Diabetes - Oral antidiabetic meds Flashcards
(45 cards)
1st choice in T2DM for overweight patients
metformin
advantages of metformin 3
does not give hypos
lower incidence of weight gain
lower plasma insulin concentration (what does this even mean?)
metformin is used unlicesnsed to treat
polycystic ovaries - initiated by a specialist
reduces weight gain
normalises menstral cycle
improve hirsutism
mode of action of metformin
decreasing gluconeogenisis, increasing peripheral utilisation of glucose
- only acts in the presence of endogenous insulin therefore some residual pancreatic function is required
metformin is contraindicated in …………… 2
ketoacidosis general aneasthsia (restart when renal funciton returns to baseline)
what test is metformin contraindicated in
iodine containing contrast media - can cause renal failure. This increases metformins risk of producing lactic acidosis
Main s/e of metformin
GI effects - slow increases in dose can improve tolerability
caution metformin in egfr under
45
target hba1c for diabetes
48-59
for those at risk of arterial disease less than 48
how long does hba1c measure the average of
2-3 months
1 drug class and two drugs PO that cause hypos
sufonylureas
nateglinide
repaglinide
when should pt with diebetes get an ACEi
nephropathy causing albuminurea or establish microalbuminurea
even if BP is normal
pt with diabetes are particularly suceptable to developping what electrolyte imbalance and therefore shouldnt recieve ACEi and ARB together
hypokalaemia
what effect can ACEi have on glycaemic control
when is this more likely (2)
potential the hypogylcaemic effect of insulin and PO diabetes meds
more likely in first weeks of treatment and in renal impairment
what are the treatments for painful diabetic neuropathy
1st-4th line
1st initially paracetamol or NSAIDs 2nd duloxetine 3rd amitryptiline or nortryptiline 4th pregabalin combination therapy of the above
are opioids useful for diabetic neuropathy pain
can be but usually initiated by a specilist (usually morphine, oxycodone or tramadol used. Tramadol may be tried while waiting for specialist referal)
what can we treat autonomic nephropathy diabeteic diarrhoea with?
tetracycline
codeine
treatments for neuuropathic postrural hypertension
increase salt intake
fludrocortisone
but this may cause uncomfortable oedema
glucosary sweating can be treated with
antimuscurinics
neuropathic oedema can be treated with
ephidrine
what causes DKA
too high glucose levels and not enough insulin
as a result body burns fatty acids for energy producing ketones
what is included in the treatment of DKA
glucose (once blood levels under 14 to avoid hypos)
fluids (inclu K - clear ketones, correct hypotension & electrolytes)
soluble insulin
How long should lifestyle be tried before using an oral antidiabetic drug
3 months
when adding insulin into an oral therapy when is it given
at night (long acting or isophane)
