Management of T2DM

Question 1

what is the main treatment outline

Answer 1

1. metformin
2. metformin plus non injectable
3. metformin plus plus GLP1 or insulin
4. 4

Question 2

action of metformin

Answer 2

suppress hepatic gluconeogensis, reducing glucose output from liver and increase glucose uptake

Question 3

name of a sulphonylurea

Answer 3

gliclazide

Question 4

benefits of metformin

Answer 4

Moderate efficacy, weight reduction, low hypo risk, CV benefit, extensive experience

Question 5

benefits of sulphonylurea

Answer 5

High efficacy, extensive experience experience

Question 6

side effects of metformin

Answer 6

GI side effects, No if eGFR<30, small risk of lactic acidosis

Question 7

sulphonylurea action

Answer 7

•Close potassium channels on beta cells, stimulating release of stored insulin

Question 8

side effects of sulphonylurea

Answer 8

No CV benefit, weight gain, high hypo risk, caution in CKD
Less effective over time because like squeezing insulin from a sponge, not effective in type 1 as nothing there in first place

Question 9

name a DPP4 inhibitor

Answer 9

linagliptin

Question 10

DPP4 inhibitor benefits

Answer 10

Low/Moderate efficacy, low hypo risk, few adverse events

Question 11

DPP4 inhibits action

Answer 11

•Inhibit DPP-4 and enhance effects of endogenous incretins (eg. GLP-1)

Question 12

SGLT 2 inhibitor action

Answer 12

•Inhibit SGLT2 in the proximal convoluted tubule of the kidney

Question 13

benefits of SGLT 2

Answer 13

Moderate efficacy, CV benefit (BP + HF), renal benefit (CANA), Weight loss, low hypo risk, reduced CV events

Question 14

side effects of SGLT 2

Answer 14

Risk of GU infections, Small risk of hypovolaemia/DKA, do not start if eGFR<60

Question 15

how do thiazolidinediones work

Answer 15

PPAR gamma-receptor agonists
•Increase sensitivity of fat, muscles, and liver to endogenous and exogenous insulin
Rarely used

Question 16

name a thiazolidinediones

Answer 16

pioglitazone

Question 17

benefit of thiazolidinediones

Answer 17

Moderate efficacy, probably CV protection, low hypo risk, past experience

Question 18

side effects of thiazolidinediones

Answer 18

Weight gain, fluid retention, fractures

Question 19

GLP 1 receipt antagonist how it works

Answer 19

•Increase glucose mediated insulin secretion, suppress glucagon secretion

Question 20

benefits of GLP 1

Answer 20

High efficacy, CV benefit, low hypo risk, weight loss injected,

Question 21

side effects of GLP 1

Answer 21

GI side effects, uncertain safety re. pancreas

Question 22

name of GLP1

Answer 22

exanatide

Question 23

inlsuin how it works

Answer 23

• Increase glucose uptake and utilisation in skeletal muscle
• Reduce hepatic glucose output, increase glycogenesis
• Decrease lipolysis
• Decrease gluconeogenesis

Question 24

benefits of insulin

Answer 24

High efficacy, extensive experience

Question 25

aide effects of insulin

Answer 25

Injected, No CV benefit, weight gain,

highest hypoglycaemia risk

Question 26

DPP4 inhibitor side effects

Answer 26

Weight neutral, no CV benefit, reduce dose in CKD