Diabetes - Oral Hypoglycaemics

Question 1

Outline the broad initial steps of T2 Diabetes management

Answer 1

1) Patient Education - DESMOND programme
2) Lifestyle management - Exercise, diet
3) Screen for complications
4) Pharmacological therapies

Question 2

What is the target HBA1C for an adult T2 Diabetic managed by diet & lifestyle?

Answer 2

6.5% (48mmol)

Question 3

What is the target HBA1C for adult T2 diabetic managed by diet, lifestyle and a single drug not associated with hypoglycaemia?

Answer 3

6.5% (48mmol)

Question 4

For people who are taking a drug associated with hypoglycaemia?

Answer 4

7.0% (53mmol

Question 5

When do you need to step up diabetes management initially?

Answer 5

If HBA1C levels rise to >7.5% (58mmol) despite 1 drug & L & D

Question 6

When to relax HBA1c target? (2)

Answer 6

1) Operate or drive heavy machinery

2) People at risk of falls

Question 7

What drug should you initally offer for management of T2 Diabetes?

Answer 7

Metformin

Question 8

Name three other classes of diabetes drugs

Answer 8

Gliptin (DPP-4 inhibitor)
Pioglitazone
Sulfonylurea

Question 9

What is the mechanism of action of metformin?

Answer 9

1) Reduces gluconeogenesis in liver

2) Increases peripheral utilization of glucose & insulin sensitivity

Question 10

What type of drug is metformin?

Answer 10

Biguanide

Question 11

What monitoring must be done before starting on metformin?

Answer 11

U&Es - eGFR must be above 30ml/min to start otherwise risk of lactic acidosis

Question 12

What are two main side-effects of metformin?

Answer 12

Lactic acidosis
GI disturbance - nausea, vomiting, diahrrhoea
B12 deficiency

Question 13

What should happen to metformin before elective surgeyr?

Answer 13

Should be stopped 48 hours before surgery, and resumed 48 hours afterwards

Question 14

Name a gliptin

Answer 14

Sitagliptin

Question 15

What is the mechanism of action of Gliptins?

Answer 15

Gliptins are DPP-4 inhibitors. DPP-4 is an enzyme that degrades incretins which stimulate postprandial insulin secretion and suppress glucagon secretion

Question 16

Can gliptins be used in renal impairment?

Answer 16

Yes

Question 17

Give two adverse effects of gliptins

Answer 17

GI disturbances - nausea, vomiting, diarrhoea

Acute pancreatitis

Question 18

Name a gliatzone

Answer 18

Pioglitazone

Question 19

What is the mechansim of action of pioglitazone?

Answer 19

Reduces peripheral insulin resistance

Question 20

What are three things to check before starting pioglitazone?

Answer 20

1) Does the person have heartfailure?
2) Liver function
3) FBC - contraindicated in anaemia
4) History of bladder cancer

Question 21

What are three side effects of pioglitazones?

Answer 21

1) Fluid retention
2) Weight gain
3) Bladder cancer

Question 22

Name two sulfonylureas

Answer 22

Tolbutamide, glipizide

Question 23

What is the mechanism of action of sulfonylureas?

Answer 23

Stimulate insulin secretion from BIN cells in islets of langerhans

Question 24

Why be careful prescribing sulfonylureas in liver failure?

Answer 24

Reduced hepatic gluconeogensis - can exacerbate hypoglycaemia

Question 25

Give three adverse effects of sulfonylureas

Answer 25

Gastrointesintal disturbances
Hypersensitivity
HYPOGLYCAEMIA

Question 26

Name two other drugs not in NICE guidelines

Answer 26

GLP-1 mimetic

SLGT-1 inhibitors

Question 27

Namea GLP-1 mimetic

Answer 27

Exenatide

Question 28

What is the mechanism of action of GLP-1 mimetics?

Answer 28

Increase insulin release, inhibit glucagon

Question 29

What are the adverse effects of GLP-1 mimetics?

Answer 29

Gastrointestinal

Question 30

What is the mechanism of action of SLGT-1 inhibitors?

Answer 30

Inhibit SGLT transporters in renal tubule, prevent reabsorption