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Diabetes & Endocrinology > Management of Type II DM > Flashcards

Management of Type II DM Flashcards

1
Q

What are the ABCDEF’s of diabetes care?

A 
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
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2
Q

What are the two major deficits/failings in T2DM? What are a further two causative failings for each major defecit?

A

Decreased insulin production - Beta cell dysfunction, Diminished incretin effect

Decreased insulin action - Insulin resistance, Excess glucagon

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3
Q

What medications can be used to treat decreased insulin production in T2DM?

A

Sulphonylureas
Meglitinides
Incretin Mimetics
DPP IV Inhibitors

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4
Q

What medications can be used to increase insulin action in T2DM?

A

Biguanides
Thiazolidinediones
Pharmacological weight reduction

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5
Q

What is the action of sulphonylureas?

A

Augmenting insulin secretion from beta cells, therefore there must be some beta activity remaining

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6
Q

What is the main possible side effect of sulphonylureas? Give others

A

Hypoglycaemia

Weight gain
GI disturbances
Liver disturbances

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7
Q

What are the most commonly used sulphonylureas?

A

Glimeperide, glipizide, gliclazide

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8
Q

What is the only biguanide in use for DM treatment?

A

Metformin

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9
Q

Where is metformin the drug of choice?

A

In obese T2DM patients

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10
Q

What is the action of metformin?

A

Inhibits gluconeogenesis

Increases peripheral utilisation of glucose

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11
Q

Give some of the contraindications for metformin

A 
Renal failure
Hepatic impairment
Alcohol abuse
Significant cardiac disease
Pregnancy and lactation
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12
Q

What are some side-effects of metformin?

A

GI effects

20-30% experience abdo pain, nausea, metallic taste

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13
Q

What is the primary action of thiazoldinediones (glitazones)?

A

Primarliy in the periphery where they decrease lipolysis and increase muscle uptake

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14
Q

What are some risks associated with thiazolidinediones (glitazones)?

A

Fluid retention
Hepatic failure
Increased fracture risk in women
Concerns in people with IHD

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15
Q

By what other name are the prandial glucose regulators class of drugs know? What are the two drugs in this class?

A

Meglitinides

Repaglinide and Nateglinide

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16
Q

What type of drug is repaglinide, what is its action?

A

Prandial glucose regulator/meglitinide

Stimulates the same secretory mechanism as sulphonylureas but dos not promote insulin release in the absence of glucose

17
Q

What type of drug is nateglinide? What is its action?

A

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

18
Q

What type of drug is acarbose?

A

An alpha glucosidase inhibitor which delays digestion and absorption of starch and sucrose

19
Q

What are the two classes of incretin mimetics? Give some examples of both

A

DPP4 Inhibitors - sitagliptin, saxagliptin, vidagliptin

GLP-1 Analogs - exenatide, liraglutide

20
Q

What is important to note in terms of incretin mimetics?

A

They both have a number of potentially unpleasant side-effects

21
Q

What are the first line pharmacological treatments for T2DM?

A

Metformin

OR

Sulphonylurea if intolerant or weight loss/osmotic symptoms

22
Q

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?

A

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

23
Q

What is the third line pharmacological treatment for T2DM?

A

Add or substitute one with ONE OF-

Oral; TZD or DPP-1V Inhibitor

Injectable; Bedtime insulin or GLP-1 -agonist

Diabetes & Endocrinology (18 decks)

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