Management of Type II DM Flashcards
What are the ABCDEF’s of diabetes care?
Assessment of heart disease & stroke risk & daily aspirin Blood pressure control Management of high cholesterol Diabetes blood G Diet Exercise Follow up for complication screening
What are the two major deficits/failings in T2DM? What are a further two causative failings for each major defecit?
Decreased insulin production - Beta cell dysfunction, Diminished incretin effect
Decreased insulin action - Insulin resistance, Excess glucagon
What medications can be used to treat decreased insulin production in T2DM?
Sulphonylureas
Meglitinides
Incretin Mimetics
DPP IV Inhibitors
What medications can be used to increase insulin action in T2DM?
Biguanides
Thiazolidinediones
Pharmacological weight reduction
What is the action of sulphonylureas?
Augmenting insulin secretion from beta cells, therefore there must be some beta activity remaining
What is the main possible side effect of sulphonylureas? Give others
Hypoglycaemia
Weight gain
GI disturbances
Liver disturbances
What are the most commonly used sulphonylureas?
Glimeperide, glipizide, gliclazide
What is the only biguanide in use for DM treatment?
Metformin
Where is metformin the drug of choice?
In obese T2DM patients
What is the action of metformin?
Inhibits gluconeogenesis
Increases peripheral utilisation of glucose
Give some of the contraindications for metformin
Renal failure Hepatic impairment Alcohol abuse Significant cardiac disease Pregnancy and lactation
What are some side-effects of metformin?
GI effects
20-30% experience abdo pain, nausea, metallic taste
What is the primary action of thiazoldinediones (glitazones)?
Primarliy in the periphery where they decrease lipolysis and increase muscle uptake
What are some risks associated with thiazolidinediones (glitazones)?
Fluid retention
Hepatic failure
Increased fracture risk in women
Concerns in people with IHD
By what other name are the prandial glucose regulators class of drugs know? What are the two drugs in this class?
Meglitinides
Repaglinide and Nateglinide
What type of drug is repaglinide, what is its action?
Prandial glucose regulator/meglitinide
Stimulates the same secretory mechanism as sulphonylureas but dos not promote insulin release in the absence of glucose
What type of drug is nateglinide? What is its action?
Works by restoring the early phase of insulin release within the Beta cells and has a synergistic action with metformin, it is inly licensed for combination treatment with metformin
What type of drug is acarbose?
An alpha glucosidase inhibitor which delays digestion and absorption of starch and sucrose
What are the two classes of incretin mimetics? Give some examples of both
DPP4 Inhibitors - sitagliptin, saxagliptin, vidagliptin
GLP-1 Analogs - exenatide, liraglutide
What is important to note in terms of incretin mimetics?
They both have a number of potentially unpleasant side-effects
What are the first line pharmacological treatments for T2DM?
Metformin
OR
Sulphonylurea if intolerant or weight loss/osmotic symptoms
What are the second line pharmacological treatments for T2DM? What other measures must be in pace along with the prescription of these 2nd line measures?
Sulphonylurea
OR
Thiazolidinedione if hypos are a concern and there is no CCF
OR
DPP-1V Inhibitor if hypos are a concern
Lifestyle measures, adherence to medicate and dose optimisation
What is the third line pharmacological treatment for T2DM?
Add or substitute one with ONE OF-
Oral; TZD or DPP-1V Inhibitor
Injectable; Bedtime insulin or GLP-1 -agonist
