week 7 managment of diabetes in the community

Question 1

what are the managemtn tragets?

Answer 1

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

Question 2

what non-pharmacologicl managment is there?

Answer 2

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

Question 3

what are the pharmocolgical managments?

Question 4

what does metformin do?

Answer 4

decreases glucose production in liver - increases uptake in muscles and decreases glucose intestinal absorption

activates ampk receptors in liver - stop producing more glucose

Question 5

what doe sulfonylureas do?

Answer 5

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

Question 6

what do SGL2 inhibitors do?

Answer 6

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

Question 7

what does pioglitazone do?

Answer 7

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

Question 8

what do alpha - glucosie inhibitors do?

Answer 8

block glucose absorbtion in gut
side efffect - diarrhoea, bloating and gas

acarbose

Question 9

what do the GLP-1 analogs and DPP$ - inhibitors do?

Answer 9

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

Question 10

what are some things to consider with medications and adherence?

Answer 10

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