Flashcards in Diabetes - Oral Hypoglycaemics Deck (30):
Outline the broad initial steps of T2 Diabetes management
1) Patient Education - DESMOND programme
2) Lifestyle management - Exercise, diet
3) Screen for complications
4) Pharmacological therapies
What is the target HBA1C for an adult T2 Diabetic managed by diet & lifestyle?
What is the target HBA1C for adult T2 diabetic managed by diet, lifestyle and a single drug not associated with hypoglycaemia?
For people who are taking a drug associated with hypoglycaemia?
When do you need to step up diabetes management initially?
If HBA1C levels rise to >7.5% (58mmol) despite 1 drug & L & D
When to relax HBA1c target? (2)
1) Operate or drive heavy machinery
2) People at risk of falls
What drug should you initally offer for management of T2 Diabetes?
Name three other classes of diabetes drugs
Gliptin (DPP-4 inhibitor)
What is the mechanism of action of metformin?
1) Reduces gluconeogenesis in liver
2) Increases peripheral utilization of glucose & insulin sensitivity
What type of drug is metformin?
What monitoring must be done before starting on metformin?
U&Es - eGFR must be above 30ml/min to start otherwise risk of lactic acidosis
What are two main side-effects of metformin?
GI disturbance - nausea, vomiting, diahrrhoea
What should happen to metformin before elective surgeyr?
Should be stopped 48 hours before surgery, and resumed 48 hours afterwards
Name a gliptin
What is the mechanism of action of Gliptins?
Gliptins are DPP-4 inhibitors. DPP-4 is an enzyme that degrades incretins which stimulate postprandial insulin secretion and suppress glucagon secretion
Can gliptins be used in renal impairment?
Give two adverse effects of gliptins
GI disturbances - nausea, vomiting, diarrhoea
Name a gliatzone
What is the mechansim of action of pioglitazone?
Reduces peripheral insulin resistance
What are three things to check before starting pioglitazone?
1) Does the person have heartfailure?
2) Liver function
3) FBC - contraindicated in anaemia
4) History of bladder cancer
What are three side effects of pioglitazones?
1) Fluid retention
2) Weight gain
3) Bladder cancer
Name two sulfonylureas
What is the mechanism of action of sulfonylureas?
Stimulate insulin secretion from BIN cells in islets of langerhans
Why be careful prescribing sulfonylureas in liver failure?
Reduced hepatic gluconeogensis - can exacerbate hypoglycaemia
Give three adverse effects of sulfonylureas
Name two other drugs not in NICE guidelines
Namea GLP-1 mimetic
What is the mechanism of action of GLP-1 mimetics?
Increase insulin release, inhibit glucagon
What are the adverse effects of GLP-1 mimetics?