Management of type 2 diabetes Flashcards
what is the first line treatment for diabetes? (drug class and name)
biguanides -= Mteformin
when is sulphonylureas used for the treatment of type 2?
second line treatment if asymptomatic
first line treatment if symptomatic
name an example of a sulphonylurea drug.
glimerpride
gluclazide
glipizide
what are the side effects of metformin?
risk of lactic acidosis by inhibiting lactic acid uptake by the liver; hypoxia, renal failure, hepatic failure, alcohol abuse
GI side effects
risk of vitamin B12 deficiency
how does metformin improve insulin sensitivity?
improves insulin receptor function
improved glucose transport
reduce fatty acid synthesis
how does sulphonylureas work to decrease blood glucose?
bind to sulphonylure receptors in the pancreatic beta cells
they close K channels therefore causing depolarisation of the cell
this causes Ca influx = exocytosis of insulin
what are the side effects of sulphonylureas?
hypersensitivity
photosensitivity
blood disorders
what are the disadvantages of sulphonylureas?
risk of hypoglycaemia
weight gain
can cause renal and hepatic disease
Cl in pregnancy and breast feeding
name a thiazolidinedione drug.
giltazone
what are the disadvantages of thiazolidinediones?
risk of bladder cancer
fluid retension
weight gain
fractures in females
what drugs used in the treatment of type 2 diabetes cause weight gain?
sulphonylureas i.e. Glimepride
thiazolidineodiones i.e. Giltazone
what is a condraindication for metformin?
eGFR < 30
why would you choose giltazone instead of sulphonylueas as a second line treatment ?
if hypo’s are a concern
what are the defects in type 2 diabetes?
beta cell dysfunction
diminished incretin effect (stimulates insulin production & glucose uptake)
excess glucagon
insulin resistance
what medication improves insulin action and which increases insulin release?
sulphonylureas increase insulin release
metformin & giltazone improve insulin action
what are the aims of treatment in diabetes?
relief of primary symptoms
prevention of complications
preservation of quality of life
damage minimisation
what effects do giltazone’s have?
modulates the transcription of insulin sensitive genes which play a role in regulating BG -
decreases glucose removal from the liver
reduces insulin resistance in liver and other tissues
decreases HbA1c, BG and insulin in the blood
What drugs used for the treatment of type 2 diabetes cause weight loss?
SGLT-2 inhibitors
GLP-1 analogues
What drugs used for the treatment of type 2 diabetes have nausea as a side effect?
DPP-4 inhibitors
GLP-1 analogues
What insulin is used for the treatment of type 2 diabetes?
Humalin I or H insulatard
How do DPPIV- inhibitors work?
They blocks the DPP-4 enzyme which causes the degradation of incretin hormones
Therefore DPP4 prolongs incretin effects =
Increased release of insulin from B cells, decreased release of glucagon from A cells (thus decreased releases of glucose form the liver)
What are the disadvantages of DPPIV-inhibitors?
Increased risk of pancreatitis and pancreatic cancer
Relatively small effect on glycaemic control
Contraindicated in pregnancy and breast feeding
Name examples of DPPIV-inhibitors.
Gliptins i.e. saxagliptin, sitagliptin, vildagliptin
Name examples of GLP-1 analogues.
Lixisenatide
Liraglutide
Exenatide
How does GLP-1 analogues work?
GLP-1 is an incretin hormone which is resistant to degradation
Therefore synthetic injection of GLP-1 analogues will prolong incretin effect
What are the disadvantages of GLP-1 analogues?
Expensive
Injections
Risk of pancreatitis and pancreatic cancer
Contraindicated in pregnancy and breast feeding
What are the side effects of GLP-1 analogues?
Nausea and vomiting
What a re the incretin mimetic drugs?
GLP-1 analogues
DPPIV-inhibitors
Name examples of SGLT2-inhibitors.
Gliflozins i.e. canagliflozins, explagliflozin
How does SGLT2 inhibitors work?
They inhibit the SGLT2 which is involved in the reabsorption of glucose from the renal proximal tubule
This increases the excretion of glucose in the urine
What are the disadvantages of SGLT2 inhibitors?
Postural hypotension Increased risk of digital amputation Risk of DKA Cannot be used in renal impairment Contraindicated in pregnancy and breast feeding
What are the side effects of SGLT2 inhibitors?
UTI’s
Fungal infections
Osmotic symptoms
What are the advantages of SGLT-2 inhibitors?
Weight loss
No risk of hypoglycaemia
Beneficial effect on CV morbidity and mortality
Good effect on glycaemic control
What drugs used to treat type 2 diabetes cannot be used in renal impairement and what are the cut offs for treatment in such cases?
Metformin - stop if eGFR <30
GLP-1 analogues - avoid if eGFR <30
SGLT2 inhibitors - only start if eGFR > 60 but stop if falls below 45
When would you reduce a patients target HbA1c?
Frail or older patients Intensive management isn’t possible Type 2 with: - reduced life expectancy - high risk of complications with hypo i.e no warning signs, operate machinery’s, risk of falling
how does SGLT 2 inhibitors help reduce CV morbidity and mortality?
reduces systolic blood pressure due to excretion of Na due less re-uptake
