Management of type 2 diabetes Flashcards
Name some members of the diabetes team
gp DSN practice nurse diabetes doctors podiatry dietitian the patient clinical psychologists other specialists
Ways in which the patient can seek information
practice nurse/GP
online education eg mydiabetesmyway, DUK
group education session
dietitian advice
What should patients expect from their care/have done?
BG monitoring lipid monitoring blood pressure smoking cessation support weight emotional support pregnancy eyes checked feet checked kidney function education support
What is SCI diabetes?
How information is shared between healthcare professionals
What is mydiabetesmyway?
Information available to patients
What SIGN guidelines are relevant?
116 and 154
What is SIGN 154?
Pharmacological management of glycaemic control in people with type 2 diabetes
What is SIGN 116?
management of diabetes
What are the main aims of treatment?
relief of primary symptoms
improve quality of life
prevent complications
damage minimalisation
Do we need tight glycaemic control in everyone?
heterogeneous population
risk of hyp
effect on those with established CVD
U shaped curve
2 step framework for glucose lowering drug
target HbA1c other risk factors addressed first? current treatments optimised? options? CI, pros vs cons and preference review date and target HbA1c
In what populations should we relax HbA1c?
old and frail reduced life expectancy risk of falling machinery operators polypharmacy and comorbidities
What class of medications is metformin?
biguanide
Why is metformin usually first choice?
cheap
well tolerated
improves outcomes
How does metformin work?
improves insulin sensitivity and reduced insulin resistance via improving insulin action
What does metformin do?
reduce FA and gluconeogenesis
improves receptor function
Metformin half life
6 hours
Advantages of metformin
improves CV outcomes no weight gain used in pregnancy lowers HbA1c and glucose cheap well tolerated
Disadvantages of metformin
risk of lactic acidosis by inhibiting liver uptake
GI upset
risk of vitamin B12 malabsorption
CI if eGFR<30
Name a sluphonylurea
glimepiride
How do SU work?
increase insulin production by working on the pancreas
What does metformin act on?
Liver and muscle
How does SU act?
bind to SURI receptors on pancreas increasing calcium exocytosis of insulin
Why is glimepride usually used and when would another SU be used instead?
1 tablet a day
glipizide in renal failure as slower excretion
Advantages of SU
used with metformin
rapid improve in control
rapid titration - increased dose
cheap and well tolerated
Disadvantages of SU
risk of hypo
weight gain
not used in pregnancy
caution in renal and hepatic failure
List the normal 1st, 2nd and 3rd line treatment plan
metformin
SU
TZD
Name a TZD
plioglitazone
How does TZD work and what does it target?
like metformin - improves insulin sensitivity
act on PPAR gamma receptors to modulate transcription
muscle, adipose tissue and liver
Advantages of TZD
good for significant insulin resistance
decrease HbA1c
cheap
Disadvantages of TZD
fluid retention
increase risk of bladder cancer
weight gain
fractures in females
