Diabetes Management and Therapeutics Flashcards
Why aren’t you as aggressive with HbA1c target in patient with Hx of IHD?
A hypoglycaemic event might trigger another ischaemic event
How do you screen for the risk of pancreatic complications prior to starting GLP-1 agonists?
Ask about Hx of pancreatic cancer
Ask about hx of unexplained pancreatitis
How do SGLT2 inhibitors promote glycosuria?
Inhibit glucose reabsorption in the kidneys
What are the long acting insulins?
Glargine (lantus)
Determir (levemir)
What are the current principles of glycaemic control over the course of a patient’s disease?
Tight control early <=7 (as low as 6 if otherwise healthy)
Loosen control later in the disease
What is the HbA1c cutoff for diagnosis of diabetes?
>6.5%
What is the best second line therapy in T2?
There is none, taylor to each patient
When are people “cured” of diabetes?
When they’ve had the disease for a short period, 2-5 years maximum
What did the DCCT study show?
Marked reduction in microvascular complications with good glucose control
A “legacy” effect of good glucose control at the start of the disease
How is insulin initiated in T2DM?
Basal long acting insulin
Which SU is prefered?
Gliclazide
What is the principle behind of basal bolus insulin?
Imitates the background physiological insulin level present in non-diabetics
What is novomix? What is the typical treatment regimen?
30% novarapid (aspart), 70% NPH (median acting)
Twice daily
What are the rapid acting insulins?
Aspart
Glulisine
Lispro
Which cohort of patients, T1 and T2, are more sensitive to insulin administration?
T1 - as they are still insulin sensitive
What is the limitations of alpha-glucosidase inhibitors?
GI side effects
What is the EGR cut off from dose reduction and ceasation of metformin?
<40 dose reduce
<30 cease
Why is twice a day, mixed insulin not ideal?
Risk of hypo’s if lunch isn’t eaten
High glycose late in the day
When optimizing someone’s insulin therapy, what should be done about the dose?
Keep it the same
What is the average insulin requirement in a type I patient?
0.5-1 unit per kilogram
What did the ACCORD trial show?
Aiming for a HbA1C of 6.4% increases mortality secondary to hypoglycaemic events
Reducing blood glucose affects which diabetic complications most?
Microvascular
Which diabetes drugs are the gliptins?
DPP4i
What is the evidence behind weight loss in diabetes?
5-10% weight loss will cause HbA1c reduction and reduced insulin requirement
