Management of Type 2 DM

Question 1

Where should diabetics go for advice?

Answer 1

Practice nurse/GP
Online
Group education sessions
Dietetic ad

Question 2

What should you ask in a consultation with a diabetic?

Answer 2

Review data in diabetes
Review blood glucose
Ask patient concerns
Establish whether challenges are approaching
Set goals - care plan

Question 3

What are the aims of diabetes treatment?

Answer 3

Relief of symptoms
Prevent complications
Preserve QoL
Damage minimalisation

Question 4

Which treatments improve insulin action?

Answer 4

Biguanides (metformin)
Thiazolidiadiones (Glitazones)
Weight loss

Question 5

Which treatments improve insulin release?

Answer 5

Sulphonylureas (Gliclazide)
metiglinides
Incretin mimetics
DPPIV inhibitors

Question 6

What is the effect of beta cell dysfunction?

Answer 6

Decreased insulin production

Question 7

What is the action of SGLT2 inhibitors?

Answer 7

Increase excretion of glucose

Question 8

What is the effect of decreased incretin effect?

Answer 8

Decreased insulin production

Question 9

Which factors decrease insulin action?

Answer 9

Insulin resistance (periphery)
Excess glucagon

Question 10

What factors can be controlled to reduce the potential complications of diabetes?

Answer 10

Lipids
Smoking
HTN
Mood 
Dietary change
Sedentary behaviour

Question 11

What is the 5step framework for choosing a glucose lowering drug?

Answer 11

1. Set target HbA1c
2. Are there other current risk factors needing Rx
3. Are the current treatments optimised
4. What Rx options are there
5. Agree to review date

Question 12

What factors must be taken into account in setting a target HbA1c?

Answer 12

Age/frailty
Reduced life expectancy
What risk would a hypo have?
Is intense management appropriate?

Question 13

What is the first line management for T2D?

Answer 13

Metformin

Sulfonylurea if symptomatic

Question 14

After metformin, what is the second line therapy for T2D?

Answer 14

Sulfonylurea
Thiazolidinedione
DPP-IV inhibitor
SGLT-2 inhibitor

Question 15

After sulfonylurea, what is the second line therapy for T2D?

Answer 15

Metformin

Question 16

When is Thiazolidinedione indicated for second line T2D therapy?

Answer 16

If hypos are a concern

If no CCF

Question 17

When are inhibitors

indicated for second line T2D therapy?

Answer 17

If hypos are a concern

If weight gain are a concern

Question 18

What are the third line therapies for T2D?

Answer 18

Thiazolidinedione
DPP-IV/SGLT-2 inhibitor
GLP-1 agonist
Insulin

Question 19

When is insulin indicated in T2D?

Answer 19

Third line

If osmotic symptoms/rising HbA1c

Question 20

When is GLP-1 agonist indicated in T2D?

Answer 20

Third line
BMI>30
Desire to lose weight
<10y from Dx

Question 21

What class of drug is metformin?

Answer 21

Biguanides

Question 22

Metformin acts on what?

Answer 22

Liver

Muscles

Question 23

How does metformin work?

Answer 23

Improves Insulin Action
Decreased FA synthesis
Improve receptor function
Inhibits gluconeogenesis

Question 24

What is the half life of metformin?

Answer 24

6hrs

Question 25

What are the disadvantages of metformin?

Answer 25

Risk of lactic acidosis GI side effects (20-30%) Risk of vitamin B12 malabsorption

Question 26

How does metformin cause lactic acidosis?

Answer 26

Inhibits lactic acid uptake by the liver

Question 27

Sulphonylureas act on what?

Answer 27

Pancreas

Question 28

What is the mechanism of Sulphonylurea action?

Answer 28

Bind to Sulphonylurea receptors (SUR-1) on B-cells Closes ATP K channels Decreases depolarisation Ca2+ channels open Translocation of secretory granules of insulin

Question 29

Which sulphonylurea is indicated in reduced renal function?

Answer 29

Gliclazide

Question 30

What are the disadvantages of sulphonylureas?

Answer 30

Risk of hypoglycaemia Weight gain Caution in renal/hepatic issues Cant pregnant/breastfeeding

Question 31

What side effects are associated with sulphonylureas?

Answer 31

Hypersensitivity Photosensitivity Blood disorders

Question 32

What is the action of Thiazolidiones?

Answer 32

Improve insulin action Modulates transcription of insulin-sensitive genes Reduces insulin resistance

Question 33

Thiazolidiones act on what?

Answer 33

Liver Muscle Adipose tissue

Question 34

What are the disadvantages of Thiazolidiones?

Answer 34

Increased risk blader cancer Fluid retention (NO USE IN CCF) Weight gain Fractures in females

Question 35

When are Thiazolidiones contraindicated?

Answer 35

CONGESTIVE CARDIAC FAILURE | Bladder neoplasm

Question 36

What is the main contraindication of metformin?

Answer 36

Reduced eGFR