type 2 diabetes - drug mx

Question 1

which patient factors do you consider deciding which drugs to use?

Answer 1

1. weight
2. risk of hypos
3. occupation
4. patients attitude towards needles

Question 2

Name 3 class of drugs which cause weight loss?

Answer 2

1. Biguanide
2. SGLT2 inhibitor
3. GLP - receptor antagonist

Question 3

Name 3 class of drugs which cause weight gain?

Answer 3

1. Insulin
2. Glitazones
3. Sulphonyurease

Question 4

Which drug is contraindicated in renal conditions?

Answer 4

Biguanide

Question 5

Which drugs have a risk of hypos?

Answer 5

1. Suphonylurea

2. Insulin

Question 6

What is the glycaemic target on diabetic drugs?

Answer 6

1. 48 mmol HBA1C if on drug non associated with hypos

2. 53 mmol if on drugs associated with hypos

Question 7

What is the first line tx?

Answer 7

1. Metformin

offered if HB1AC rises to 48 on life style interventions

Question 8

What is second line tx?

Answer 8

1. If HB1AC rises to 58 on Metformin
2. Add either
   - sulfonylurea
   - gliptin
   - glitazone
   - SGLT - 2 inhibitor

‘DUAL THERAPY’

Question 9

What is third line tx?

Answer 9

1. TRIPLE THERAPY

OR

2. Consider insulin therapy alone

Question 10

What is the criteria for GLP-1 to be started?

Answer 10

1. Given as ‘ triple therapy’ with; metformin/sufonylurea/+ GLP-1
   - BMI > 35

or

• BMI < 35 but insulin therapy would have significant ocupational implications

Question 11

What is assessed at GLP-1 follow up?

Answer 11

reasses in 6 months and only continue if

1. reduction of atleast 11 mmol
2. weight loss of 3% body weight

Question 12

What is the mx if metformin in CI?

Answer 12

1. use sulfonylrea/gliptin/pioglitazone

2. dual therapy once HBA1C > 58