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Treatment of Diabetes - Coggle Diagram

- - - - Potentiation of insulin signalling: Downstream effects result in Decreased lipid synethesis, decrease gluconeogenesis and increase action of GLUT-4 and glucose uptake/synthesis
      - Benefits: Rare hypoglycemia, weight neutral, improved CV risk factors, inexpensive
      - Risks: GI side effects, Renal: reduce dose required with declining eGFR, B12 deficiency
  - - - In response to food, insulin secretion increases, glucagon secretion decreases, satiety increases and gastric emptying decreases
    - - Rare hypoglycemia, weight loss, CVD benefit
  - - - Blocks glucose reabsorption by proximal renal tubule leading to urinary excretion of glucose
    - - Weigt loss, CVD benefit, Decreased hospitalization for heart failure
    - - Mycotic Genital infections, hypotension, rare cases of ketoacidosis
  - - - Inhibits breakdown of endogenous GLP1 and GIP which leads to increased signalling leading to increased insulin
      - Benefits: Weight neutral, hypoglycaemia low risk, CV event neutral
      - Risks: GI Side effects, rare cases of pancreatitis
  - - - Benefits: Decrease A1C
      - Risks: Weight gain, hypoglycemia
    - - Benefits: Decrease A1C, better postprandial coverage, safe in renal impairment
      - Risks: Weight gain, Hypoglycaemia, Moderate cost
  - - - Reduces digestion of carbohydrates/disaccharides
      - Benefits: Decreases A1C, weight neutral, low risk of hypoglycemia
      - Risks: GI side effects
  - - - Enhances insulin sensitivity in peripheral tissues and liver (via activation of PPARy receptors)
    - - Lower A1C, Low risk of hypoglycemia, Reduce stroke risk, reduces fatty liver
      - Risks: Weight gain, hypoglycemia, peripheral edema, Osteopenia/Fractures
  - - - Otherwise metformin widely considered first-line
    - - Best efforts at healthy behavioural interventions
      - Temporarily
    - - Common initial approach = Basal insulin
      - Basal-bolus insulin if extreme hyperglycemia
- - - - Then calculate how much the glucose needs to be lowered by and calculate dosage