T2DM drugs

Question 1

When should SGLT2 inhibitors be added?

Answer 1

If the pt has or develops CV disease or Qrisk >10% (ensure metformim in is titrated to correct dose first)

Question 2

Options to add to metformin for dual therapy

Answer 2

Sulfonylurea, DPP4 inhibitor, pioglitazone, SGLT2 inhibitor

Question 3

What is the next step after dual therapy

Answer 3

Triple therapy (add in another drug)

Question 4

If triple therapy doesn’t work what are the options

Answer 4

Swap one for a GLP1 mimetic or insulin (started by diabetic nurse)

Question 5

When is switching to a GLP1 mimetic indicated

Answer 5

BMI>35 or if being on insulin would have occupational impact

Question 6

What are the side effects of metformin?

Answer 6

Lactic acidosis (secondary to AKI), GI upset

Question 7

How does a SGLT2 inhibitor work?

Answer 7

Increase glucose excretion by blocking SGLT2 transporter in PCT

Question 8

Side effects of SGLT2 inhibitor?

Answer 8

Glycosuria increase risk of UTIs and Fournier gangrene
DKA
Increased risk of amputation (check feet)
Pts often lose weight

Question 9

In a basic way how do DPP4 inhibitors and GLP1 mimetic works ?

Answer 9

Increase incretins which increases insulin release

Question 10

Side effects of DPP4 inhibitors?

Answer 10

Pancreatitis and headaches

Question 11

Side effects of GLP1 mimetic

Answer 11

Reduced appetite, weight loss, GI upset

Question 12

How do sulfonylureas work? (Gliclazide)

Answer 12

Stimulates insulin release from the pancreas

Question 13

Sulfonylureas side effects?

Answer 13

Weight gain
hypoglycaemia
SIADH
cholestasis

Question 14

How does pioglitazone work?

Answer 14

Increases insulin sensitivity and reduces liver production of glucose (gluconeogenesis)

Question 15

Side effects of pioglitazone

Answer 15

Weight gain, heart failure, increased risk of fracture, small risk of bladder cancer

Question 16

Pharmacokinetics of rapid acting insulins (novo-rapid)

Answer 16

Starts working after 10 mins and lasts 4 hours

Question 17

Pharmacokinetics of short acting insullin? (Actrapid)

Answer 17

Strats working in 30 mins and lasts 8 hours

Question 18

Pharmacokinetics of intermediate acting insullin? (Humilin 1)

Answer 18

Starts working in 1 hour, and lasts about 16 hours

Question 19

Pharmacokinetics of long acting insullin?( levemir and lantus)

Answer 19

Starts working around 1 hour and lasts 24 hours or longer

Question 20

Sulfonylureas on day of surgery

Answer 20

• omit on the day
• if bidaily and morning surgery skip morning and take afternoon dose

Question 21

Contraindications of metformin

Answer 21

CKD: creatinine >150 and eGFR<30
Tissue hypoxia (e.g MI) due to lactic acidosis risk
Iodine containing X-ray contract
Alcohol abuse

Question 22

When should an SGLT2 inhibitor be added

Answer 22

When QRISK is over 10