Type 2 diabetes

hedalamei's version from 2015-09-20 09:25

Section 1

Question Answer
Name 5 classes of oral antidiabetic meds.1. Biguanide (Metformin). 2. Sulfonylurea (Gliclazide). 3. DPP-IV inhibitor (Sitagliptin). 4. SGLT inhibitor (Dapagliflozin). 5. Alpha-glucosidase inhibitor (acarbose).
Metformin (diabex): MOA, ADR, dosage.MOA: biguanide; decreased gluconeogenesis. 1.5% HbA1c reduction. ADR: GI, LA, B12 malabsorption. Dosage: start 500mg CR nocte, titrate up to 2000 as tolerated.
Gliclazide (diamicron): MOA, ADR, dosage.MOA: sulfonylurea; insulin secretagogue. 1.5% HbA1c reduction. ADR: hypoglycaemia, weight gain. Dosage: 30-120mg CR daily.
Sitagliptin (Januvia): MOA, ADR, dosage.MOA: DPP-IV inhibitor, incretin mimetic; increases insulin secretion + suppresses glucagon release by increasing concentration of GLP-1 by blocking its metabolism. 0.5% HbA1c. ADRs: minimal. Dose: 100mg daily, adjusted for GFR.
Exanatide (Byetta): MOA, ADR, dosage.MOA: GLP-I agonist, stimulates insulin secretion, suppresses glucagon release, slows gastric emptying, decreases appetite, assoc. w. wt loss.1.5% HbA1c reduction. ADR: GI, rarely hypos, rarely necrotising pancreatitis. Dosage: 5microg BD SC, increase to 10 BD if tolerated.
Acarbose: MOA, ADR, dosage.Alpha-glucosidase inhibitor; inhibits conversion of poly-/di-saccharides into monosaccharides. 0.5% HbA1c reduction. Not well tolerated due to GI effects. Dosage: 50mg daily - 150mg tds, with food.

Section 2

Question Answer
Insulin GLARGINE. Brandname, onset, peak, duration.Lantus. Onset 1-2h. No peak. Lasts 24h.
Insulin DETEMIR. Brandname, onset, peak, duration.Levemir. Onset 3-4h. Peak 9h. Lasts 12-24h.
NEUTRAL insulin. Brandname, onset, peak, duration.Actrapid. Onset 30m. Peak 2-3h. Lasts 6-8h.
Insulin ASPART. Brandname, onset, peak, duration.Novorapid. Onset 15m. Peak 1h. Lasts 4-5h.
Novomix 30. Composition, onset, peak, duration.30% insulin aspart, 70% protamine insulin. Onset 15m. Peak 1h. Lasts 4-5h.

Section 3

Question Answer
Glycaemic targets.HbA1c <7%. BGL <5.5 fasting / <7 post-prandial.
BP targets.<130/70. If proteinuria, <125/65. ACEi first line.
Lipid targets.Start a statin (equiv. 40mg statin). Aim total<4, LDL<2, trig<2, HDL>1.
SNAP targets.No-smoking. Balanced diet with >3 serves/d wholegrain. Alcohol per usual guidelines. >30min/day of mod physical activity.
Weight targets?Try to lose 5-10% of weight if overweight. Consider bariatric surgery if BMI >40, or >35 (if comorbidities).
Yearly cycle of care?Foot exam (+ podiatrist referral). Fundus/acuity exam q1-2y. Annual albuminuria + GFR.

Section 4