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
    - Genital infections common
    - Inhibits reuptake of glucose in kidneys
    - Empagliflozin (Jardiance), Dapagliflozin (Forxiga), Canagliflozin (Invokana)
    - Weight loss
    - CV benefits
  - 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
- 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),
        
        Mix of fast and slow acting insulin
        
        Humulin M3 Humalog Mix NovoMix
      - Long-acting
        Detemir (Levemir)
        
        Glargine (Abasaglar, Lantus)
        
        Degludec (Tresiba)
      - Intermediate-acting
        Isophane (Humulin I)
        
        Up to 24 hrs
    - Bolus
      - Short-acting
        30-60 mins onset - Up to 9 hrs
        
        Soluble (Humulin S, Actrapid)
      - Rapid-acting
        Aspart (Fiasp, Novorapid)
        
        Lispro (Humalog),
  - 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)

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Diabetes Treatment

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