Management of Diabetes D - Type 2 Diabetes Mellitus - Part 1 Flashcards
Who makes up part of the diabetes team?
- The patient!
- GP
- Diabetes doctors
- Other specialists
- Specialist nurse
- Dietician
- Podiatrist
- Clinical psychologist
What should a diabetic patient expect from their Care?
- Blood glucose levels
- Blood pressure measurement
- Blood lipid levels
- Foot screening
- Eye screening
- Smoking cessation
- Weight loss advice
- Kidney function
- Individual care plan
- Education course
- Emotional and psychological support
What are the aims of diabetes treatment?
- Relief of any primary symptoms
- Prevention of complications
- Preservation of quality of life
- Damage minimalization (avoidance of emergencies)
A 5 step framework for choosing a glucose lowering drug:
What is the first line pharamacological/medical treatment for Type II diabetes? (after health and lifestyle changes)
- Metformin
What does metformin do that helps with Type II diabetes?
- It improves insulin sensitivity
Advantages and disadvantages of metformin:
- Metformin adv: Improves CVS outcomes and is normally well tolerated
- Metformin disadv: GI side effects
What class of drugs are added to metformin if no success?
- Sulphonylureas (dual therapy)
What are the 3 types of sulphonylureas that I should know about?
- Glimepiride
- Gliclazide
- Glipizide
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
Which sulphonylurea has the lowest rate of renal excretion?
- Gliclazide
Sulphonylureas advantages and disadvantages:
- Sulphonylurea adv: Rapid improvement if symptomatic and is normally well tolerated
- Sulphonylurea disadv: Risk of hypoglycaemia
What drug is added for triple therapy in the treatment of Type II diabetes
- Pioglitazone
(class = thiazolidinediones)
What is the mechanism of aciton of pioglitazone? (LATER)
LATER
Pioglitazone advantages and disadvantages:
- Pioglitazone adv: Good for people if insulin resistance significant
- Pioglitazone disadv: Increased risk of bladder cancer and also fluid retention
Look at this table!
