Management of type 2 diabetes

Question 1

Which gender is diabetes more common in (Type 1 + 2)

Answer 1

Men

Question 2

What increases risk of diabetetes

Answer 2

Being obese

Question 3

What drugs cause increase in insulin release

Answer 3

Sulphonylureas
Metiglinides
Incretin mimetics
DPPIV inhibitors

Question 4

What drugs cause increased excretion of glucose

Answer 4

SGLT2 inhibitors

Question 5

What drugs improve the insulin action

Answer 5

Biguanides
Thiazolidines
Weight reduction

Question 6

What non-pharmaceutical method improves insulin activity

Answer 6

Physical activity

Question 7

What is the first choice diabetic medication and why

Answer 7

Metformin - improves outcome and is cheap and well tolerated

Question 8

What type of drug is metformin

Answer 8

A Bigunaide - imprroves the action of insulin - increasing insulin sensitivity in tissues

Question 9

What is the target tissues of metformin

Answer 9

Liver and muscles

Question 10

What is the negatives of metformin

Answer 10

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

Question 11

When are sulphonylureas used

Answer 11

When there is a rapid improvement required in blood glucose control e.g rapidly increasing HbA1c

Question 12

What is the function of sulphonylureas

Answer 12

Increase insulin release from the pancreas

Question 13

How do sulphonylureas work

Answer 13

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

Question 14

What are examples of sulfonylureas

Answer 14

Glimepride daily
Gliclazide 2x daily
Glipizide 2x daily

Question 15

What are the disadvantages of sulfonylureas

Answer 15

Can cause hypoglycaemia
Weight gain
can be nephrotoxic and hepatotoxic
Contraindicated in PREGNANCY!
side effects of hypersensitivity and photosensitivity with blood disorders

Question 16

What is the function of thiazolidinedones

Answer 16

Improve insulin action - sensitivity of tissues - reduces resistance to insulin in the luver and peripheral tissue

Question 17

What tissues do thiazolidinedones target

Answer 17

Liver, muscles and adipose tissue

Question 18

What is the main thiazolidinedones

Answer 18

Piaglitazone

Question 19

What are the main side effects of pioglitazone

Answer 19

Increased risk of bladder cancer
Fluid retention - congestive cardiac failure
weight gain
fractures in females

Question 20

what is the function of SGLT2

Answer 20

Sodium, glucose linked transporter - majority of glucose is absorbed by SGLT2 at the proximal tubule

Question 21

What is another name for SGLT2 inhibitors

Answer 21

Gliflozins

Question 22

What is the effect of SGLT2 inhibitors

Answer 22

Excretes more glucose, water, calories and sodium

Causes weight loss

Lowes blood pressure due to less sodium

Greater risk of urogenital infection

Question 23

What is the effect of gliflozins in renal disease

Answer 23

Reduces morbidity and mortality

Question 24

When is canagliflozin contraindicated

Answer 24

eGFR<30

Question 25

When is empagliflozin contraindicated

Answer 25

eGFR <60 - do not start Stop if eGFR is drops below 45 If they have CV disease avoid empagliflozin if eGFR <30

Question 26

When is dapagliflozin contraindicated

Answer 26

If eGFR is below 15

Question 27

What is the first line treatment for diabetes type 2 when there is high CV risk and metformin is not tolerated

Answer 27

SGLT-2 inhibitors - e.g canagliflozin

Question 28

What is the SECOND line treatment for diabetes type 2 when there is high CV risk - metformin first line is tolerable

Answer 28

SGLT-2- inhibitor

Question 29

What are the disadvantages of SGLT-2inhibitors

Answer 29

UTI, fungal infection, osmotic symptoms Digital amputations DKA Contraindicated in PREGNANCY and breast feeding ! Cannot use in renal impairment

Question 30

What are GLP1 and DPPIV

Answer 30

Incretin mimetics

Question 31

What is the incretin effect

Answer 31

The difference between taking oral glucose and IV glucose

Question 32

What is the function of DPP-4

Answer 32

Causes the breakdown of incretin

Question 33

What is the function of Gliptins

Answer 33

DPP-4 inhibitors so incretin is not broken down

Question 34

What are examples of DPPIV inhibitors

Answer 34

...Gliptins

Question 35

What has to be done to DPPIV when there is CKD

Answer 35

Make adjustments to dosage

Question 36

When are DPPIV inhibitors contraindicated

Answer 36

Pregnancy and breast feeding

Question 37

What are GLP1 analogues

Answer 37

Resistant to degradation

Question 38

When should GLP-1 analogues be started

Answer 38

BMI>35

Question 39

When shoukld GLP-1 analogues be stopped

Answer 39

6 months later unless it is proven effective (HbA1c decrease more than 1 % or decrease in weight over 3%)§

Question 40

When should GLP-1 analogues be avoided

Answer 40

eGFR<30

Question 41

What are examples of GLP-1 analogues

Answer 41

...tide - exenatide

Question 42

What are the negatives of GLP-1 analogues

Answer 42

Injection expensive Contraindicated in PREGNANCY and breast feeding! Causes nausea and vomiting

Question 43

What is the first, second and third line for diabetes

Answer 43

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