Diabetes - Oral Hypoglycaemics Flashcards Preview

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Flashcards in Diabetes - Oral Hypoglycaemics Deck (30):
1

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

2

What is the target HBA1C for an adult T2 Diabetic managed by diet & lifestyle?

6.5% (48mmol)

3

What is the target HBA1C for adult T2 diabetic managed by diet, lifestyle and a single drug not associated with hypoglycaemia?

6.5% (48mmol)

4

For people who are taking a drug associated with hypoglycaemia?

7.0% (53mmol

5

When do you need to step up diabetes management initially?

If HBA1C levels rise to >7.5% (58mmol) despite 1 drug & L & D

6

When to relax HBA1c target? (2)

1) Operate or drive heavy machinery
2) People at risk of falls

7

What drug should you initally offer for management of T2 Diabetes?

Metformin

8

Name three other classes of diabetes drugs

Gliptin (DPP-4 inhibitor)
Pioglitazone
Sulfonylurea

9

What is the mechanism of action of metformin?

1) Reduces gluconeogenesis in liver
2) Increases peripheral utilization of glucose & insulin sensitivity

10

What type of drug is metformin?

Biguanide

11

What monitoring must be done before starting on metformin?

U&Es - eGFR must be above 30ml/min to start otherwise risk of lactic acidosis

12

What are two main side-effects of metformin?

Lactic acidosis
GI disturbance - nausea, vomiting, diahrrhoea
B12 deficiency

13

What should happen to metformin before elective surgeyr?

Should be stopped 48 hours before surgery, and resumed 48 hours afterwards

14

Name a gliptin

Sitagliptin

15

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

16

Can gliptins be used in renal impairment?

Yes

17

Give two adverse effects of gliptins

GI disturbances - nausea, vomiting, diarrhoea
Acute pancreatitis

18

Name a gliatzone

Pioglitazone

19

What is the mechansim of action of pioglitazone?

Reduces peripheral insulin resistance

20

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

21

What are three side effects of pioglitazones?

1) Fluid retention
2) Weight gain
3) Bladder cancer

22

Name two sulfonylureas

Tolbutamide, glipizide

23

What is the mechanism of action of sulfonylureas?

Stimulate insulin secretion from BIN cells in islets of langerhans

24

Why be careful prescribing sulfonylureas in liver failure?

Reduced hepatic gluconeogensis - can exacerbate hypoglycaemia

25

Give three adverse effects of sulfonylureas

Gastrointesintal disturbances
Hypersensitivity
HYPOGLYCAEMIA

26

Name two other drugs not in NICE guidelines

GLP-1 mimetic
SLGT-1 inhibitors

27

Namea GLP-1 mimetic

Exenatide

28

What is the mechanism of action of GLP-1 mimetics?

Increase insulin release, inhibit glucagon

29

What are the adverse effects of GLP-1 mimetics?

Gastrointestinal

30

What is the mechanism of action of SLGT-1 inhibitors?

Inhibit SGLT transporters in renal tubule, prevent reabsorption