Diabetes drugs tutorial Flashcards
what is an acceptable eGFR
60 and above
when should diabetics (T2) go on statins
when 40 (or younger if have cardiovascular problems)
how should dosage of metformin be adjusted as renal function decreases
should also be decreased
what level of eGFR should metformin be stopped
30
what does monocular vision cause
loss of vision depth
what must vision be to drive
better than 6/12 in one eye
must have 120 degrees of arc vision
I’ve woken up in the morning vomiting – I can’t keep anything down. Should I stop my insulin? I’m on Novomix30, 26 units, twice daily. Concern is DKA
Keep going with insulin, insulin requirement increases when your unwell
try and take carbs
what is the advice for T1DM and alcohol
Can drink just need to be careful, avoid drinks with high sugar content. Risk is hypoglycaemia , often later in the night as alcohol blocks the release of sugar from the liver.
can SUs cause hypos
yes
how do SUs affect weight
cause gain via appetite increase
do SUs need functioning B cells to work
yes
name the only biguanide
metformin
what are the roles of metformin
reduces hepatic gluconeogenesis
increases glucose uptake in skeletal muscle
reduces carb absorption
increases fatty acid oxidation
does metformin cause hypos
no
what are the most common SEs of metformin
anorexia, diarrhoea, nausea
why should metformin not be given to patients with renal or hepatic disease
as might cause lactic acidosis
what can metformin be combined with
SUs, insulin, glitazones
what are glitazones
thiazolidinediones (TZDs)
what do TZDs bind to and where
PPARgamma
in liver, adipose tissue and skeletal muscle
what is the role of TZDs
increase lipogenesis,
enhanced uptake of fatty acids and glucose
what are the most common side effects of TZDs
weight gain and fluid retention
why are TZDs contraindicated in patients with heart problems
as SE of fluid retention can exacerbate heart failure
what do TZDs double the risk of
fractures
what releases GLP1
L cells throughout ileum and colon
what does GLP1 do
when released stimulates insulin
what is exenatie
GLP1 receptor agonist
what is the action of GLP1 RAs
increase insulin secretion
suppresses glucagon secretion
slows gastric emptying
how do GLP1 RAs affect weight
causes loss
can GLP1 RAs cause hypos
yes
how are GLP1 RAs administered
injected before first and last meals of the day
what releases GIP
K cells in duodenum and proximal jejnum
what does DPP4 do
inhibits GIP and GLP1 - stops the release of insulin
what do DPP4 inhibitors do
competitively inhibit DDP4 = lowing blood sugar
how do DPP4 inhibitors affect weight
are weight neutral
how does metformin affect weight
causes weight loss
how much do oral agents lower HbA1c
by 1-2%
how does insulin affect weight
causes gain
when would you use a GLP1 analogue
if patients are very overweight
what drug is being used less and less
TZDs, should be low on the list when prescribing
what is the max metformin dose
3g in 24 hrs
should you give GLP1s in pregnancy
no
should you give TZDs in pregnancy
no
is metformin okay in pregnancy
yes
can you give SUs in pregnancy
no
should you give DPP4 agonists in pregnancy
no
is insulin okay in pregnancy
yes
what should expecting mothers with poor glycaemic control on metformin switch to
insulin therapy
