Management of diabetes and its complications (2) Flashcards
What is the annual review for diabetes like
glycemic control BP Foot checks and care Retinopathy screening Nephropathy screening- albumin:creatinine ratio, U&E Lipid management Smoking cessation Secondary prevention- anti-platelets Pregnancy planning Mental health
What are ways in which insulin can be given
Basal-bolus (4-5 SC injections a day. requires carb counting)
BD mixed insulin
Insulin pump
What should insulin always be administered with
Insulin syringe or pen device
Action of metformin
decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization.
Disadvantages of metformin
When not to use
GI intolerability, contraindicated with renal impairment (eGFR<30 – risk lactic acidosis)
Action of sulphonylureas (e.g. gliclazide)
stimulate insulin secretion from the pancreatic beta-cell. They close ATP-sensitive K-channels in the beta-cell plasma membrane, and so initiate a chain of events which results in insulin release.
Advantages and disadvantages of sulphonylureas (gliclazide)
Advantages: Cheap, rapidly effective
Disadvantages: weight gain, hypoglycaemia
action of glp1 agonists
act by stimulating glucose-dependent insulin release from the pancreatic islets. They also slow gastric emptying, inhibit inappropriate post-meal glucagon release, and reduce food intake.
Advantages and disadvantages of glp1 agonists
Advantages: Weight loss, reduction in major adverse cardiovascular events in established CVD (with liraglutide, semaglutide, dulaglutide)
Disadvantages: S/C injection (daily to weekly), GI side effects, expensive
Action of ddp4 inhibitors
increase incretin levels (GLP-1 and GIP), which inhibit glucagon release, which in turn increases insulin secretion, decreases gastric emptying, and decreases blood glucose levels.
Advantages and disadvantages of ddp4 inhibitors
Advantages: Weight neutral, simple dose regimen
Disadvantages: Expensive for modest benefit
Thiazolidinediones/ glitazones action e.g. pioglitazone
cause an improvement of insulin sensitivity. TZDs exert their antidiabetic effects through a mechanism that involves activation of the gamma isoform of the peroxisome proliferator-activated receptor (PPAR gamma).
Advantages and disadvantages of glitazones e.g. pioglitazone
Advantages: Improved lipid profile
Disadvantages: Fluid retention, heart failure, weight gain, bone fractures, potential increased risk bladder cancer.
sglt2 inhibitors ode of action
work byinhibiting SGLT2in the PCT, this prevents the reabsorption of glucose and facilitates its excretion in urine. As glucose is excreted, its plasma levels falls.
Advantages and disadvantages of sglt2 inhibitors
Advantages: Weight loss, reduction in SBP, reduced CV mortality in patients with established CVD, improved renal outcomes in patients with nephropathy.
Disadvantages: UTI, candidiasis, DKA (rare), may increase risk of lower limb amputations (toes), long term safety not established.
