Diabetes drugs

Question 1

If Metformin is not bringing down the HbA1c sufficiently, what other options can be given?

Answer 1

In order of preference after Metformin:

1. Sulfonylureas (glibenclamide, gliclazide, glimepiride, glipizide, tolbutamide)
2. Pioglitazone
3. DPP4 inhibitors / gliptins (eg Sitagliptin)
4. SGLT2 inhibitors (canagliflozin, dapagliflozin, and empagliflozin)

Question 2

which diabetic drugs most associated with serious hypoglycaemia?

Answer 2

Sulfonylureas eg glicazide

because increase insulin conc

Question 3

side effects of sulfonylureas?

Answer 3

Hypoglycaemia - often fatal

Weight gain - DO NOT GIVE IF BMI IS HIGH eg >25

Question 4

If a patient has T2DM with proven CVD, which drugs do we prefer?

Answer 4

In addition to Metformin:

1. SGLT2 inhibitors - empagliflozin
2. GLP-1 (as combination therapy) - exanatide, liraglutide (once weekly INJECTION)

Question 5

what is HBA1C target with dual antihyperglycaemic therapy?

Answer 5

When two or more antidiabetic drugs are prescribed, an HbA1c concentration target of 53 mmol/mol (7.0%)

Question 6

If dual therapy is unsuccessful, treatment should be intensified again.

which regime should be used?

Answer 6

1. Metformin + Sulfonylurea (Gliclazide) + :a. DDP4
   b. Pioglitazone
   c. SGLT2

Question 7

when are GLP1 agonists used?

Answer 7

If triple therapy with metformin hydrochloride and two other oral drugs is tried and is not effective, not tolerated or contra-indicated

Use as part of a triple combination regimen with:

metformin hydrochloride + sulfonylurea

Question 8

what is contraindicated in heart failure and bladder cancer?

Answer 8

pioglitazone

Question 9

which diabetes drug is best in those with CKD?

Answer 9

DPP4 inhibitors- eg Sitagliptin

Question 10

MOA pioglitazone?

Answer 10

insulin sensitiser

Question 11

MOA metormin?

Answer 11

stimulates GLP1 which reduces basal and post prandial BMs

Question 12

how do we adapt insulin doses?

Answer 12

1. When making changes to insulin doses you should only increase or decrease in steps
   of approximately 10% and ensure that you have monitored for a response before
   making any further changes.
2. correction factor calculation