Type 2 diabetes Flashcards
what causes type 2 diabetes
when the body becomes resistant to insulin
why does metformin NOT cause hygoglycaemia
because metformin only decreases blood glucose, it does not stimulate insulin secretion (which can cause hypoglycaemia)
how do you minimise the risk of gastrointestinal side effects associated with metformin
by gradually increasing the dose
- is standard release not tolerated, can give modified release
name some examples of Sulfonylureas and side effects associated with this class on antidiabetics
gliclazide, glimepiride, glipizide, tolbutamide
side effects:
- may cause hypoglycaemia
- modest weight gain
name some examples of The DPP-4 inhibitors (gliptins)
what are the advantages of this class of antidiabetics
linagliptin, sitagliptin, saxagliptin
advantages:
- no weight gain (weight neutral)
- less incidence of hypoglycaemia than the sulfonylureas
*note: DPP-4 = dipeptidylpeptidase-4 inhibitors *
name examples of The SGLT2 inhibitors (end in “flozin”
what is the main disadvantages of this class of antidiabetics
canagliflozin, dapagliflozin, and empagliflozin
main disadvantage:
they are associated with a risk of diabetic ketoacidosis
note: SGLT2 = sodium glucose co-transporter 2 inhibitors
what is the target HbA1c in type 2 diabetes when the patient is taking one antidiabetic not associated with hypoglycaemia (e.g metformin)
48 mmol/mol
what is the target HbA1c if a type 2 diabetic is taking two or more antidiabetic drugs in combination or a single antidiabetic associated with hypoglycaemia
53 mmol/mol
when do you intensify treatment and add another antidiabetic drug if treatment with metformin is insufficient
when the HbA1c increases to 58 mmol/mol or above
what is the first-line drug for all type 2 diabetics
metformin
what is the alternative if metformin is contraindicated in a patient
SGLT2 inhibitor (‘flozin’)
examples: canagliflozin, dapagliflozin, and empagliflozin
when would you consider starting an insulin-based treatment for type 2 diabetes
If dual therapy is unsuccessful
- if dual therapy unsuccessful, can either start triple therapy or consider insulin
if a type 2 diabetic start taking insulin, how does that affect their other oral antidiabetics
- Metformin should be continued unless it is contra-indicated or not tolerated
- Other antidiabetic drugs should be reviewed and stopped if necessary.
what are the antidiabetic drugs that can de added/switched when treatment with one drug (metformin) is ineffective
- a sulfonylurea (gliclazide, glimepiride, glipizide, tolbutamide)
- Pioglitazone
- a DPP-4 inhibitor (linagliptin, saxagliptin, sitagliptin, or vildagliptin);
- a SGLT2 inhibitor (canagliflozin, dapagliflozin or empagliflozin) .
only when sulfonylureas are contra-indicated or not tolerated, or if the patient is at significant risk of hypoglycaemia or its consequences.
what is the main risk/side effect associated with metformin
what counselling points should be given to patients due to this
risk of lactic acidosis
patient should seek immediate medical attention if they get symptoms such as:
- dyspnoea (difficulty breathing)
- muscle cramps
- abdominal pain
- hypothermia (low body temp)
- asthenia (weakness/ lack of energy)
how do you change the dose from standard-release metformin to modified-release metformin
if patient is taking 2g per day or less of standard-release metformin, they can start on the same dose of modified-release metformin
what monitoring is needed for patients whilst taking metformin
monitor renal function
how does renal impairment affect the dose of all oral antidiabetic
need to reduce the dose of all oral antidiabetics (or avoid) if a patient has renal impairment
why may you need to discontinue sulfonylureas
if a patient gets symptoms of acute pancreatitis: such as persistent, severe abdominal pain
sulfonylureas (gliclazide, glimepiride, glipizide, tolbutamide)
what needs to be monitored if treatment with SGLT2 inhibitors is interrupted
monitor ketones in blood during treatment interruption for surgical procedures or acute serious medical illness
note: SGLT2 inhibitor = canagliflozin, dapagliflozin, empagliflozin
which antidiabetic causes an increased risk of lower-limb amputation (mainly toes)
Canagliflozin (an SGLT2 inhibitor)
note: need to emphasis routine preventative foot care for diabetics + start treatment for foot problems (e.g. ulceration, infection, or new pain or tenderness) as early as possible
why should patients taking SGLT2 inhibitors seek urgent medical attention if they experience severe pain, tenderness, redness in the genital or perianal area
because these are symptoms of Fournier’s gangrene, a rare but serious and potentially life-threatening infection, has been associated with the use of (SGLT2) inhibitors
*note: SGLT2 inhibitor = canagliflozin, dapagliflozin, empagliflozin *
which antidiabetics can cause weight gain
- Pioglitazone
- Sulfonylureas (gliclazide, glimepiride, glipizide, tolbutamide)
which class of antidiabetics can cause weight loss
SGLT2 inhibitors : canagliflozin, dapagliflozin, empagliflozin
what are the diabetic complications
- nephropathy (renal impairment)
- neuropathy (nerve damage most common in legs + feet)
- retinopathy (vision loss or blindness)
to prevent all of these, ensure blood glucose and blood pressure controlled. These complications are due to damage to blood vessels caused by uncontrolled blood glucose + blood pressure
what is the consequence if pioglitazone is combined with insulin
there is an increased risk of heart failure
note: if a patient is taking both, monitor them for symptoms of heart failure. it should not be used in patients with heart failure or a history of heart failure
why should patients be assessed for risk factors of bladder cancer before starting treatment with pioglitazone
because pioglitazone increases the risk of bladder cancer
