Type 2 Diabetes Mellitus Flashcards
What is the first line pharmacological treatment in T2DM?
OD Metformin 500mg (starting dose) to be taken with breakfast
How does metformin help in T2DM?
Reduces glucose production in the liver and increases insulin tissue sensitivity. It also has cardioprotective properties
What are the common side effects of metformin?
Nausea and diarrhoea, abdominal pain, hypoglycaemia
What is a contraindication to metformin?
eGFR < 30 - due to the risk of lactic acidosis with renal failure
Which drugs can be individually combined with metformin for the first intensification of T2DM?
A sulfonylurea (e.g. Gliclazide) A DDP-4 inhibitor (e.g. Sitagliptin) - generally well tolerated, weight neutral A Glitazone (e.g. pioglitazone)
What are important side effects to be aware of for gliclazide?
Hypoglycaemia and weight gain
What is the important information that patients should be told if they are started on pioglitazone?
Side effect: weight gain
Contraindicated in heart failure as it causes oedema.
Need yearly LFTs as there’s a risk of liver toxicity
What drug combinations are possible for triple therapy (2nd intensification)?
Metformin+gliptin+sulfonylurea
Metformin+pioglitazone+Sulfonylurea
Metformin+sulfonylurea+GLP-1 (very expensive)
Insulin+metformin (+/- sulfonylurea) - review sulfonylurea need regularly as the patient will now be on 2 hypo inducing agents
What things should be reviewed in someone with T2DM as part of the annual review?
BP, height and weight.
Review blood glucose control - HbA1c
Qrisk2 score (inc. HTN & cholesterol levels)
Review lifestyle and medication
Check insulin injection site if taking insulin
Screen for diabtetic retinopathy, neuropathy, nephropathy sexual dysfunction and depression
What are some side effects of insulin injection for T2 and T1 diabetics?
Hypoglycaemia, weight gain, lipohypertrophy at injection site.
