Treating type 2 diabetes

Question 1

Microvascular complications

Answer 1

Retinopathy

Nephropathy

Question 2

Microvascular complications

Answer 2

Ischaemic heart disease
Stroke
Peripheral vascular disease

Question 3

Statin use in diabetics

Answer 3

Start statins at diagnosis due to increased CVS risk - initially use ACEi

Question 4

treatment ladder type 2 diabetes

Answer 4

Diet and lifestyle advice

-> metformin to max -> sulphonylurea/thiazolidinedione/DPP-4/SGLT2 -> insulin

Question 5

Can you use metformin in pregnancy?

Answer 5

Yes

Question 6

Side effects of metformin

Answer 6

GI side effects - nausea, diarrhoea and flatulence

Question 7

Dosing metformin

Answer 7

begin at 500mg and increase by 500mg per week - max is 2000mg daily

Question 8

Sulphonylurea moa

Answer 8

Increase insulin production by stimulating B cell K/ATP channel

Question 9

s/e sulphonylureas

Answer 9

hypoglycaemia, weight gain

Question 10

Contraindications sulphonylureas

Answer 10

Renal failure, not approved in pregnancy

Question 11

Thiazolidinediones

Answer 11

Improves insulin resistance through PPAR-y receptor

Question 12

Side effects thiazolidinediones

Answer 12

Weight gain, fluid retention, osteoporosis

Question 13

Contraindications thiazolidinediones

Answer 13

heart failure, osteoporosis or fracture risk, pregnancy or bladder cancer

Question 14

What is the incretin effect?

Answer 14

incretins released by gut when you eat food stimulate insulin secretion and reduce gastric emptying - GLP-1

Question 15

DPP-4 inhibitors

Answer 15

Stop GLP-1 being broken down

Question 16

SGLT2 inhibitors MOA

Answer 16

Inhibit renal glucose reabsorption - increase urinary glucose loss

Question 17

SGLT2 inhibitors contraindications

Answer 17

Not effective in CK but can improve renal function and avoid in pregnancy

Question 18

medication if:

High Hba1c and symptomatic

Answer 18

Sulphonylurea

Question 19

medication if:

slightly high Hba1c and hypoglycaemic

Answer 19

DPP4 i

Question 20

medication if:

Heart failure/ IHD

Answer 20

SGLT2i

Question 21

medication if:

renal failure

Answer 21

DPP4i or low dose SU