management of diabetes Flashcards
(23 cards)
name 7 people making up the MDT for a patient with diabetes?
dietician podiatrist pharmacist diabetes doctor GP psychologist specialist nurses
name 8 things a diabetic patient should expect from their care?
BG levels checked BP checked blood lipids checked eyes screened feet checked kidney function weight smoking cessation support
4 reasons why patients have an interest in treatment?
relief of 1y symptoms
prevention of complications
preservation of quality of life
damage minimilisation
5 stages to the 5-step framework for choosing a GLC lowering drug?
1 - set target HbA1c
2 - treat other risk factors
3 - optimise current treatments
4 - GLC lowering options
5 - set review date and target HbA1c with patient
why is metformin normally first choice?
improves outcome
well tolerated
cheap
class of drug - metformin?
biguanides
role of metformin?
improves insulin sensitivity
decreases fatty acid synthesis
inhibits gluconeogenic pathways
improves receptor function
half life of metformin?
6 hrs
benefits of taking metformin in overweight patients?
reduces MI risk and other macrovascular complications
microvascular risks also decrease
name 4 advantages of metformin?
well tolerated
no weight gain
cheap
used in pregnancy
name 4 disadvantages of metformin?
vitamin B12 malabsorption
lactic acid uptake by liver is inhibited - leads to hypoxia, hepatic failure etc.
GI side effects in 20-30% cases
name 3 Sulphonylureas?
Glimepiride
Gliclazide
Glipizide
how are Sulphonylureas named?
Gli___ide
action of Sulphonylureas?
bind to SUR-1 receptor
- > K+ cancels close
- > decreased K+ influx depolarisation
- > Ca2+ channels open
- > exocytosis of secretory granules of insulin to cell surface
action of Sulphonylureas?
bind to SUR-1 receptor
- > K+ cancels close
- > decreased K+ influx depolarisation
- > Ca2+ channels open
- > exocytosis of secretory granules of insulin to cell surface
where are Sulphonylureas metabolised?
liver
how often to take Sulphonylureas?
glimepiride - once/day
gliclazide - twice daily
glipizide - twice daily
4 advantages of Sulphonylureas?
used with metformin
rapid improvement in control
cheap
well tolerated
disadvantages of Sulphonylureas?
risk of HYPOglycaemia
weight gain
caution needed in renal and hepatic disease
photosensitivity reactions as a side effect
name a thiazolidinedione?
Pioglitazone
3 functions of Pioglitazone?
stimulates PPAR-gamma (receptor)
reduces insulin resistance in liver and peripheral tissues
reduces quantity of GLC, insulin and glycated haemoglobin in the blood
disadvantages of Pioglitazone
weight gain
fractures in females
increase risk bladder cancer
disadvantages of Pioglitazone
weight gain
fractures in females
increase risk bladder cancer
