Diabetes

Question 1

What are the common side effects of metformin?

Answer 1

• Abdominal pain, anorexia, diarrhoea (usually transient), nausea, taste disturbance, vomiting
• Rare SE: decreased B12 absorption
• Can cause lactic acidosis in severe liver disease/renal failure

Question 2

Who can get free prescriptions?

Answer 2

• 60 or over
• Under 16
• 16-18 and full time education
• Are pregnant or have had a baby in the last 12 months and have a valid maternity exemption certificate (MatEx)
• Have a specified medical condition and a valid medical exemption certificate (MedEx)
• Have a continuing physical disability that prevents you from going out without help from another person and have a valid MedEx
• Hold a valid war pension exemption certificate and the prescription is for you accepted disability
• Are an NHS inpatient
• Those being treated for cancer

Question 3

What is the monitoring for diabetes on medication?

Answer 3

Generally measure blood glucose at home isn’t as important for insulin, metformin, DPP-4 inhibitors e.g. alogliptin etc. However, sulphonylureas e.g. gliclazide, can cause a sudden drop in glucose, hypoglycaemia, so measuring their blood glucose is very important.

Question 4

What is the recommended diabetes treatment in heart failure and kidney disease?

Answer 4

• Gliclazide is best option as it can be given regardless of HF and CKD - gliclazides cause hypos so need to discuss this with the patient as well as their occupation as if they drive, they need to tell the DVLA
• Alogliptin dosage needs to be reduced in CKD (gliptins in general, predominantly have renal excretion profile) - exception is linagliptin which is mainly secreted via bile and gut (so no dose adjustment is required in renal disease)
• Pioglitazone is contraindicated in HF
• Metformin to be used with caution in patients with renal eGFR <45 and discontinued if eGFR <30

Question 5

What are the DVLA rules for diabetes?

Answer 5

In a group 1 driver on non-insulin medication for diabetes you do not need to notify unless:

• You have had 2 episodes of severe hypoglycaemia within the last 12 months (where you were completely dependent on someone to treat the hypos)
• You develop impaired awareness of hypoglycaemia (where you’re unable to recognise hypo when it starts)
• You experience disabling hypo whilst driving
• You have other medical conditions or changes to existing medical conditions which could affect your ability to drive safely e.g. problems with vision - laser treatment/injections

Question 6

What tablets are most likely to cause hypos in diabetes?

Answer 6

Sulphonylureas or glinide tablets