week 7 managment of diabetes in the community Flashcards

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1
Q

what are the managemtn tragets?

A

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

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2
Q

what non-pharmacologicl managment is there?

A

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

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3
Q

what are the pharmocolgical managments?

A
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4
Q

what does metformin do?

A

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

activates ampk receptors in liver - stop producing more glucose

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5
Q

what doe sulfonylureas do?

A

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

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6
Q

what do SGL2 inhibitors do?

A

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

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7
Q

what does pioglitazone do?

A

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

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8
Q

what do alpha - glucosie inhibitors do?

A

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

acarbose

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9
Q

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

A

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

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10
Q

what are some things to consider with medications and adherence?

A

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

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