Management of type 2 diabetes Flashcards
most common complaicon of diabes
1st diabetic retionpay
2nd nephrophaty
3rd neruopaty
4th microalmumiuira
where is metaform orgin from
french lilac or goats rue plant
effect of metaformin
imporve insulin senvity in the liver and muslce tissue
half life of metformin
6 hour
advantages of metformin
improves cvd outcomes
decrease fasting bg by 22%
not associated iwth weiht gain
reduion in hbac
cheap
disadvanctes of metrformin
gi side effects in 20 - 30% of paitents
risk of lactic acidosis by inhibiting lactic uptake by the liver, b12 deficency
signs of latic aciddossi
hypox, renal failrue, hepatic flure , alchol abuse
first line drug for t2d and gestestion diabtes
metformin
what is sulphonylureas examples
glimepiride, gliclazide, glipizide
effect of sulphonyureas
increas insulin relesae by binding to sulonylurea recptos of pancreic beta cell
this closes the atp sensitive potassium channels
this decreas the potaum depolation of the cell membrne
this resuls in an influx of calcium and caues exoctoos of the secretory granules and realse of insuin
where are sulphonly ureas metabolised
liver
what are the advantages of sulphonyurea
cheap, lead to a rapid inmprovement in control
rapid titration
well tolerated
down side of sulpholyrea
riskof hypoglycema
weight gain
cause renal and hepatic disae
ci in breast feeding and pregnacy
se of hypersentivy and phosentitivity
blood disorder
sglt2 inhibitor types
canglifozin, dapaglifozin, empagliflozin
where is sglt2 inhibtor maily sued
in cases of chronic hert fialrue and cvd risk
how do sglt2 inhiorr work
help to remove glucose by blocking the sglt3 enzyme which cuase glucose to be retinated in the blood at the kindyes, his cuase glucose to be excreted in urine
effect of slg2 inhibtor on sodu
removes itthus lower bp
benifit of sglt2 inhiot
weight loss
no hypoglycmeia
good glycmic contorl
cvd risk reduction
can add to insulin regimes
downside of sglt2 inhibtor
there expensive
can cuase side effects including uti, fungal infeciton, osmoic sympoms, fourneir gnacre
risk of dka
ci in preany and breast feeding
less glycemic efec in renl impairent
what are examples of dppiv inbitpors
sitagliptin, aloglipitns, saxaglipitin
how do dpp1v inhibitors work
delay the break down of increptin which are hormones from food relased during ddiestin, this then incres the levle of increptin which then stimulers the acre more to increase the ammount of insulin realsd and reduce glucaon relases
advancteages of ddpiv inhibotrs
well tolerated
can be used in renal imparet
no risk of hypoglcema
weigth neuraol
down sides of dppiv inhobrs
small effect on glycmeic conrol
ci in pregnacy and breast feeding
nausesa
what are exampels of glp 1 agonsits
liraglutide, semaglutide, exenatide
mode of action of glp1 agonists
they mimic the effect of glp1 hormone and thus cuase the pancreas to relase more insulin and less glucogaon
sdie effect of glp1 agons
nause
who is elegpoe for glp 1 agons acoring to nice
bmi over 35
and only on for 6 or 12 monts unless no large effec
advances of glp analgoes
weight loss
no risk of hypogleymia
3rd line
can be used with basal insulin
disadvances of glp analgones
exspensive, ci in pregnacy, nausea and vommiting
what are exampels of thiazolidinediones
pioglitazone
where do thiazoliodones work
on adipose tisue
liver and muscle glucose absoption
effect of thiazoline
it stiumaltes the nuclear recprot peroxisome prolifator activted recor called gamma
it modultes the trancopin of the inulin sentive gens involed in teh control of glucose and lipid metabnolsm in mucle, adipose tissue and liver
redcues the insulin liver and peripharl tissues
increase the exspence of insulin depent glucose
decreases withdrawl of glucose from the liver
reducs quanti of glucose , insulin and glycertaed hameoglin
benifits of thiazoldines
good for insulin resitance
cheap
cvd saftey
down sides of thiazolidinediones
incrase the risk of bladder cancer
fluid retention
weigh gain
fractures increase in femalses due to recued bone density
what is isophane nsul
long acting insulin that only need injected dialy at bedtime
