Diabetes (more questions)

Question 1

Type 2 diabetes, when do u add a second drug?

Answer 1

only add a second drug if the HbA1c rises to

58 mmol/mol (7.5%)

Question 2

Treatment of diabetic Neuropathy

what about the rescue therapy?

localised pain?

Answer 2

• first-line treatment: amitriptyline, duloxetine, gabapentin or pregabalin
• if the first-line drug treatment does NOT work try one of the other 3 drugs
• tramadol may be used as ‘rescue therapy’ for exacerbations of neuropathic pain
• topical capsaicin may be used for localised neuropathic pain (e.g. post-herpetic neuralgia)
• pain management clinics may be useful in patients with resistant problems

Question 3

what is Gastrointestinal autonomic neuropathy?

symptoms?

Tx?

Answer 3

damage to the nerves of the GI system

• symptoms include erratic blood glucose control, bloating and vomiting
• metoclopramide, domperidone or erythromycin (prokinetic agents)

Metoclopramide is a pro-kinetic drug that can improve gastric emptying