Diabetes Therapeutics

Question 1

how to prevent macrovascular complications?

Answer 1

statin, exercise, lifestyle

Question 2

what is DCCT?

Answer 2

diabetes complication and control study, done in 1993

Question 3

results of DCCT-EDIC

Answer 3

Legacy effect: early glycaemic control = less microvascular complications
Both Type I and II (UKPDS)

Basically: aim for early and aggressive control

Question 4

what happened in the ACCORD trial?

Answer 4

DM2 aimed for Hba1c of 6.4%: increased mortality due to severe hypoglycaemic episodes

Question 5

preg, what should HbA1c be?

Question 6

if having a lot of hypos, what should HbA1c be?

Question 7

Type I diabetes insulin giving is different how to Type II?

Answer 7

Type1 have absolute dependence so any insulin given to type 1 will be felt, no insulin resistance

Question 8

PRinciples of insulin type 1 diabetes? which is preferred?

Answer 8

basal then bolus regimen post meals

Question 9

insulin in body is secreted how?

Answer 9

pancreas to portal vein straight to liver

Question 10

what is major contributor to HbA1C if you’re really well controlled?

Answer 10

post prandial glucose

Question 11

2 long acting insulins are?

Answer 11

detemir:
glargine: lantus

Question 12

Principal of DMII therapy?

Answer 12

1. weight loss: 5-10% (bariatric surgery could cure DMII if early and fast weight loss)
2. exercise
3. Meds: mono, dual, triple–> Insulin

Question 13

renal impairment, careful with which DMII drug?

Answer 13

metformin

Question 14

what DMII drug lose weight?

Answer 14

GLP-1 : exanitide

DPP4i

Question 15

what increase insulin sensitivities?

Answer 15

glitazone (TZD)

metformin

Question 16

what is first line for everyone DMII drug? unless?

Answer 16

metformin

unless renal impairment (accumulates in kidneys, not metabolized there) eGFR

Question 17

glitazone causes?

Answer 17

no hypos

weight gain, fluid retention

Question 18

GLP1 causes?

Answer 18

no hypo’s weight loss

but INJECT

Question 19

DPP4i causes?

Answer 19

no hypos

no weight gain

Question 20

when start insulin, what stops?

Answer 20

DPP4i of GLP1 usually ceased

Question 21

what insulin regimen most start for DM2?

Answer 21

basal (less hypos)

sulfonylureas continued if no insulin after meals

Question 22

how many units of insulin do ppl need?

Answer 22

0.5-1unit per kg

Question 23

glycaemic control is best to prevent which complications?

Answer 23

microvascular complications

Question 24

when don’t you use SGLT2?

Answer 24

older ppl with risk of dehydration

Question 25

GLP1 antagonist small risk of?

Answer 25

pancreatitis