Diabetes: Management

Question 1

What is drug is first line for DM2?

Answer 1

Metformin

Question 2

How does metformin work?

Answer 2

Increases sensitivity to insulin & decreses glucose production in the liver

Question 3

What are is the most common reason for people not tolerating metformin?

Answer 3

GI upset

Question 4

When is metformin contraindicated?

Answer 4

In renal failure & AKI

Question 5

How should someone take metformin?

Answer 5

Swallow tablets whole with a glass of water with or after food

Question 6

What can help if someone is experiencing GI upset on metformin?

Answer 6

Changing to a modified-release preparation

Question 7

What drug class is an alternative first-line treatment if metformin isn’t tolerated?

Answer 7

Sulphonylurea (SU)

Question 8

Give 2 examples of SUs

Answer 8

Glicazide & glimepiride

Question 9

How do SUs work?

Answer 9

Stimulate pancreatic insulin secretion

Question 10

What are three side effects of SUs?

Answer 10

Hypoglycaemia
Weight gain
GI upset (usually mild & infrequent)

Question 11

What are options for additional drugs (e.g. used in triple therapy)

Answer 11

Gliptins (DPP-4 inhibitors)
Pioglitazone
SGLT-2 inhibitors
GLP-1 Agonist
Insulin

Question 12

Give two examples of gliptins (DPP-4 inhibitors)

Which one is safe in renal impairment?

Answer 12

Linagliptin (safe in renal impairment)

Sitagliptin

Question 13

How do gliptins (DPP-4 inhibitors) work?

Answer 13

Increase insulin secretion and decrease glucagon secretion (so reduce glycogen breakdown)

Question 14

What are 2 side effects of gliptins (DPP-4 inhibitors)?

Answer 14

Pancreatitis

Weight loss

Question 15

How does pioglitazone work?

Answer 15

Preserves B cell function & reduces insulin resistance

Question 16

What type of cancer is pioglitazone associated with?

Answer 16

Bladder cancer

Question 17

When is pioglitazone contraindicated?

Answer 17

Heart & liver failure

Bladder cancer

Question 18

What is a side effect of pioglitazone?

Answer 18

Increased risk of long bone fractures

Question 19

How do SGLT2 inhibitors work?

Answer 19

Increase resabsorption of glucose, therefore increase glucose excretion in urine

Question 20

What are 3 SEs of SGLT2 inhibitors? (think inc glucose in wee)

Answer 20

Thrush
UTI
Weight loss

Question 21

Give two examples of SGLT2 inhibitors

Answer 21

Dapagliflozin

Canagliflozin

Question 22

Which SGLT2 inhibitor increases DKA risk?

Answer 22

Canagliflozin

Question 23

How do GLP-1 agonists work?

Answer 23

Incretin mimetics: slow gastric emptying

Question 24

How is GLP-1 delivered?

Answer 24

S/C injection

Question 25

What is a side effect of GLP-1?

Answer 25

weight loss

Question 26

When would you consider adding insulin?

Answer 26

If HbA1c still not well controlled/ Beta cell failure

Question 27

Which medications can cause weight gain?

Answer 27

Pioglitazone (due to water retention)

Sulfonlyureas

Insulin

Question 28

Which medications can cause weight loss?

hint: the ones with numbers in them

Answer 28

DPP4 inhibitors (gliptins)

SGLT2 inhibitors

GLP-1 agonists

Question 29

Which medications can cause hypos?

Answer 29

Sulfonylureas

Question 30

What should you check for in a diabetic foot exam?

Answer 30

Ulcers
Callouses (may hide ulcers)
Hammer toe (more likely to rub on shoes)
Charcot foot 
Haemosidin deposition