Management of Diabetes type 2 Flashcards
Treatment plan
Metformin
OR IF INTOLLERANT e.g. weight loss/osmotic factors
Sulfonylurea e.g GLIMEPIRIDE/ GLICLAZIDE
2nd line of treatment
Sulfonylurea
OR if concerned with HYPO
Thiazolidinedione (but with no congestive cardiac failure)
DDP IV inhibitor (concerned about weight gain)
SGLT2 inhibitor (concerned about weight gain)
3rd line of treatment ORAL Thiazolidinedione e.g. PLIOGLITAZONE DDP IV inhibitor SGLT2 inhibitor
INJECTABLE
GLP-1 agonists (If BMI >30kg/m2 and interested in losing weight)
Insulin (if rising Hb1Ac)
How does Metformin work
-It acts up the muscle and liver cells to improve uptake of glucose into cells
-It is a biguanide meaning it improves the action of insulin
-It has a half-life of 6 hours
-It acts upon insulin sensitivity by:
• Improving glucose synthesis and decreasing FFA synthesis
• Inhibiting gluconeogenic pathways
• Improving receptor function
Pros of Metformin
- cheap
- well tolerated
- improve mortality and CVS outcomes
- used in pregnancy
- efficacious
- Not associated with weight gain
Cons of Metformin
- GI issues
- Risk of vitamin B12 malabsorption
- Risk of lactic acidosis by inhibiting uptake of lactic acid in the liver: hypoxia, renal failure, hepatic failure
Mechanism Sulphonyurea
- It acts by increasing insulin release
- It acts on the Pancreas
Mechanism:
- Binds to receptors on the Beta cells – SUR-1
- Closes the ATP sensitive K channels
- Calcium comes into cell
- Causes insulin-filled vescicles to be released
Pros of sulfonylurea
- used with metformin
- Generally well tolerated
- Generally cheap
- Rapid improvement when symptomatic
Cons of Sulphonylurea
- risk of hypoglycemia
- weight gain
- Caution in renal/hepatic disease
- CI in pregnancy and breast-feeding
How do Thialidinediones work?
Work on the liver, the muscle and adipose tissue
-Improves insulin action
Mechanism
- Modulates gene transcription in the liver, muscle and adipose tissue by acting upon PPAR receptors
- Reduces insulin resistance in the liver and surrounding tissues
- Decreases withdrawal of glucose from the liver
- Reduces amount of glucose, insulin and glycated haemoglobin in the blood
Pros of Thialidiones
- good for people who have high insulin resistance
- cheap
- CV safe
Cons of Thialidiones
- Risk of bladder cancer
- Fluid retention which can lead to CCF
- Weight gain
- Can lead to fractures in wo men as they affect bone turnover
Example of Thialidiones
Pioglitazone
Example of SSU
Glicazide
Glimeripide
What check ups will a person with diabetes type 2 have?
- BG
- Blood lipids
- BP
- Eyes checked
- Kidney function
- Weight
- Smoking cessation
- Individual care plan
- Educational and psychological support
How do DDPIV inhibitors work?
Increase insulin release
Inhibit the DPP enzyme which would degrades incretin hormones
DDP enzymes usually increase gut motility and increase the action of insulin and decrease the action of glucagon
Examples of DDPIV inhibitors
THE GLIPTINS saxagliptin, sitagliptin, vildagliptin
