Type 2 management

Question 1

What 4 areas/types of defects can contribute to diabetes T2 deveopment

Answer 1

Beta cell dysfunction
Diminished Incretin Effect
Excess Glucagon
Insulin resistance

Question 2

What is the 5 step framework for diabetes type 2 management?

Answer 2

1. Set a target HbA1c
2. “Take 5” Are there other risk factors that should be also be treated?
3. Are the current treatments optimised. Max dose? Tolerated? Taken?

4What are the glucose lowering options?

Remove any that are contraindicated

Of the remaining what are the pros and cons

Select the preferred choice.

5. Agree a review date (for new treatment)and the target HbA1c with the patient

Question 3

1st line medication for T2 diabetes

Answer 3

Metformin - This is a biguanide
It acts on the liver and muscle. Decreases fatty acid production, improve recpetor function and inhibits gluconeogenic pathway.
The overall action is improved insulin sensitivity.

Is cheap, can be used in pregnancy and is well tolerated

Question 4

What are the disadvantages of Metformin?

Answer 4

GI side effects
Risk of vit B12 malabsorption
Risk of Lactic acidosis

Question 5

What are the 2nd line options?

Answer 5

Sulhonylureas “Gli…ides” e.g. Glimepiride, Glicalzide, Glipizide