Management of Type 2 Flashcards
What should a patient expect from their care?
- BG levels
- BP
- Blood lipids
- Eyes screened
- Feet checked
- Kidney function
- Weight
- Smoking cessation support
- Individual care plan
- Education course
- Emotional + psychological support
What sort of questions should be asked in a type 2 consultation?
- How has life/health/diabetes been? (open Q)
- What improvements patient feels they could make
- Establish challenging times for glycaemic control ahead e.g. hols, weddings
- Review BG levels
What are the 4 main aims of diabetes treatment?
Relief of primary symptoms
Prevention of complications
Preservation of quality of life
Damage minimalisation
What are the 3 pancreatic defects found in type 2 and what are their effects?
BETA CELL DYSFUNCTION
DIMINISHED INCRETIN EFFECT
= decreased insulin production
EXCESS GLUCAGON
= decreased insulin action
What is the defect found in the periphery in type 2 and what is its effect?
INSULIN RESISTANCE
= insulin resistance
Name 4 meds which increase insulin release
Sulphonylureas
Metiglinides
Incretin Mimetics
DPPIV inhibitors
What med increases excretion of glucose?
SCLT2 inhibitors
Name 3 meds/methods which improve insulin action
Biguanides
Thiazolidiones
Weight reductions
Give 7 signs of type 2 DM
Thirst
Blurry vision
Drowsiness/sleepiness
Increased hunger
Frequent urination
Slow/improper healing of cuts and bruises
Tingling, pain or numbness in hands + feet
Other than meds, what else needs considered in type 2 to prevent complications?
Smoking Mood Statins Blood pressure Physical activity Diet
Step 1 of framework for choosing glucose lowering drug
Set a target HbA1c
Step 2 of framework for choosing glucose lowering drug
‘Take 5’ - are there other risk factors to be treated first
Step 3 of framework for choosing glucose lowering drug
Are the current treatments optimised; max dose, tolerated, taken?
Step 4 of framework for choosing glucose lowering drug
What are the glucose lowering options?
- remove any contraindicated
- of remaining what r pros n cons
- select preferred choice
Step 5 of framework for choosing glucose lowering drug
Agree a review date and target HbA1c with patient
In who should the target HbA1c level be relaxed?
People who r older/frail
Adults with reduced life expectancy
Adults at high risk of the consequences of hypo (falling, impaired awareness of it, those who drive/operate machinery)
People in whom intensive management is not appropriate - multiple comorbidities
What is the usual first line oral treatment for type 2?
Metformin
What is the first line is there are osmotic/weight loss symptoms?
Sulfonylurea
What is added as the usual 2nd line oral treatment for type 2?
Sulfonylurea
What other 3 meds can be 2nd line if contraindications to Sulfonylurea (for all - if hypos a concern)?
Thiazolidinedione(if no CCF)
DPP-IV inhibitor (if weight gain a concern)
SGLT-2 inhibitor (if weight gain a concern)
Then review 2nd line meds, if not reaching target then move to 3rd line and add/substitute - give the 3 oral 3rd line agents?
Thiazolidinedione
DPP-IV inhibitor
SGLT-2 inhibitor
Give the 2 injectable 3rd line meds, and the indications for each?
GLP-1 agonist (if BMI>30kg/m2; if desire to lose wt; usually <10 yrs from diagnosis)
Insulin (if osmotic symptoms/rising HbA1c)
Continue medication if either…
glycaemic target acheived or HbA1c falls >5mmol/mol in 3-6 months
Give the 3 common names for Sulfonylureas
GLIMEPIRIDE
GLICLAZIDE
GLIPIZIDE
(the ‘gli…ides’)
