Diabetes medications

Question 1

What is first line for T2DM?

Answer 1

Metformin

Question 2

Why would you offer modified release metformin to a patient?

Answer 2

If they had GI side effects

Question 3

What are some side effects of metformin?

Answer 3

GI side effects + lactic acidosis

Question 4

What is second line for T2DM? (there are 4 drug classes)

Answer 4

DPP-IV inhibitor + pioglitazone or DPP-IV inhibitor + sulphonylurea or Pioglitazone + sulphonylurea
SGLT-2 inhibitors are used instead of sulphonylurea if it is not tolerated or the person is at risk of hypoglycaemia

Question 5

Name an example of a DPP-IV inhibitor

Answer 5

Sitagliptin, linagliptin, saxagliptin

Question 6

Name an example of a sulphonylurea

Answer 6

Gliclazide, glibenclamide

Question 7

Name an example of a SGLT-2 inhibitor

Answer 7

Dapagliflozin, canagliflozin, empagliflozin

Question 8

What is third line treatment for T2DM?

Answer 8

Triple therapy = metformin, DPP-IV inhibitor, sulphonylurea or
Metformin + pioglitazone + sulphonylurea (can add SGLT-2 inhibitor)

Question 9

When is rapid acting insulin taken? Name some examples

Answer 9

Taken just before or with a meal. Examples include novorapid, humalog, apidra

Question 10

What is the onset of action, time to peak effect and duration of effect of rapid-acting insulin?

Answer 10

Onset of action - 5-15 mins
Peak effect - 30-90 mins
Duration - 3-5 hours

Question 11

When is short acting insulin taken? Name some examples

Answer 11

Usually taken 15-30 mins before meals. Examples include humulin S, actrapid and insuman rapid

Question 12

What are some examples of mixed insulin?

Answer 12

Novomix 30, humalog mix25, humalog mix50 and humulin M3

Question 13

What are some examples of long-acting insulin?

Answer 13

Levemir, lantus and tresiba

Question 14

What strength are most insulins made in?

Answer 14

100 units/ml - insulin is always prescribed in units

Question 15

What is the NICE target for glucose control?

Answer 15

HbA1c <48mmol/mol (6.5%)

Question 16

At what HbA1c would a second drug be prescribed?

Answer 16

> 58mmol/mol (7.5%)

Question 17

What are the recommended blood glucose levels in adults?

Answer 17

4-9mmol/l

Question 18

What are the recommended blood glucose levels in children?

Answer 18

4-10mmol/l

Question 19

Once acutely managed, how is a patient’s insulin therapy managed in DKA?

Answer 19

A weight based fixed rate IV insulin infusion (FRIII)

STOP short acting insulin but continue long acting insulin

Question 20

How is hypoglycaemia managed first line?

Answer 20

Lift glucose liquid, glucose tablets, glucogel, pure fruit juice, sucrose can all be used and are first line in the community
If in hospital give IV glucose

Question 21

How is hypoglycaemia managed if blood glucose has not responded after 30-45 minutes?

Answer 21

IM glucagon or IV glucose (10%, 100-200ml)