Diabetes Treatment
- Created by: Melissaloughlin
- Created on: 12-03-23 22:20
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- Diabetes Treatment
- Oral Hypo glycemic Agents
- Sulfonylureas (SUs)
- Gliclazide
- Stimulates insulin secretion from pancreatic beta cells
- Risk of hypoglycemia
- Weight gain
- Can contribute to worsening of dementia
- Access to BG monitoring
- No CV benefits
- DPP-4 Inhibitors
- Alogliptin, Sitagliptin, Linagliptin, Saxagliptin
- Inhibits DPP-4 enzyme that breaks down GLP-1. This increases exposure and increases insulin release
- Neutral weight gain/loss
- No CV benefits
- SGLT2 Inhibitors
- Sick day rules
- Biguanides
- Increases insulin sensitivity
- 1st line after diet/exercise
- Contra-indicated in GFR < 30ml/min
- Weight reduction
- CV benefits
- Biguanides
- Genital infections common
- Inhibits reuptake of glucose in kidneys
- Empagliflozin (Jardiance), Dapagliflozin (Forxiga), Canagliflozin (Invokana)
- Weight loss
- CV benefits
- Sick day rules
- Biguanides
- Increases insulin sensitivity
- 1st line after diet/exercise
- Contra-indicated in GFR < 30ml/min
- Weight reduction
- Thiazolidinediones
- Increased risk of bladder cancer
- Dose-related weight gain
- Probable CV benefits but can cause fluid retention - increased when combined with insulin
- Increased risk of fracture
- Do not use in heart failure/history of, hepatic impairment, DKA
- Sulfonylureas (SUs)
- Injectable Hypoglycemic Agents
- Insulin
- Insulin for Type 1
- BG and ketone monitoring required
- Basal-bolus regime
- Biphasic regime
- Insulin pump therapy
- All type 1 diabetics need insulin
- Hypo glycaemia
- Weight gain
- Insulin for Type 2
- Continue metformin to maintain glycaemic control
- Reduce/stop SUs risk of hypoglycemia
- Initiate with OD bedtime basal insulin
- Basal
- Biphasic Insulin
- Bolus
- Short-acting
- 30-60 mins onset - Up to 9 hrs
- Soluble (Humulin S, Actrapid)
- Rapid-acting
- Aspart (Fiasp, Novorapid)
- Lispro (Humalog),
- Short-acting
- Mix of fast and slow acting insulin
- Humulin M3 Humalog Mix NovoMix
- Bolus
- Long-acting
- Detemir (Levemir)
- Glargine (Abasaglar, Lantus)
- Degludec (Tresiba)
- Intermediate-acting
- Isophane (Humulin I)
- Up to 24 hrs
- Biphasic Insulin
- Bolus
- Short-acting
- 30-60 mins onset - Up to 9 hrs
- Soluble (Humulin S, Actrapid)
- Rapid-acting
- Aspart (Fiasp, Novorapid)
- Lispro (Humalog),
- Short-acting
- Insulin for Type 1
- GLP-1 Agonists
- Stop DPP-4 inhibitors when initiating this
- BMI >30kg/m2
- Mimicks endogenous GLP-1 but is not broken down by DPP-4 enzyme, increasing exposure to receptor and insulin release
- Weight loss
- CV benefits (Liraglutide)
- Semaglutide (Ozempic) Dulaglutide (Trulicity) Liraglutide (Saxenda, Victoza)
- Insulin
- Oral Hypo glycemic Agents
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