effects
If patients find metformin intolerable, what can be offered?
Modified release preparation
Which 5 drugs are in the sulfonylureas class?
- Glibenclamide
- Gliclazide
- Glimepiride
- Glipizide
- Tolbutamide
Which adverse effect can sulfonyureas cause?
Hypoglycaemia
Which sulfonylureas is hypoglycaemia more likely with? and why?
Glibenclamide
Long acting
Which oral antidiabetic has the poorest anti-hyperglycaemic effect?
Arcabose
Meglitinides are less preferred compared with sulphonylureas. Give two examples (DVLA)
- Nateglinide
2. Repaglinide
Which oral antidiabetic drug is associated with several long term risks and has 2 MHRA alerts?
Pioglitazone
What are the 2 MHRA alerts concerning pioglitazone?
- Cardiovascular safety
2. Bladder cancer
Incidence of heart failure is increased when pioglitazone is combined with which other antidiabetic drug?
Insulin
What should happen if a patient on pioglitazone has deteriorating cardiac status?
Discontinue treatment
Can pioglitazone be used in patients with heart failure or those with a history of heart failure?
No
Although pioglitazone carries a risk of bladder cancer, why is it still used?
Benefits outweigh risks
Due to its risk of bladder cancer, in which patients should pioglitazone note be used?
- Active bladder cancer
- Past history of bladder cancer
- Uninvestigated haematouria
In which group of patients should pioglitazone be used with caution, due to the risk of bladder cancer?
Elderly
After how long should the safety and efficacy of pioglitazone be reviewed?
3-6 months
If there is an inadequate response to treatment with which T2DM drug should treatment be discontinued?
Pioglitazone