1st and 2nd line treatment - Oral Hypo, Insulin and laxatives

Question 1

Are Bulk Forming laxatives suitable for children?

Answer 1

No

Question 2

What is first line treatment for children suffering constipation/impaction?

Answer 2

Polyethylene glycol 3350 (PEG or Macrogol)
OR
Lactulose
+ dietary modifications

Question 3

What if Osmotic laxative or Macrogol is not tolerated in children?

Answer 3

Switch to a stimulant laxative

Question 4

What is the second line treatment for children with constipation/impaction?

Answer 4

Stimulant laxative

Question 5

What stimulant laxatives are appropriate for children?

Answer 5

Sodium picosulfate
Senna
Docusate Sodium
Bisacodyl

Question 6

What is first line treatment for insulin therapy in an adults or children with T1DM?

Answer 6

Multiple daily injection basal–bolus insulin regimens

Question 7

What is the recommended long acting insulin for adults with T1DM and how often should it be injected?

Answer 7

Twice daily Insulin detemir

Question 8

What is the alternative long acting insulin for adults if twice daily insulin detemir is not tolerated?

Answer 8

Once daily Insulin detemir or Insulin Glargine

Question 9

What is the alternative to a multiple daily injection basal bolus insulin regime for adults?

Answer 9

Twice daily human mixed insulin regime

Question 10

What is the ideal Hb1AC target for children with T1DM?

Answer 10

48mmol/mol (6.5%)

Question 11

How frequently should children with T1DM have their Hb1AC checked?

Answer 11

4 times per year and more frequently if unstable Blood sugars

Question 12

What does a multiple daily injection basal-bolus insulin regime consist of?

Answer 12

Injections of short‑acting insulin or rapid‑acting insulin analogue before meals, together with 1 or more separate daily injections of intermediate‑acting insulin or long‑acting insulin analogue.

Question 13

What does a mixed insulin regime consist of?

Answer 13

One, two or three insulin injections per day: these are usually injections of short‑acting insulin or rapid‑acting insulin analogue mixed with intermediate‑acting insulin.

Question 14

How often should Hb1Ac be checked in children with T2DM?

Answer 14

Every 3 months

Question 15

How often should adults with T1DM have their Hb1AC checked?

Answer 15

Every 3-6 months

Question 16

What is the ideal Hb1AC target for adults with T1DM?

Answer 16

48mmol/mol (6.5%)

Question 17

What is first line treatment for T2DM in children

Answer 17

Diet and lifestyle

Standard release metformin

Question 18

How often should adults with T2DM have their Hb1AC checked?

Answer 18

Every 3 to 6 months until stable

Every 6 months once stable

Question 19

What are Hb1AC targets for adults with T2DM?

Answer 19

Metformin or similar - 48mmol/mol

Drug that can cause hypoglycaemia (SU) - 53mmol/mol

Question 20

What is first line treatment for adults with Hb1AC of 48mmol/mol or above?

Answer 20

Metformin standard release

or if not tolerated modified release

Question 21

If metformin is contra-indicated what is the alternative first line treatment?

Answer 21

DPP-4i
Pioglitazone
Sulfonylurea
or if above not tolerated
SGLT-2i

Question 22

If HbA1C rises to 58mmol/mol what is the 2nd line treatment?

Answer 22

Metformin 
\+ either
DPP-4i
Pioglitazone
Sulfonylurea
SGLT-2i

Question 23

If metformin is contraindicated what is the intensification (2nd line treatment)?

Answer 23

DPP-4i + Pioglitazone
DPP-4i + SGLT-2i
DPP-4i + SU

Question 24

What is first line treatment with laxatives for non-opioid chronic constipation?

Answer 24

Bulk forming laxatives - plus plenty of fluids

Question 25

What is second line treatment with laxatives for non-opioid chronic constipation?

Answer 25

Macrogols (PEG)
alternatively
Lactulose as secondline to macrogols
Add stimulant laxative if stools are soft but difficult to pass and there is a sensation of inadequate emptying

Question 26

Side effects of Metformin?

Answer 26

Abdo pain
anorexia
diarrhoea
nausea
taste disturbance
vomiting