Management of Diabetes - Type 2 Flashcards
Aware of the medications used in the treatment of T2 Diabetes.
a
Mechanism of action of these treatments.
a
Describe the important side effects and adverse drug interactions of medications used to treat Diabetes Mellitus.
a
Understanding of Home blood glucose monitoring and targets HbA1c and glycaemic control.
a
Appreciate SIGN guidance 116 and choice of therapies.
a
Demonstrate an awareness of new drug developments in Diabetes Mellitus.
a
Risk stratification for patients with T2 Diabetes.
a
Aware of patient education resources.
a
Discuss the natural progression of diabetes and the importance of patient centred care.
a
What type of support should a diabetic patient receive?
- Blood glucose levels checked
- Blood pressure checked
- Blood lipids checked
Annual checks;
- Eye screened
- Feet checked
- Kidney function monitored
Social;
- Education course
- Emotional and psychological support
- Weight
- Smoking cessation support
What are the aims of diabetes treatment?
- Relief of primary symptoms
- Prevention of complications
- Preservation of QoL
- Damage minimalisation
Why does increasing insulin release help treat T2DM?
Pancreas: beta cell dysfunction + diminished incretin effect –> decreased insulin production
Thus, increasing insulin release counteracts this.
What medications increase insulin release?
- Sulphonylureas
- Metiglinides
- Incretin Mimetics
- DPPIV inhibitors
What medications increase excretion of glucose?
SGLT2 inhibitors
Why does improving insulin action help treat T2DM?
Pancreas: excess glucagon –> decreased insulin action –> increase blood glucose levels
Periphery: insulin resistance –> decreased insulin action –> increase blood glucose levels
What medications improve insulin action?
- Biguanides
- Thiazolidiones
AND Weight reduction
Name the modifiable risk factors of T2DM.
- Smoking
- Dietary change
- Physical activity
- Blood pressure
- Statins
- Mood
Describe the 5 step framework for choosing a glucose-lowering drug.
- Set a target HbA1c.
- Are there other risk factors that should be treated first?
- Are the current treatments optimised?
- Max dose?
- Tolerated?
- Taken? - What are the glucose lowering options?
- Remove any that are contraindicated.
- List pros and cons.
- Select the preferred choice. - Agree a review date and the target HbA1c with the patient.
In what cases should the target HbA1c levels be relaxed?
- People who are older or frail
For adults with type2 diabetes:
- With reduced life expectancy
- High risk of the consequences of hypoglycaemia (increased risk of falling, impaired awareness of hypoglycaemia, people who drive or operate machinery as part of their job)
- Intensive management not appropriate (multiple comorbidities)
What is the first line medication for T2DM and why?
Metformin.
- Improves outcomes
- Well-tolerated
- Cheap
(- Can be used in pregnancy
- Not associated with weight gain)
Metformin;
- What type of drug is it?
- What is its mechanism of action?
- What is its half-life?
- Biguanide
Improves insulin sensitivity;
- Affects glucose production
- Decreases fatty acid synthesis
- Improves receptor function
- Inhibits gluconeogenic pathways
- Half-life: 6 hours
What are the side effects of metformin?
- GI side effects (20-30%)
Risk of lactic acidosis (inhibits lactic acid uptake by liver);
- Hypoxia
- Renal failure
- Hepatic failure
- Alcohol abuse
- Vitamin B12 malabsorption
What are sulfonylureas? And how are they named?
- Second line medication for T2DM
- The “Gli…ides” – Glimepiride, Gliclazide, Glipizide
What is the mechanism of action of sulfonylureas?
Increase insulin release (by the pancreas).
- Binds to sulfonylurea receptors (SUR-1) on functioning pancreatic beta-cells
- Which closes the linked ATP-sensitive K+ channels
- Decreased K+ influx –> depolarisation of the beta-cell membrane
- Voltage-dependent Ca2+ channels open and result in an influx of Ca+
- Translocation and exocytosis of secretory granules of insulin to the cell surface
