Management of type 2 diabetes

Question 1

Name some members of the diabetes team

Answer 1

gp 
DSN
practice nurse 
diabetes doctors 
podiatry 
dietitian 
the patient 
clinical psychologists 
other specialists

Question 2

Ways in which the patient can seek information

Answer 2

practice nurse/GP
online education eg mydiabetesmyway, DUK
group education session
dietitian advice

Question 3

What should patients expect from their care/have done?

Answer 3

BG monitoring 
lipid monitoring 
blood pressure 
smoking cessation support 
weight 
emotional support 
pregnancy 
eyes checked 
feet checked 
kidney function 
education support

Question 4

What is SCI diabetes?

Answer 4

How information is shared between healthcare professionals

Question 5

What is mydiabetesmyway?

Answer 5

Information available to patients

Question 6

What SIGN guidelines are relevant?

Answer 6

116 and 154

Question 7

What is SIGN 154?

Answer 7

Pharmacological management of glycaemic control in people with type 2 diabetes

Question 8

What is SIGN 116?

Answer 8

management of diabetes

Question 9

What are the main aims of treatment?

Answer 9

relief of primary symptoms
improve quality of life
prevent complications
damage minimalisation

Question 10

Do we need tight glycaemic control in everyone?

Answer 10

heterogeneous population
risk of hyp
effect on those with established CVD
U shaped curve

Question 11

2 step framework for glucose lowering drug

Answer 11

target HbA1c 
other risk factors addressed first?
current treatments optimised?
options? CI, pros vs cons and preference 
review date and target HbA1c

Question 12

In what populations should we relax HbA1c?

Answer 12

old and frail 
reduced life expectancy 
risk of falling 
machinery operators
polypharmacy and comorbidities

Question 13

What class of medications is metformin?

Answer 13

biguanide

Question 14

Why is metformin usually first choice?

Answer 14

cheap
well tolerated
improves outcomes

Question 15

How does metformin work?

Answer 15

improves insulin sensitivity and reduced insulin resistance via improving insulin action

Question 16

What does metformin do?

Answer 16

reduce FA and gluconeogenesis

improves receptor function

Question 17

Metformin half life

Answer 17

6 hours

Question 18

Advantages of metformin

Answer 18

improves CV outcomes 
no weight gain 
used in pregnancy 
lowers HbA1c and glucose 
cheap 
well tolerated

Question 19

Disadvantages of metformin

Answer 19

risk of lactic acidosis by inhibiting liver uptake
GI upset
risk of vitamin B12 malabsorption
CI if eGFR<30

Question 20

Name a sluphonylurea

Answer 20

glimepiride

Question 21

How do SU work?

Answer 21

increase insulin production by working on the pancreas

Question 22

What does metformin act on?

Answer 22

Liver and muscle

Question 23

How does SU act?

Answer 23

bind to SURI receptors on pancreas increasing calcium exocytosis of insulin

Question 24

Why is glimepride usually used and when would another SU be used instead?

Answer 24

1 tablet a day

glipizide in renal failure as slower excretion

Question 25

Advantages of SU

Answer 25

used with metformin
rapid improve in control
rapid titration - increased dose
cheap and well tolerated

Question 26

Disadvantages of SU

Answer 26

risk of hypo
weight gain
not used in pregnancy
caution in renal and hepatic failure

Question 27

List the normal 1st, 2nd and 3rd line treatment plan

Answer 27

metformin
SU
TZD

Question 28

Name a TZD

Answer 28

plioglitazone

Question 29

How does TZD work and what does it target?

Answer 29

like metformin - improves insulin sensitivity
act on PPAR gamma receptors to modulate transcription
muscle, adipose tissue and liver

Question 30

Advantages of TZD

Answer 30

good for significant insulin resistance
decrease HbA1c
cheap

Question 31

Disadvantages of TZD

Answer 31

fluid retention
increase risk of bladder cancer
weight gain
fractures in females