Treating type 2 diabetes Flashcards
Microvascular complications
Retinopathy
Nephropathy
Microvascular complications
Ischaemic heart disease
Stroke
Peripheral vascular disease
Statin use in diabetics
Start statins at diagnosis due to increased CVS risk - initially use ACEi
treatment ladder type 2 diabetes
Diet and lifestyle advice
-> metformin to max -> sulphonylurea/thiazolidinedione/DPP-4/SGLT2 -> insulin
Can you use metformin in pregnancy?
Yes
Side effects of metformin
GI side effects - nausea, diarrhoea and flatulence
Dosing metformin
begin at 500mg and increase by 500mg per week - max is 2000mg daily
Sulphonylurea moa
Increase insulin production by stimulating B cell K/ATP channel
s/e sulphonylureas
hypoglycaemia, weight gain
Contraindications sulphonylureas
Renal failure, not approved in pregnancy
Thiazolidinediones
Improves insulin resistance through PPAR-y receptor
Side effects thiazolidinediones
Weight gain, fluid retention, osteoporosis
Contraindications thiazolidinediones
heart failure, osteoporosis or fracture risk, pregnancy or bladder cancer
What is the incretin effect?
incretins released by gut when you eat food stimulate insulin secretion and reduce gastric emptying - GLP-1
DPP-4 inhibitors
Stop GLP-1 being broken down
SGLT2 inhibitors MOA
Inhibit renal glucose reabsorption - increase urinary glucose loss
SGLT2 inhibitors contraindications
Not effective in CK but can improve renal function and avoid in pregnancy
medication if:
High Hba1c and symptomatic
Sulphonylurea
medication if:
slightly high Hba1c and hypoglycaemic
DPP4 i
medication if:
Heart failure/ IHD
SGLT2i
medication if:
renal failure
DPP4i or low dose SU
