ENDOCRINE - T2D Flashcards
How long would you try diet management and exercise for before going on meds?
3 months
What would you suggest if hba1c was 48mmol/L?
Monotherapy
- metformin (standard release then m/r)
- If contraindicated = DPP or PIO or SU
- Target = 48mmol/L and 53mmol/L with SU
What would you suggest if hba1c was 58mmol/L?
Dual therapy
- Metformin with (DPP or PIO or SU or SGLT)
- CI = (DPP and PIO) or (DPP and SU) or (PIO and SU)
- If it continues to rise - triple therapy or insulin programme
What does metformin do?
decreases synthesis of glucose by the liver
What are the side effects of metformin?
- Lactic acidosis if egfr <30ml/min - avoid in renal imp or tissue hypoxia
- GI disturbance
- weight loss
- taste disturbance
- reduced vit b12 absorption
Who is metformin contraindicated in?
- renally impaired
- general anaesthesia
- iodine-containing contrast media
What do sulphonylureas do?
augment insulin secretion
What are some examples of short acting sulphonylureas?
- gliclazide
- tolbutamide
What are some examples of long acting sulphonylureas?
- glibenclamide (2nd and 3rd trimester)
- glimepiride
What are the side effects of sulphonylureas?
- hyponatraemia
- hypoglycaemia
- weight gain
- jaundice
- hypersensitivity in first 6-8 weeks
What interacts with sulphonylureas?
- warfarin and ACE = increased hypo
- NSAIDs = reduced renal excretion
What are the side effects of pioglitazone?
- heart failure - CI if already existing
- bladder cancer - CI if already existing
- hepatotoxicity - stop if jaundice occurs
What are some examples of SGLT-2 inhibitors (gliflozins)?
- empaglaflozin (jardiance)
- dapaglaflozin (forxiga)
- canagliflozin
What do the gliflozins do?
- prevent glucose reabsorption in the kidneys
- increase urine output with glucose combined
What are the side effects of gliflozins?
- life threatening atypical DKA with only moderately raised BG level - report symptoms
- volume depletion - hypotension, dizziness
- canagliflozin can cause increased risk of lower limb amputations
What do the gliptins do?
break down the hormone incretin therefore helps increase insulin secretion
What are the side effects of gliptins?
- pancreatitis - ab pain
- vidagliptin can cause liver toxicity
What are examples of meglitinides?
- repaglinide
- nateglinide
What are the side effects of meglinitides?
- hypersensitivity
- visual disturbance
- GI discomfort
When would acarbose be used?
- last resort - when other oral hypoglycaemics cant be taken
- delays digestion and absorption of starch and glucose
What are the side effects of acarbose?
- flatulence
- diarrhoea
How would you diagnose T2D?
- HbA1c blood test - 6.5% or above to diagnose type 2
- oral glucose tolerance test
What would you monitor in T2D?
- urinanalysis - ketones, protein (albumin), glucose
- blood monitoring - ketones and glucose
What is the pre-prandial blood glucose target (Before meals) in T2D?
4-7 mmol/L
