Diabetes - Oral Hypoglycemic medications

Question 1

What test is done to screen for diabetes?

Answer 1

HbA1c

Question 1

What is the range for someone experiencing pre-diabetes?

Answer 1

HbA1c - 41-49mmol/mol

Question 2

What is Biguanides

Answer 2

An oral diabetes medication - Metformin

Question 3

What is the mechanism of action for Metformin?

Answer 3

Increase glucose uptake and utilisation in skeletal muscle, reduces glucose production in the liver, increases insulin sensitivity, reduces low & very low density lipoproteins

Question 4

Pharmacokinetics of Metformin

Answer 4

Well absorbed from small intestines, does not bind to plasma proteins, does not undergo hepatic biotransformation, excretion unchanged in urine.

Question 5

What is the half-life of Metformin? And how often is it taken?

Answer 5

1.5 - 4.5 hours - Taken in three doses with meals

Question 6

What are some contra-indications of Metformin?

Answer 6

Renal or hepatic impairment
Cardiac disease
Dehydration
Severe burns
severe infections
Ketoacidosis
Recent major surgery
Trauma
Not recommended for use in pregnancy

Question 7

Name some cautions for use with Metformin

Answer 7

Vomiting & diarrhoea - Stop while unwell
Stop prior to surgery to reduce risk of lactic acidosis

Question 8

Patient education for a patient taking Metformin

Answer 8

Start on low dose titrating up slowly.
Monitor for anaemia
Take with food or at the end of a meal
Avoid alcohol
Healthy diet and exercise
Regular checks of HbA1c

Question 9

Why does Metformin not cause hypoglycaemia?

Answer 9

Because there is no effect on the beta cells

Question 10

What are the adverse drug reactions to Metformin?

Answer 10

GI upset - abdominal pain, nausea, diarrhoea, metallic taste
lactic acidosis - rare but potentially life threatening

Question 11

What factors determine which oral hypoglycaemic agent is selected?

Answer 11

Patient age, co-morbidities, duration of diabetes, history of hypoglycaemia and overall health status