type 2 diabetes updated management

Question 1

what 2 drugs can be used to treat hyperglycaemia as ‘rescue therapy’ at any stage of treatment?

*pt presents with signs of hyperglyacemia eg thirst

Answer 1

insulin

sulfonylureas eg gliclazide

Question 2

what is the alternative treatment for type 2 diabetes if standard release metformin is causing side effects [GI side effects]?

Answer 2

MR metformin

Question 3

what must be investigated in type 2 diabetics if metformin is not enough to control blood glucose and they must be moved to step 2 of treatment?

Answer 3

investigate the CVD risk on all patients as this will determine the next step

Question 4

what is the course of treatment for a type 2 diabetic whom metformin was inadequate for and their CVD assessment has shown a high risk of CVD [>10%] or they already have established CVD?

Answer 4

They must be given a SGLT2 inhibitor [flozins] IN ADDITION to the metformin

Question 5

why are SGLT2 inhibitors given with metformin as 2nd line for type 2 diabetics with high risk of CVD?

Answer 5

SGLT2 inhibitors known to assist in CVD and weight loss

Question 6

what must be checked before initiating a type 2 diabetic with CVD a SGLT2 inhibitor?

Answer 6

check DKA risk, illness, low carb diet

Question 7

what is the 2nd line treatment for type 2 diabetics whom metformin is inadequate for and they have NO CVD risk?

Answer 7

Move onto intensification process as normal with other drugs eg sulfonylureas etc

Question 8

what is the 1st line and 2nd line treatment for patients with type 2 diabetes and Chronic kidney disease?

Answer 8

1 - ACE/ARB. titrate the dose to the highest licensed dose

1. can add SGLT2 inhibitor! [flozins]