Management of T2DM
A 58 y/o man with severe CKD is recently diagnosed with T2DM. What is the first-line treatment?
Sulfonylurea (Glipizide, Gliclazide, Glibenclamide) + either:
- SGLT2i OR
- GLP1 RA
Name 1 medical condition that is contraindicated with Metformin
- severe CKD
- severe HF
- liver dysfunction
What is the value for hypoglycaemia?
≤ 4.0 mmol/L
How to counsel the genital infections for males & females caused by SGLT2i?
- keep area dry & clean
- wipe from front to back (females)
A 30 y/o woman has T2DM with elevated HbA1c levels, mild non-proliferative diabetic retinopathy. What is the target HbA1c range?
6.0-6.5%
Why is Metformin often preferred over Sulfonylureas (like Glipizide)?
- does not cause weight gain (often weight-neutral or leads to minor loss).
- has a very low risk of hypoglycemia unlike SU
Explain what is the 15-15 rule.
15g of fasting-acting sugars, followed by 15 min wait before checking blood glucose again
What is the 'Sick-Day' Rule?
- stop the medication if you can't eat because you are sick
- resume again when you can eat & drink
Name 2 drug classes which are 1st line therapies for a pt with T2DM who requires significant weight loss
any 2 of the 4:
- Biguanides
- SGLT2i
- GLP1 RA
- DPP4i
What is the MOA of metformin?
insulin sensitisers => increase effective insulin-IR (insulin receptor) interaction to allow:
> uptake of glucose into muscle
> inhibit gluconeogenesis in the liver
Name 3 points to prevent hypoglycaemia
any 3 of the 4:
- Do not skip meals even when busy
- Bring a few sugar-containing sweets along whenever you go out
- Close follow instructions on when to take your medications (in relation to meal)
- Do not take T2DM meds in the morning when fasting for a blood test
A patient is newly started on oral semaglutide (rybelsus)
a) what is the recommended starting dose?
b) what is the next dose the patient is typically escalated to?
3mg => 7mg