Management of type 2 diabetes Flashcards
Which gender is diabetes more common in (Type 1 + 2)
Men
What increases risk of diabetetes
Being obese
What drugs cause increase in insulin release
Sulphonylureas
Metiglinides
Incretin mimetics
DPPIV inhibitors
What drugs cause increased excretion of glucose
SGLT2 inhibitors
What drugs improve the insulin action
Biguanides
Thiazolidines
Weight reduction
What non-pharmaceutical method improves insulin activity
Physical activity
What is the first choice diabetic medication and why
Metformin - improves outcome and is cheap and well tolerated
What type of drug is metformin
A Bigunaide - imprroves the action of insulin - increasing insulin sensitivity in tissues
What is the target tissues of metformin
Liver and muscles
What is the negatives of metformin
Can cause GI discomfort
Can cause lactic acidosis by inhibiting lactic acid uptake by the liver
Can cause Vit b12 malabsorption
Cannot be used in eGFR <30
When are sulphonylureas used
When there is a rapid improvement required in blood glucose control e.g rapidly increasing HbA1c
What is the function of sulphonylureas
Increase insulin release from the pancreas
How do sulphonylureas work
They bind to their receptors on beta cells and close the ATP sensitive potassium linked channels - this decreases influx of potassium and therefore depolarisation - this causes voltage gated calcium channels to open and influx calcium - causes translocation and exocytosis of secretory granules of insulin to the cell surface
What are examples of sulfonylureas
Glimepride daily
Gliclazide 2x daily
Glipizide 2x daily
What are the disadvantages of sulfonylureas
Can cause hypoglycaemia
Weight gain
can be nephrotoxic and hepatotoxic
Contraindicated in PREGNANCY!
side effects of hypersensitivity and photosensitivity with blood disorders
What is the function of thiazolidinedones
Improve insulin action - sensitivity of tissues - reduces resistance to insulin in the luver and peripheral tissue
What tissues do thiazolidinedones target
Liver, muscles and adipose tissue
What is the main thiazolidinedones
Piaglitazone
What are the main side effects of pioglitazone
Increased risk of bladder cancer
Fluid retention - congestive cardiac failure
weight gain
fractures in females
what is the function of SGLT2
Sodium, glucose linked transporter - majority of glucose is absorbed by SGLT2 at the proximal tubule
What is another name for SGLT2 inhibitors
Gliflozins
What is the effect of SGLT2 inhibitors
Excretes more glucose, water, calories and sodium
Causes weight loss
Lowes blood pressure due to less sodium
Greater risk of urogenital infection
What is the effect of gliflozins in renal disease
Reduces morbidity and mortality
When is canagliflozin contraindicated
eGFR<30
When is empagliflozin contraindicated
eGFR <60 - do not start
Stop if eGFR is drops below 45
If they have CV disease avoid empagliflozin if eGFR <30
When is dapagliflozin contraindicated
If eGFR is below 15
What is the first line treatment for diabetes type 2 when there is high CV risk and metformin is not tolerated
SGLT-2 inhibitors - e.g canagliflozin
What is the SECOND line treatment for diabetes type 2 when there is high CV risk - metformin first line is tolerable
SGLT-2- inhibitor
What are the disadvantages of SGLT-2inhibitors
UTI, fungal infection, osmotic symptoms
Digital amputations
DKA
Contraindicated in PREGNANCY and breast feeding !
Cannot use in renal impairment
What are GLP1 and DPPIV
Incretin mimetics
What is the incretin effect
The difference between taking oral glucose and IV glucose
What is the function of DPP-4
Causes the breakdown of incretin
What is the function of Gliptins
DPP-4 inhibitors so incretin is not broken down
What are examples of DPPIV inhibitors
…Gliptins
What has to be done to DPPIV when there is CKD
Make adjustments to dosage
When are DPPIV inhibitors contraindicated
Pregnancy and breast feeding
What are GLP1 analogues
Resistant to degradation
When should GLP-1 analogues be started
BMI>35
When shoukld GLP-1 analogues be stopped
6 months later unless it is proven effective (HbA1c decrease more than 1 % or decrease in weight over 3%)§
When should GLP-1 analogues be avoided
eGFR<30
What are examples of GLP-1 analogues
…tide - exenatide
What are the negatives of GLP-1 analogues
Injection
expensive
Contraindicated in PREGNANCY and breast feeding!
Causes nausea and vomiting
What is the first, second and third line for diabetes
1st line - metformin - biguanide
2nd line - sulphonylurea - glimapride or glicazide
2nd line with CVD risk - SGLT2 inhibitor - canagliflozin
2nd line with need for weight loss - GLP-1 analogue - .e.g ..tide
