Diabetes

Question 1

Metformin MOA, side effects and contraindications?

Answer 1

Insulin receptor sensitiser, decreases gluconeogenesis in the liver, decrease GI uptake and increases insulin sensitivity and glucose uptake in the skeletal muscles.

Side effects include GI symptoms such as diarrhoea, lactic acidosis, anorexia.

Contraindicated in those with decreased renal & hepatic function.

Question 2

Which two drugs are contraindicated in pregnancy?

Answer 2

Sulfonylureas and alpha-glucosidase inhibitors

Question 3

Sulfonylureas MOA, side effects and contraindications?

Answer 3

Block ATP sensitive potassium channels, causing depolarisation and calcium influx, leading to insulin release.

Side effects such as weight loss, GIT discomfort, hypoglycaemia, bone marrow toxicity rarely.

Contraindicated in pregnancy, severe renal failure patients, co-use with trimethoprim.

Question 4

GLP-1 agonist and DPP4 antagonist MOA, side effects and contraindications?

Answer 4

GLP-1 agonist is a incretin-mimetic. It stimulates GLP release from duodenum and jejunum, which increases insulin secretion and decrease glucose absorption. DPP4 inhibitor helps prolong availability of GLP.

Side effects include pancreatitis, nausea and vomiting and headache.

Contraindications include severe GI disease and gallbladder disease.

Question 5

Alpha-glucosidase inhibitors MOA, side effects and contraindications?

Answer 5

Decrease uptake of glucose from the small intestine, decreasing digestion. Side effects include bloating, diarrhoea, abdominal pain, flatulence. Contraindicated in patients with diabetic ketoacidosis, IBD or intestinal obstruction.

Question 6

What glycaemic marker targets do you aim for?

Answer 6

Fasting BSL: <7
OGTT: <7.8
HbA1c: 6.5%

Question 7

What are some advantages of using Jardiance (empagliflozin)?

Answer 7

It has been shown to decrease the RRR of cardiovascular events by 38%. Also helps in losing weight (2-4Kg) which helps with the patient’s metabolic profile.

Question 8

Explain the management of Type 1 diabetes

Answer 8

Can only give insulin as therapy. There are short-acting (novorapid), mixed (humalog mix, novomix) and long-acting insulins, with the long-acting usually given overnight (e.g. lantus). Major side effects include the risk of hypoglycaemia, poor adherence, weight gain. The number of units of insulin needs to be titrated accordingly and usually the patient requires help from a diabetes educator in the beginning to learn about the benefits of insulin therapy, how to self administer, and lifestyle changes they can make.
(There are newer forms of therapy now where the patient gets a port device through which they insert the insulin syringe instead of having to repeatedly jab.)

Question 9

How do you monitor for effectiveness of diabetic management?

Answer 9

• Twice daily morning BSL readings (but expensive)
• HbA1c levels for longer term management
• GP follow up every 3 months with blood test check, and for any complications of diabetes which indicates poor management
• GP follow up can also measure weight, BMI, waist circumference, BP
• Encouraging appropriate lifestyle modifications (e.g. DASH diet, exercise, cessation of smoking and alcohol)