Please enable JavaScript.
Coggle requires JavaScript to display documents.
Pharmacological management of Type 2 diabetes (Metformin (First-line…
Pharmacological management of Type 2 diabetes
Metformin
First-line treatment
biguanide class of drugs
Increases hepatic insulin sensitivity
Increases the uptake of glucose into peripheral cells
reduces hepatic glucose production
Aids weight loss
Side Effects - Mostly GI e.g. nauseas, abdominal cramps
BNF recommends starting at 500mg daily
Sulfonylureas
e.g gliclazide, glimepiride, meglitinides
second-line agents
Can be added to metformin if glycaemic control is inadequate
Bind to receptor on pancreatic beta cells, leading to increased secretion of endogenous insulin
Main side effects - weight gain and hypoglycaemia
Thiazolidinediones
e.g. piglitazone
Thiazolidinediones act via the peroxisome proliferator-activated receptor-γ (PPAR-γ), a nuclear transcription factor to decrease insulin resistance
Been shown to lead to a significant reduction in HbA1C, both as a monotherapy and when used in combination with other oral agents such as metformin and/or sulphonylureas
Associated with an increased fracture risk and in some patients can lead to heart failure
Insulin replacement Therapy
Required in majority of patients with type 2
Basal insulin alone
Twice daily biphasic insulin containing a mix of rapid-acting and long-acting insulins
Basal bolus regimen with long-acting insulin with additional doses of rapid-acting at meal times
All insulin regimens are associated with and increased risk of hypoglycaemia and can cause weight gain