Management of Diabetes D - Type 2 Diabetes Mellitus - Part 2 Flashcards Preview

Year 2 - Endocrine System > Management of Diabetes D - Type 2 Diabetes Mellitus - Part 2 > Flashcards

Flashcards in Management of Diabetes D - Type 2 Diabetes Mellitus - Part 2 Deck (17)
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1
Q

SUMMARY of the diabetes drugs:

A
2
Q

What class of drug is metformin?

A
  • Biguanide
3
Q

What does incretin do?

A
  • Stimulates a decrease in blood glucose levels (wiki)
4
Q

How do DPPIV inhibitors (gliptans) work?

A
  • Delays the breakdown of incretins
  • Therefore ↑ active incretin levels
  • This ↓ blood glucose becuase incretin augments/promotes the secretion of insulin from pancreatic β cells and lowers the secretion of glucagon from pancreatic α cells
5
Q

DPPIV inhibitors list:

A
6
Q

State the advantages and disadvantages of DPPIV inhibitors

A

Advantages:

  • Usually well tolerated
  • Can be used as a 2nd or 3rd line agent
  • Can be used in renal impairment
  • No risk of hypoglycaemia
  • Weight neutral

Disadvantages:

  • Trial data shows relatively small effects on glycaemic control
  • CI in pregnancy and breastfeeding
  • Possible increased risk of pancreatitis and pancreatic cancer
  • SE: nausea
7
Q

How do GLP-1 analogues work? (LATER)

A
8
Q

GLP-1 analogue list:

A
9
Q

What is exenatide?

A

Injectable pen (with glucagon-like peptide-1 receptor agonist (GLP-1 receptor agonist))

10
Q

What are the advantages and disadvantages of GLP-1 analogues?

A

Advantages:

  • Weight loss
  • No risk of hypoglycaemia
  • 3rd line agent
  • Can be used with basal insulin

Disadvantages:

  • Injection
  • Very expensive
  • Possible increased risk of pancreatitis and pancreatic cancer
  • CI in pregnancy and breastfeeding
  • SE: Nausea and vomiting
11
Q

How do SGLT2 inhibitors (…gliflozins) work?

A
  • Normally, most glucose is reabsorbed by SGLT2 in the renal proximal tubule of the kidney
  • Gliflozins selectively inhibit SGLT2 in the renal proximal tubule
  • This leads to ↓ glucose absorption into the blood and ↑ urinary glucose excretion
12
Q

List some effects of SGLT2 inhibitors.

A
  • Excretes/gets rid of glucose/glycosuria
  • Lowers HbA1c
  • Gets ride of water/osmotic diuresis
  • Lose weight with same uptake
13
Q

SGLT-2 inhibitors list:

A
14
Q

State the advantages and disadvantages of SGLT2 inhibitors

A

Advantages:

  • Weight loss
  • No risk of hypoglycaemia
  • Good effects on glycaemic control
  • May have beneficial effect on cardiovascular morbidity and morality
  • 2nd or 3rd line agent
  • Can add to insulin regimens in Type II Diabetes Mellitus

Disadvantages:

  • Expensive
  • Side effects: UTI, fungal infections, osmotic symptoms

↑ Risk of digital amputaiton

↑ DKA

  • CI in pregnanct and breastfeeding
  • Cannot use in renal impairment
15
Q

Insulin is the main treatment for Type I diabetes mellitus but can it be used in Type II?

A
  • YES
16
Q

Give the name of an insulin injection

A
  • Humalin I

(Once daily injection usually at bedtimw)

17
Q

What are the HbA1c targets in those with Type II diabetes?

A

HbA1c targets:

  • Adults with Type II diabetes managed by lifestyle/ diet changes + single drug NOT associated with hypoglycaemia: Aim for HbA1c ≤48 mmol/mol
  • For adults on drugs associated with hyperglycaemia: Aim for HbA1c ≤53 mmol/mol
  • If HbA1c rises to ≥58 mmol/mol and is not adequately controlled by a single drug: Reinforce diet/ lifestyle changes, reinforce adherence to drug treatment and intensify this drug treatment and support the person to aim for HbA1c ≤53 mmol/mol