T1DM & T2DM

Question 1

What is the main medication for T1DM?

Answer 1

INSULIN

Question 2

Where are insulin injections delivered into the body?

Answer 2

Into the subcutaneous fat

Question 3

What aspects of their lifestyle do T1DM patients need to manage?

Answer 3

Controlled carbohydrate diet
Exercise
Hypoglycaemia
Illness

Question 4

What are the types of insulin?

Answer 4

Quick acting - SC injection/IV
Slow acting - been modified to reduce/slow its entry to blood stream
Bi-phasic (mix of quick acting and slow acting insulin)
- ration usually 25:75 or 30:70

Question 5

What needs to be managed in terms of lifestyle for T2DM?

Answer 5

Exercise - e.g. walking: 150 min per week; 1hr/d; 10 000 steps
Weight management - e.g. minimise refined carbohydrate

Question 6

What are the escalations for treatment in T2DM?

Answer 6

Lifestyle
Lifestyle + Metformin (unless GI SE)
Lifestyle + Metformin + further drugs
Lifestyle + metformin + further drugs + insulin

Question 7

How is glucose control monitored?

Answer 7

Urine glucose
Blood glucose 
- 4x a day in T1DM
- Targeted for those on hypoglycaemic risk meds (T2DM)
HbA1c
- For risk assessment
- Every 6 months

Question 8

Insulin regimes?

Answer 8

Long-acting insulin - offer 2x daily detemir as basal insulin
Rapid-acting insulin - before meals

CSII - continuous subcutaneous insulin infusion (aka insulin pump) may be considered

Question 9

What is the first line drug treatment for T2DM?

Answer 9

Metformin

- Decreases hepatic glucose production and reduces insulin resistance

Question 10

What are the side effects of metformin?

Answer 10

GI symptoms (e.g. diarrhoea, nausea, abdominal discomfort)
Weight loss

Question 11

What medications can be given alongside metformin at the first intensification?

Answer 11

DPP4 inhibitors (e.g. Sitagliptin, Vildagliptin, Linagliptin, Alogliptin)
Pioglitazone
Sulphonylurea (Glicazide, Glipizide, Glibenclamide)

Question 12

What does a DPP4 inhibitor do?

Answer 12

Increase insulin secretion and decreases glucagon secretion
DPP4 metabolises GLP-1, so by inhibiting DPP4 it prolongs the action of GLP-1

Sitagliptin, Vildagliptin, Linagliptin, Alogliptin

Question 13

What is pioglitazone?

Answer 13

A thiazolindenediones
Increases insulin sensitivity (therefore reduces insulin resistance)

SE - osteoporosis

Question 14

What are sulphonylureas?

Answer 14

Increases insulin secretion by increasing beta-cell activity

Glicazide, Glipizide, Glibenclamide

Question 15

What are the side effects of sulphonylureas?

Answer 15

Weight gain

Hypoglycaemia

Question 16

What are GLP-1 agonists?

Answer 16

aka incretins e.g. Exenatide, Liraglutide

GLP-1 is secreted from GI tract after ingestion of food and stimulates insulin secretion from beta cells and suppresses glucagon secretion and slows down absorption of food
◦ Resistant to DDP4

SE - GI symptoms (diarrhoea, nausea, abdominal discomfort)

Question 17

What are SGLT2 inhibitors?

Answer 17

e.g. Dapagliflozin, Canagliflozin, Empagliflozin

Increases glucose excretion from kidneys - by inhibiting reabsorption of glucose (in the proximal tubule)

SE - weight loss, UTI

Question 18

What other classes of drugs are there for T2DM?

Answer 18

Meglitinides (e.g. Nateglinide, Repaglinide)
- Increases insulin secretion by increasing beta-cell activity
- Used less than the sulphonylureas and are quicker acting
Acarbose: Alpha-glucosidase inhibitor - slows intestinal carbohydrate/glucose absorption