Type 2 diabetes

Question 1

Prediabetic HbA1c levels

Answer 1

42-48 mmol/mol

Question 2

Diabetic HbA1c level
Diabetic fasting plasma glucose levels

Answer 2

48mmol/L
7mmol/L

Question 3

DPP-4 inhibitors

Answer 3

‘GLIPTINS’
- linagliptin
- sitagliptin

Question 4

Sulfonylureas

Answer 4

Gliclazide

Question 5

SGLT-2 inhibitors

Answer 5

Dapagliflozin
Empagliflozin

Question 6

Treatment of type 2 diabetes in someone with a LOW CVD risk

Answer 6

Step 1: Metformin

Step 2: pioglitazone or gliclazide

Step 3: triple therapy
- adding/ swapping with SGLT-2s or DPP-4i

Question 7

Factors that consider someone HIGH CVD risk with type 2 diabetes

Answer 7

• established atherosclerosic CVD or HF
• QRISK > 10% in those over 40

Question 8

Treatment of type 2 diabetes in someone with a HIGH CVD risk

Answer 8

STEP 1: Metformin

STEP 2: + SGLT2 inhibitor (once metformin tolerated)
- SGLT2 used alone if metformin not tolerated

STEP 3: same as LOW CVD risk

Question 9

Which antidiabetic drugs are associated with HYPOglycaemia?

Answer 9

1. Sulphonylureas (compensate by having HBA1C target of 53 mmol/mol)
2. Insulin

Question 10

MHRA warning with metformin

Answer 10

Reduced levels of vitamin B12
- this can cause fatigue, weakness, and neurological issues like numbness and tingling in the extremities

Question 11

Side effects associated with metformin

Answer 11

Lactic acidosis (especially in renally impaired)
GI side effects- N&V (give MR preparation)

Question 12

What renal function should metformin be avoided in?
- why

Answer 12

If eGFR<30ml/min/1.73m2
- increases risk of LACTIC acidosis

STOP IN AKI

Question 13

When should DPP-4 inhibitors be used with caution?
- ‘gliptins’

Answer 13

Heart failure

Avoid: ketoacidosis

Question 14

When should DPP-4i’s be discontinued?

Answer 14

If pancreatitis develops
- persistent severe abdominal pain

Question 15

Contraindications of pioglitazone?

Answer 15

Heart failure

Question 16

what can pioglitazone increase the risk of?

Answer 16

Bladder cancer and Liver toxicity
- Bone fractures
- Infections

Question 17

What are the symptoms associated with bladder cancer due to pioglitazone?
- When is it reviewed?

Answer 17

Haematuria (blood in urine)
Dysuria/ urinary urgency
Urinary urgency
- reviewed for efficacy after 3-6 months

Question 18

When are sulphonylureas (gliclazide) usually given?

Answer 18

If the patient has a higher HbA1c as a rescue therapy

Question 19

3 MHRA warnings accosted with SGLT-2 inhibitors

Answer 19

1. Life threatening DKA
2. Monitor ketones if treatment is interrupted due to a surgical procedure or illness
3. Fournier gangrene

Question 20

MHRA warning associated with canagliflozin?

Answer 20

Risk of lower-limb amputation (mainly toes)

Question 21

What must be corrected before starting treatment with SGLT-2 inhibitors?

What is common side effect of SGLT-2 inhibitors?

Answer 21

Volume depletion- correct hypovolemia

Increased risk of urinary tract infections and thrush

Question 22

What are the MHRA warnings associated with GLP-1 agonists?
- 3

Answer 22

1. DKA risk when insulin is rapidly reduced
2. Risk of pulmonary aspiration during general anaesthesia or deep sedation
3. Potential misuse and reminder of side effects

Question 23

What are the side effects associated with GLP-1?

Answer 23

Acute pancreatitis- severe abdominal pain
GI effects- weight loss, nausea and vomiting
Dehydration- due to GI side effects

Question 24

What is acarbose?
- what are the side effects

Answer 24

Delays digestion of starch and sucrose
- gastro intestinal side effects

Question 25

what are meglitides? - when should this be switched to insulin?

Answer 25

Stimulates insulin secretion - Swap to insulin in periods of stress (fever, trauma or infection)

Question 26

which antidiabetic medications cause weight GAIN? Which are NEUTRAL? Which cause weight LOSS?

Answer 26

GAIN: Pioglitazone and sulphonylureas (gliclazide) NEUTRAL: DPP-4i and metformin LOSS: GLP-1 and SGLT-2i

Question 27

Answer 27