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Flashcards in Management of T2DM Deck (26)
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1

what is the main treatment outline

1. metformin
2. metformin plus non injectable
3. metformin plus plus GLP1 or insulin
4. 4

2

action of metformin

suppress hepatic gluconeogensis, reducing glucose output from liver and increase glucose uptake

3

name of a sulphonylurea

gliclazide

4

benefits of metformin

Moderate efficacy, weight reduction, low hypo risk, CV benefit, extensive experience

5

benefits of sulphonylurea

High efficacy, extensive experience experience

6

side effects of metformin

GI side effects, No if eGFR<30, small risk of lactic acidosis

7

sulphonylurea action

•Close potassium channels on beta cells, stimulating release of stored insulin

8

side effects of sulphonylurea

No CV benefit, weight gain, high hypo risk, caution in CKD
Less effective over time because like squeezing insulin from a sponge, not effective in type 1 as nothing there in first place

9

name a DPP4 inhibitor

linagliptin

10

DPP4 inhibitor benefits

Low/Moderate efficacy, low hypo risk, few adverse events

11

DPP4 inhibits action

•Inhibit DPP-4 and enhance effects of endogenous incretins (eg. GLP-1)

12

SGLT 2 inhibitor action

•Inhibit SGLT2 in the proximal convoluted tubule of the kidney

13

benefits of SGLT 2

Moderate efficacy, CV benefit (BP + HF), renal benefit (CANA), Weight loss, low hypo risk, reduced CV events

14

side effects of SGLT 2

Risk of GU infections, Small risk of hypovolaemia/DKA, do not start if eGFR<60

15

how do thiazolidinediones work

PPAR gamma-receptor agonists
•Increase sensitivity of fat, muscles, and liver to endogenous and exogenous insulin
Rarely used

16

name a thiazolidinediones

pioglitazone

17

benefit of thiazolidinediones

Moderate efficacy, probably CV protection, low hypo risk, past experience

18

side effects of thiazolidinediones

Weight gain, fluid retention, fractures

19

GLP 1 receipt antagonist how it works

•Increase glucose mediated insulin secretion, suppress glucagon secretion

20

benefits of GLP 1

High efficacy, CV benefit, low hypo risk, weight loss injected,

21

side effects of GLP 1

GI side effects, uncertain safety re. pancreas

22

name of GLP1

exanatide

23

inlsuin how it works

•Increase glucose uptake and utilisation in skeletal muscle
•Reduce hepatic glucose output, increase glycogenesis
•Decrease lipolysis
•Decrease gluconeogenesis

24

benefits of insulin

High efficacy, extensive experience

25

aide effects of insulin

Injected, No CV benefit, weight gain,
highest hypoglycaemia risk

26

DPP4 inhibitor side effects

Weight neutral, no CV benefit, reduce dose in CKD