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Gwen - Diabetes > Type 2 Diabetes - Management > Flashcards

Type 2 Diabetes - Management Flashcards

1
Q

What are the main aspects of management of type II diabetes?

A
  • Lifestyle modification
  • Dietary intervention
  • Weight loss
  • Exercise
  • Medications
    • Diabetic meds
    • Meds for BP and vascular risk factors
  • Driving advice
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2
Q

What sort of dietary advice would you give someone with diabetes?

A
  • Low in sugar (though not sugar free)
  • High in starchy carbohydrate (esp. with a low glycaemic index) - slower absorption
  • High in fibre
  • Low in fat (especially saturated fat).
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3
Q

When advising on diet, who is important to involve in the discussion?

A

Consult dietician!!

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4
Q

What would be your initial approach to managing someone with diabetes?

A

Non-pharmacological approach - Lifestyle modification

  • Diet
  • Exercise
  • Weight loss
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5
Q

What would you consider giving as first line diabetic medication for type II diabetes?

A

Normal approach - Metformin

If weight loss or osmotic symptoms - Sulphonylurea

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6
Q

When should diabetic medications be considered for implementation in type II diabetes?

A

Prescribed when lifestyle changes have been implemented. Tablets will however be needed if satisfactory metabolic control is not established within 4–6 weeks.

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7
Q

What are the main medications used in type II diabetes?

A

7 main groups

  1. Binguanides - metformin
  2. Sulfonylureas
  3. DPP-4
  4. Glitazones
  5. GLP1
  6. SGLT2
  7. Insulins
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8
Q

If diabetic control on metformin and lifestyle changes alone was not adequate to keep HbA1c <53mmol/L after 3-6 months, what would you consider as the next step of treatment?

A

Review adherence, then consider:

  • Metformin, plus one of:
    • Sulphonylurea
    • DPP-4 inhibitor
    • Pioglitazone
    • SGLT2
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9
Q

If someone on dual drug therapy and lifestyle modification for type II diabetes’ HbA1c rose to 53 mmol/L or above after 3-6 months, what changes to their medications would you make?

A

Review adherence, then consider:

  • Metformin, plus combination of:
    • Sulphonylurea
    • DPP-4 inhibitor
    • Pioglitazone
    • SGLT2
    • GLP-1 - BMI <30
    • Basal insulin - BMI > 30
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10
Q

When would you consider using GLP-1 therapy in someone with type II diabetes?

A

Step 3 - BMI <30

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11
Q

If someone on triple drug therapy and lifestyle modification for type II diabetes’ HbA1c rose to 58 mmol/L or above after 3-6 months, what would you do?

A

Seek expert advise

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12
Q

When would you consider basal insulin as an option in someonewith type II diabetes?

A

Step 3 - BMI >30

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13
Q

What are the main risks/side effects of using sulphonylureas?

A
  • Hypoglycaemia
  • Weight gain
  • Gastro-intestinal upset
  • Hepatic impairment
  • Hypersensitivity reaction (rash, liver disease)
  • Rarely haematological abnormalities
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14
Q

What are the main risks/side effects of using metformin?

A
  • Lactic acidosis
  • GI upset
  • B12 malabsorption
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15
Q

What are the main risks/side effects of glitazones?

A
  • Gastrointestinal upset
  • Weight gain
  • Oedema
  • Hepatic toxicity
  • Visual disturbance
  • Bladder cancer (very rare)
  • Can cause hypoglycaemia.
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16
Q

When should you avoid metformin use?

A

eGFR < 36 ml/min - risk of lactic acidosis

17
Q

What is important to do when someone on metformin has a vomiting or diarrhoeal illness?

A

Stop metformin - see if metformin is the cause

18
Q

What are side effects/risks of using DPP-4 inhibitors?

A
  • Gastrointestinal upset
  • Oedema
  • Hepatic toxicity (vildagliptin)
  • Pancreatitis
  • Upper respiratory tract infection / nasopharyngitis
  • Stevens-Johnson syndrome

Can cause hypoglycaemia.

19
Q

What are side effects of GLP-1 agonists?

A
  • Gastrointestinal upset
  • Pancreatitis
  • Injection site reactions
  • Anaphylaxis

Can cause hypoglycaemia.

Tend to reduce weight, which may be beneficial, but may be problematic if too rapid.

20
Q

What two diabetic medications are most commonly associated with hypo’s?

A
  • Insulin
  • Sulphonylureas
21
Q

What diabetic medication can cause lactic acidosis?

A

Metformin

22
Q

What are the main side effects of SGLT-2 inhibitors?

A
  • Genital mycotic infections
  • UTIs
  • Increased urinary frequency
23
Q

What are contraindications to glitazone use?

A
  • Hepatic impairment
  • History of bladder cancer
  • CCF
  • Pregnancy / breast feeding
24
Q

What is the target HbA1c in those with diabetes?

A

<53 mmol/L

25
Q

Under what circumstances might you use DPP-4 inhibitors?

A

If weight gain was a concern

26
Q

When would you consider measuring blood glucose in someone who is diabetic?

A
  • Type 2 diabetes who are using insulin
  • Increased risk of hypoglycaemia
  • Experiencing acute illness
  • Undergoing significant changes in pharmacotherapy or fasting, for example, during Ramadan
  • Those with unstable or poor glycaemic control (HbA1c>64 mmol/mol)
  • Pregnant or planning pregnancy.
  • Steroid therapy
27
Q

What medications would you start someone on for vascular protection and BP control in type II diabetes?

A
  • ACEi
  • CCB
  • Thiazide diuretics
  • Statins
28
Q

What target BP would you aim for in type II diabetes?

A

<140/80 or <130/80 if kidney, eye or CVA

29
Q

Which diabetic medications increase weight?

A
  • Sulphonylureas
  • Glitazones
30
Q

Which diabetic medications help reduce weight?

A
  • GLP-1 inhibitors - delay gastric emptying, increase satiety. V expensive and contraindicated in pregnancy. Also increased risk of pancreatitis.
  • SGLT-2 inhibitors
31
Q

What’s the safest drug to use in the elderly?

A

Sulphonylurea because of its short duration of action

32
Q

What are the main side effects of thiazolidines eg pioglitizine?

A

Weight gain - 5-6kg, plus fluid retention and therefore increased risk of heart failure, anaemia and osteoporosis.

SHOULD NOT BE USED IN PATEINTS WITH ISCHAEMIC HEART DISEASE

33
Q

Name a biguanide

A

Metformin

34
Q

Name a sulfonylurea

A

The gli..ides
Glimepiride, gliclazide, glipizide

35
Q

Name a GLP-1 analogue

A

Exenatide, liraglutide, lixisenatide

36
Q

Name a DPPVIV

A

Gliptans - saxagliptan, sitagliptin, vildagliptin

37
Q

What is orlistat?

A

A lipase inhibitor which reduces absorption of fat from the deit. Must be on a low fat diet.

38
Q

What advise would you give about diabetes and driving?

A

Check blood surgars before driving. If hypo while driving wait at the side of the road for 45 minutes and eat some carbohydrate.

39
Q
A

Gwen - Diabetes (11 decks)

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