week 7 managment of diabetes in the community Flashcards
what are the managemtn tragets?
bgl - 4-7 fasting
5-10 mol after food
Hb1ac < 7%
Cholesterol
total < 4 mmol
HDLc good > 1
LDL- c < 2mmol bad
BP
<140/90
urinary
urinary ACR < 3.5 mmol for femals <2.5 males
kiedeys shouldnt leak proteins
what non-pharmacologicl managment is there?
education - emopower person to understand treatmens - knowlage increases adherence
smoking ceasation - quit program
weightloss
safe use of alcohol
diet changes - low carb diet
exercise - aiming for 2.5 ours per week
what are the pharmocolgical managments?
what does metformin do?
decreases glucose production in liver - increases uptake in muscles and decreases glucose intestinal absorption
activates ampk receptors in liver - stop producing more glucose
what doe sulfonylureas do?
stimulate beta cells in pancrease to increase insulin prodcutiosn
increases potassium and calcium levels in cell causing relase of insulin
works only effective in type 2 diabetes where beta cells still work
zide
what do SGL2 inhibitors do?
decrease glucose absorpbtion in the kideny due to inhibition of SGLT2
SGLT2 - normally shifts glucose and sodium from nephrones back into blood
inhibiting - forces glucose out of blood stream into urine so wee them out
zines
what does pioglitazone do?
activate PPARy receptors
attach to receptor - gene transcritipn altered to increase tissue senitivity to insulin and increase glucose uptake
decrease hepatic glucose production and increase hepatic glucose uptake
Thiaxolinedione
what do alpha - glucosie inhibitors do?
block glucose absorbtion in gut
side efffect - diarrhoea, bloating and gas
acarbose
what do the GLP-1 analogs and DPP$ - inhibitors do?
GLP analogs- decreased liver production of glucose, increased insulin production, decreased gastic emptying and decreased appetiti
tide
DPP4 inhibitors
decreased liver prodc=uction glucose, increased insulin production, decreased gastric emptying and decreased appetitie
tin
what are some things to consider with medications and adherence?
cost - pbs
tolerabilty and side effects
regime too comlicated?
are they dextorise enough to use
risk factors and comorbidities - liver and renal function, heart disease, previous cancers, other medication interactions