Diabetes

Question 1

Metformin 
1/ Mechanism of Action & onset of effect 
2/ Indications 
3/ Precautions 
4/Side effects 
5/ How to titrate metformin? 
6/ Safe in breastfeeding? 
7/ Renal adjustment: 
a)CrCl 60–90 mL/minute 
b)CrCl 30–60 mL/minute 
c)CrCl 15–30 mL/minute

Answer 1

1/ decreases hepatic glucose production, decreases peripheral utilisation of glucose.
Onset to effect: 2 weeks
2/ T2DM/ PCOS
3/ CKD, don’t use in severe hepatic impairment
Pregnancy &Surgery –> Use Insulin
4/ Nausea, vomiting, diarrhoea, anorexia, abdominal cramps, malabsorption of B12
5/ Commence 500mg TDS, can increase to 850mg TDS
Controlled release tablet 500mg daily –> to 2g aily
6/ Yes
7/
a)CrCl 60–90 mL/minute, 2 g daily.
b)CrCl 30–60 mL/minute, 1 g daily.
c)CrCl 15–30 mL/minute, 500 mg daily.
(Ref: AMH)

Question 2

What is the causal relationship between Metformin and Lactic Acidosis?

Answer 2

There is no causal relationship, related agent (phenformin (a related biguanide) was withdrawn from the market for severe lactic acidosis.

Question 3

Sulfonylurea
1/ Mechanism of action
2/ Side effects 
3/ Pregnancy use? 
4/ Breastfeeding use?

Answer 3

1/ increases pancreatic secretion of insulin
2/ hypoglycaemia in elderly/ renal &heptic impairment
Other: nausea, diarrhoea, metallic taste, headache, rash
Rare: blood disorders, photosensitivity, hepatotoxicity
3/ Use insulin
4/ Avoid
(reference AMH)

Question 4

Sulfonylurea

1/ Contraindications

Answer 4

1/ Ketoacidosis
Type 1 diabetes
Acute illness (eg MI, coma, infection, trauma)—monitor blood glucose and urine ketones; substitute insulin treatment if glycaemic control is inadequate  

(reference AMH)

Question 5

Gliclazide

Dose?

Answer 5

1/ 40-320mg daily i 1 or 2 doses (upto 160mg daily as a single dose)

Controlled release
30mg daily, increase dose by 30mg daily, at not <2 week intervals, max dose =120mg

(reference AMH)

Question 6

Sulfonylurea (gliclazide)

30mg of controlled release tablet is equivalent to X of conventional tablet

Answer 6

80mg

reference AMH

Question 7

DPP4 Inhibitor that doesn’t require dose adjustment in renal failure?

Answer 7

Linagliptin (5mg daily)

Ref:AMH