What is the treatment pathway for Type 2 diabetes?
1) Metformin
2) SGLT-2 inhibitor (Canagliflozin, Dapagliflozin, Empagliflozin or Ertuglifozin) - beneficial in CVD
3) Sulfonylurea (glicazide)
4) DPP‑4 inhibitor (sitagliptin)
5) Pioglitazone
When a patient with type 2 diabetes is obese, what anti-diabetic drug should be avoided?
Sulfonylurea - glicazide
This causes weight gain
What vitamin deficiency increases with higher metformin dose?
Vitamin B12 deficiency
What is the MOA of metformin?
- Lowers blood glucose by reducing hepatic glucose output
- Involves activation of AMP Kinase
- Has an effect on glucose metabolism and othe metabolic changes such as weight loss
What are some side effects of metformin?
- GI upset
- Anorexia
- Taste disturbance
- Lactic acidosis (mainly in conditions where patient has other illnesses that lead to the accumulation of metformin in the body)
What are the warnings of metformin use?
- Renal impairment (dosage reduction)
- Acute kidney injury (eGFR < 30)
- Hepatic impairment
- Severe tissue hypoxia (MI, sepsis, cardiac or resp failure)
- Acute alcohol intoxication
- Chronic alcohol abuse
Important interactions of metformin?
- IV contrast media (should be withheld 48hrs before)
- Drugs that can cause renal failure (NSAIDS, ACEi, diuretics)
- Prednisolone, thiazide and loop diuretics elevate blood glucose
What are the hba1c targets for type 2 diabetes?
1) Single drug treatment - <48 mmol/mol
2) Double drug treatment - <53 mmol/mol
What is Carbimazole used for?
Hyperthyroidism
What is the MOA of sulfonylureas (eg. gliclazide)?
- Stimulate insulin secretion from pancreatic β-cells
What drug should be withheld before injection of IV contrast?
Metformin - before and 48 hours after
- Increased risk of renal impairment that could lead to lactic acidosis
What medications interact with gaviscon?
- Tetracycline
- Digoxin
- Iron
- Bisphosphonate
- Levothyroxine
