diabetic drugs and management Flashcards
first line insulin regime in adults
daily injection basal bolus insulin
rapid acting before meals?
when to add a second drug in T2DM
HbA1c > 58
before that titre up the metformin and encourage lifestyle changes
HbA1c target for patients on any drug which may cause hypoglycaemia
53
first line management of type 2 diabetes if patient has CVD high risk, or chronic heart failure
metformin
once established add: SGLT-2 inhibitor
what to do if metformin is not tolerated due to GI side effects
switch to modified-release metformin
drugs of choice if metformin is contraindicated
if patient has risk of CVD/ has CVD or HF: SGLT-2 inhibitor
if patient doesn’t: DPP-4 inhibitor or pioglitazone or sulfonylurea
second line management in T2DM if HbA1c not met
add one of:
DPP-4 inhibitor
pioglitazone
sulfonylurea
SGLT-2 inhibitor
third line: add another drug or start insulin based treatment
what to do if triple combination of drugs has failed to reduce HbA1c
switch one of the drugs for a GLP-1 mimetic
example: exenatide (tide?)
first line drugs for hypertension control in diabetics
ACEi or ARBs
ARBs in afro-caribbean
contraindications for pioglitazone
bladder cancer
moa of SGLT-2 inhibitors
reversibly inhibit sodium-glucose co-transporter 2 in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion
examples of SGLT-2 inhibitors
canagliflozin
dapagliflozin
empagliflozin
adverse effects of SGLT-2 inhibitors
urinary and genital infections (avoid if prone or at risk)
normoglycaemic ketoacidosis
increased risk of lower limb amputation: carefully monitor feet
weight loss
moa of sulfonylureas
increasing pancreatic insulin secretion
adverse effects of sulfonylureas
hypoglycaemic episodes (more common)
weight gain
hepatotoxicity + hyponatraemia
avoid breastfeeding and pregnancy
main side effects of insulin
hypoglycaemia
weight gain
lipodystrophy
moa of metformin
increases insulin sensitivity
decreases hepatic gluconeogenesis
side effects of metformin
GI upset
lactic acidosis
examples of sulfonylureas
gliclazide
glimepiride
moa of thiazolidinediones (pioglitazone)
active PPAR gamma receptor in adipocytes to promote adipogenesis and fatty acid uptake
side effects of pioglitazone
weight gain
fluid retention
cautions for DPP-4 inhibitors
increased risk for pancreatitis
moa of DPP-4 inhibitors
increased incretin levels which inhibit glucagon secretion
what diabetic drugs can cause weight loss
SGLT-2 inhibitors (-flozins)
GLP-1 agonists (-tides)
