Diabetes drugs

Question 1

should thiazolidinediones be used for T2DM in patients with heart failure?

Answer 1

Thiazolidinediones are associated with weight gain, oedema and fluid retention and should not be used in patients with moderate to severe (NYHA Class III or IV) heart failure.

Question 2

what is something you have to consider in thazolidinediones?

Answer 2

About 1/3 of T2DM patients do not respond to thiazolidinediones

Question 3

which oral hypoglycaemic does NOT cause hypoglycaemia

Answer 3

metformin

Question 4

if a patient has had longstanding T2 Diabetes and is on oral hypoglycaemic medications, however their HBA1c remains elevated what would you prescribe and how?

Answer 4

start prescribing insulin. Do not remove the oral hypoglycaemic medication- but make the patient aware of the possible risks of hypoglycaemia. Over time you can stop the sulfonylurea gradually.

Question 5

how is metformin cleared from the body?

Answer 5

renally excreted

Question 6

what happens if you prescribe metformin for a patient with renal impairment?

Answer 6

run the risk of lactic acidosis

Question 7

which diabetes medications are associated with increased risk of bone fracture in women?

Answer 7

Pioglitazone and rosiglitazone

Question 8

what do you use for diabetic retinopathy?

Answer 8

anti VEGF

Question 9

how does sulfonylurea work?

Answer 9

they increase insulin production from beta cells by acting on the ATPase channel that leads to depolarisation of the beta cell

Question 10

how might we try and prevent diabetic nephropathy?

Answer 10

Ace inhibitor and good blood pressure control

Question 11

what drug do we use in diabetes insipidus?

Answer 11

desmopressin

Question 12

what is the general basal bolus insulin protocol? think ratios short acting to long acting

Answer 12

Insulin is approx 0.5 units per kg of a person per day. So divide the patient’s body weight by 2 and thats the total insulin requirement. Next we need to deliver long acting insulin at night or in the morning, and short acting insulin before every meal. So 2/5 of the total insulin is long acting and 3/5 of the insulin is short acting. So 1/5 insulin is delivered prior to meals

Question 13

what type of drug is forxiga?

Answer 13

SGLT inhibitor

Question 14

what type of drug is exenatide?

Answer 14

GLP agonist. Incretin. Increases satiety, slows gastric emptying

Question 15

how do we treat severe hypoglycaemia?

Answer 15

dextrose and glucagon

Question 16

what is the relationship between beta blockers and hypoglycaemia?

Answer 16

Beta blockers blunt the adrenergic symptoms of hypoglycaemia.
Patients on insulin or sulfonylureas need to monitor adequately and be educated about the symptoms of hypoglycaemia. A beta blocker does not substantially increase risk of significant hypoglycaemia and provides substantial benefit in some conditions.