Management of Type 2 Diabetes Mellitus 2 Flashcards
What is the mechanism by which Metformin improves hyperglycaemia?
Improves sensitivity to insulin
What is the mechanism by which Sulphonylureas improves hyperglycaemia?
Stimulate pancreatic insulin release
What is the mechanism by which Thiazolidinediones improve hyperglycaemia?
Improve insulin sensitivity
What is the mechanism by which alpha-glucosidase inhibitors improve hyperglycaemia?
Prevent intestinal sugar absorption
List some examples of DPPIV inhibitors
- Saxagliptin
- Sitagliptin
- Vildagliptin
Describe the mechanism of DPPIV inhibitors
- The mechanism of DPP-4 inhibitors is to increase incretin levels (GLP-1 and GIP)
- Incretins inhibit glucagon release, which in turn increases insulin secretion, decreases gastric emptying, and decreases blood glucose levels.
Advantages of DPPIV inhibitors?
- Can be used as second or third line treatment
- Can be used in renal impairment
- No risk of hypoglycaemia
Disadvantages of DPPIV inhibitors?
- Contraindicated in pregnancy and breastfeeding
- Can make patients nauseas
What are incretins?
- GLP-1 & GIP
- Incretins are a group of metabolic hormones that stimulate a decrease in blood glucose levels
List some of the commonly used GLP-1 analogues
- Exenatide
- Liraglutide
- Lixisenatide
Mechanism of GLP-1 Analogues?
- Mimic the incretin GLP-1
- Cause a decrease in glucagon and subsequently an increase in insulin. Lowers blood [glc]
Advantages of GLP-1 Analogues?
- Weight loss (usually)
- No risk of hypoglycaemia
- 3rd line agent
- Can be used with basal insulin
Disadvantages of GLP-1 Analogues?
- taken by injection & expensive
- Contraindicated in pregnancy and breastfeeding
- Can cause nausea and vomiting
List some commonly used SGLT2-inhibitors
- Canaglifozin
- Dapaglifozin
- Empaglifozin
What is the mechanism of SGLT2-inhibitors?
- Increase excretion of glucose
- SGLT2 (sodium glucose transporter 2) is responsible for around 90% of glucose reabsorption in the proximal tubule of the kidney, inhibition of this greatly reduces glucose reabsorption
List the effects of SGLT2-inhibitors
- Excretion of glucose: lowers HbA1c
- Water excretion increased: hypotension / dehydration
- Excretion of glucose: lose weight
- Sodium excretion: lowers systolic BP
- Increases risk of urogenital infection
When should SGLT2-inhibitors not be started?
- If eGFR is below 60
- Renal impairment
Advantages of SGLT2 inhibitors?
- Weight loss / no hypoglycaemia
- May be beneficial in CVS morbidity
- 2nd or 3rd line agent
- Can be used alongside insulin regimen
Disadvantages of SGLT2 inhibitors?
- Side effects: UTI, fungal infections, osmotic symptoms
- Risk of DKA / digital amputation
- Contraindicated in pregnancy and breastfeeding
- Contraindicated in renal impairment
What are the preferred 2nd and 3rd line agents if the patient already has established CVS disease?
GLP-1 analogues OR SGLT2 inhibitors
What is usually the first insulin regimen that type 2 diabetics are put on? What type of insulin do they use?
- One daily injection usually before bedtime
Using Isophane Insulin:
- Humulin I
- Humulin Insulatard
What should your HbA1c target be for a type 2 diabetic patient?
- 48 mmol/mol in a patient managing the condition with lifestyle and a single drug NOT associated w hypoglycaemia
- 53 mmol/mol in a patient managing the condition with a drug associated w hypoglycaemia
When should a new drug being taken for diabetic control be reviewed? If not working what action should be taken?
- Review at 3 - 6 months
- If HbA1c target not being met (usually 5 mmol/mol reduction) stop the drug
