Diabetes and Medication

Question 1

Treatments

Answer 1

• Monotherapy- First Line
  1) Metformin (e-GFR <30mls/min)
• Dual Therapy: Patient has HF/Atherosclerotic occlusion- consider:
  1) DPP-4 i (gliptins)
  2) Sulfonylurea (gliclazide)
  3) SGLT2 i (Dapa,empa, cana)
• Triple therapy
  1) Biguanide (Metformin)2) DPP-4 i (gliptins) or Sulfonylurea (gliclazide) or SGLT2 i
  (Dapa,empa, cana)3) Insulin based treatment4) GLP-1 - If met + 2 other oral not effective
  - BMI > 35kg/m2

Choosing Drug Treatment:
1) Co-morbidities/Contraindication/Weight
2) Individual Preferences
3) Effectiveness/Metabolic response
4) Safety and Tolerability
5) Monitoring
6) Licensed
7) Cost

Question 2

Class of Drugs and Mechanism of Actions

Answer 2

1) Biguanide - Metformin
- Preventing the liver from converting fats and amino acids into
glucose
- Activate an enzyme (AMPK) which helps cells respond to insulin more effectively to insulin and take in glucose from the blood.

2) DPP- 4 i (Dipeptidyl peptides-4) - Gliptins
- Inhibit DPP-4 activity in peripheral plasma
- Prevents inactivation of the incretin hormone gluconlike-peptide
(GLP-1)

3) Sulfonylurea (Glicazide)
- Directly stimulate release of insulin from pancreatic beta cells and
thereby lower glucose concentrations

4) SGLT-2 i Sodium Glucose co-transporter 2 inhibitor
(cana,Dapa,empa)
- Block glucose re-absorption- urinary glucose excretion
Advantages
1) Hyperglycaemia
2) ? hypoglycaemia
3) Weight Loss
4) Blood Pressure

Contraindication:
Inc risk of diabetic ketoacidosis DKA
Body cannot use sugar for energy and starts using fat- ketones are released.

5) GLP-1 i (Glucagon-Like Peptide- 1)- Semaglutide
- Stimulate glucose- dependent insulin release from pancreatic
islets
- slow gastric emptying food intake

Question 3

Diabetic ketoacidosis (DKA)

Answer 3

DKA Signs:
1) Fast breathing
2) Dry skin and mouth
3) Smelling breath
4) Headache
5) Muscle stiffness
6) Tiredness
7) Nausea and vomiting

Treatment:
1) Insulin
2) Fluid

Question 4

Diabetes/ CKD/CARDIOVASCULAR

Answer 4

Additional Medication Heart/Kidney Protection
1) RAAS blockade (HTN)
2) Statins
3) GLP-1 i
4) Antiplatelet (CVD)
5) MRA (T2 D)

Question 5

Elevated HBA1c (53mmol/mol)

Answer 5

1) Diet- re-enforce diet advise
2) Adherence to drug therapy

Management:
1) Self Management- Capillary Blood Glucose - Glucometer
2) Continuous Glucometer- Free Style Libre