Type 2 Diabetes Flashcards
At what HbA1c should you consider adding a second agent to Metformin?
titrate up metformin and encourage lifestyle changes
BUT add a second drug if the HbA1c rises to 58 mmol/mol (7.5%)
Dietary advice for those with T2DM
- high fibre
- low fat dairy
- oily fish
- control saturated fats/ trans fatty acids
- discourage use of foods marketed specifically at people with diabetes
HOw often should HbA1c be checked?
every 3-6 months until stable
then 6 monthly
What drug class should be added to metformin to treat T2DM if a patient has a high risk of develping cardiovascular disease, or already has an element of cardiovascular disease or heart failure?
SGLT-2 inhibitor
What antihypertensive should be offered first line to modify this risk factor in diabetic patients?
ACEi/ARB
Mechanism of action of metformin
Increases insulin sensitivity
Decreases hepatic gluconeogenesis
Metformin side effects
Gastrointestinal upset
Lactic acidosis
should not be used if eGFR <30
Sulphonylureas mechanism of action
Stimulates insulin production in pancreatic beta cells
Side effects of suplhonylureas
Weight gain
Hypoglycaemia
Hyponatraemia
Mechanism of action of thiazolidinediones
Activate PPAR-gamma receptor in adipocytes
=> promote adipogenesis and fatty acid uptake
Side effects of piogiltazone
Weight gain
Fluid retention
Mechanism of DDP-4 inhibitors
Increases incretin levels
which inhibit glucagon secretion
Side effects of DDP-4 inhibitors
Generally well tolerated but increased risk of pancreatitis
Mechanism of action of SGLT-2 inhibitors
Inhibits reabsorption of glucose in the kidney
Side effects of SGLT-2 inhibitors
UTI
(weight loss is also a welcomed side effects)
