Management of Diabetes D - Type 2 Diabetes Mellitus - Flashcards
what are the aims of diabetes treatment
RELIEF OF PRIMARY SYMPTOMS PREVENTION OF COMPLICATIONS How else can this be addressed? PRESERVATION OF QUALITY OF LIFE Balance good effects against side effects DAMAGE MINIMALISATION Avoidance of emergencies.
what is the first line of type 2?
metformin
what is the 2nd line for type 2?
sulfonylurea
what is the 3rd line for type 2?
orl agents- thiazolinedione
what is the function of metformin?
Biguanide Improves insulin sensitivity Affects glucose production, decrease fatty acid synthesis Improves receptor function Inhibits gluconeogenic pathways Half life 6 hours.
what are the advantages of metformin?
Improves cardiovascular outcomes and mortality in obese T2 DM Cheap Metformin 1g bd £2.36 Metformin MR 1g bd £10.77 (x5) Efficaceous Used alone can decrease fasting blood glucose by 22- 26% Normally well tolerated Not associated with weight gain HbA1c by 12 – 17% reduction Also used in pregnancy now
what are the disadvantages of metformin?
Risk of lactic acidosis by inhibiting lactic acid uptake by liver Hypoxia Renal failure (CI if creat<150) Hepatic failure Alcohol abuse GI side effects 20 – 30 % Risk vitamin B12 malabsorption
what is the mechanism of action of sulphonylureas?
Binds to sulfonylurea receptors (SUR-1) on functioning pancreatic beta-cells.
Binding closes the linked ATP-sensitive potassium channels
Decreased potassium influx depolarization of the beta-cell membrane.
Voltage-dependent calcium channels open and result in an influx of calcium
Translocation and exocytosis of secretory granules of insulin to the cell surface
whatare the advantages of sulphonyluera?
Used with metformin Rapid improvement in control Rapid improvement if symptomatic Rapid titration Cheap Gliclazide 160mg bd £3.30 X1.4 Glimepiride 6mg od £1.72 x0.7 Generally well tolerated
what are the disadvantages of sulphonylurea?
Risk of hypoglycaemia Weight gain Caution in renal and hepatic disease CI in pregnancy and breastfeeding. SE include Hypersensitivity and photosensitivity reactions Blood disorders
what is the action of thiazolidinediones?
selectively stimulates thenuclear receptorperoxisome proliferator-activated receptor gamma (PPAR-gamma) and to a lesser extentPPAR - alpha
modulates the transcription of theinsulin-sensitive genes involved in the control of glucose andlipid metabolismin themuscle,adipose tissue, and theliver.
reduces insulin resistancein the liver and peripheral tissues;
increases the expense of insulin-dependent glucose;
decreases withdrawal of glucose from the liver;
reduces quantity of glucose, insulin andglycated haemoglobinin the bloodstream.
what are the advantages of pioglitazone?
Good for people if insulin resistance significant HbA1c by 0.6-1.3% Cheap Pioglitazone 45mg od £1.50 x 0.6 Cardiovascular safety established (Contrast with rosiglitazone)
what are the disadvantages of pioglitazone
Increase risk of bladder cancer Caution in those of increased risk bladder cancer (Age, industry etc) Fluid retention - CCF Weight gain Fractures in females Small increased risk TZDs affect bone turnover Reduced BMD Initial report were of increased distal fractures in women
