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Treatments in diabetes for torquay

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Treatments in diabetes for torquay

  1. 1. Treatments in Diabetes Pete Kelly Diabetes Specialist Nurse Diabetes Education Services
  2. 2. There are two main groups of diabetes treatment Diabetes Education Services
  3. 3. The most common tablets for the treatment of Diabetes are….•Metformin •It’s a Biguanide – a drug that reduces the release of glucose from the liver and enables glucose to be taken into muscles and fat cells more efficiently. •Metformin’s length of action is around 8 – 12 hours and it is available in 500mg and 850mg tablets. •Or it is available in a modified release form taken once or twice day. available in 500mg and 750mg tablets. •Maximum dose is total daily dose of 2g. •It is also available in liquid or powder form. Diabetes Education Services
  4. 4. •Metformin •It is best taken with food to avoid gastric disturbance the most common of side effect of the medication. •Generally it is well tolerated and produces good results on top of being very cheap. •Metformin itself does not usually cause hypos but it will augment the effects of other medications to induce a hypo. Metformin should be used with caution in patients with Renal Failure – Creatinine >150 and eGFR <50. ThereWarning is an increased risk of lactic acidosis, rare but possibly fatal complication. Metformin may not be suitable for those with heart failure (a condition whereby the pumping action of the heart is inadequate Diabetes Education Services
  5. 5. Metformin is usually withheld if a radiological dyeis required and it can be recommenced 48-72hrspost procedure. Diabetes Education Services
  6. 6. Gliclazide•It is part of the Sulfonylurea family (several types are available ‘Gliclazide’is one of the more common). Others include Glibenclamide, Glipizide andGlimepiride•Gliclazide works by making the beta cells in the pancreas to release moreinsulin.•It is available in 80mg tablets with a maximum dose of 160mg BD.•It is also available in modified release form (Diamicron MR) 30mg with amaximum daily dose of 120mg. Diabetes Education Services
  7. 7. Gliclazide •Glicazide is usually started once Metformin is no longer effective on its own or it is no longer appropriate to the patient with. •The most common side effect of Glicazide is gastric upset and then weight gain. •It is a cheap and effective treatment for diabetes. Gliclazide commonly causes hypoglycaemia . This is usuallyWarning related to a reduced dietary intake. There may be a need to temporarily reduce the Gliclazide dose to reflect the reduce dietary intake. Diabetes Education Services
  8. 8. Thiazolidinediones (glitazones)•These are Pioglitazone and Rosiglitazone; you will see Pioglitazoneused as currently Rosiglitazone is unavailable.•These work by reducing insulin resistance and improving insulinsensitivity enabling the insulin that the body produces to work moreeffectively.•Pioglitazone is available in 15mg, 30mg and 45mg tablets as wellcombined with Metformin in a preparation called Competact.•The most common side effects are gastric disturbances and weightgain secondary to fluid retention. Diabetes Education Services
  9. 9. Thiazolidinediones (glitazones) •Glitazones should not be used in patients with heart failure or with a history of heart failure. •Glitazones will exacerbate the two conditions.Thiazolidinediones (glitazones)•Both forms of glitazones should be avoided in bothPregnancy and Breastfeeding. In animal studies wasfound to be toxic during pregnancy and also found inmilk. Diabetes Education Services
  10. 10. And the not so common…..•DPP-4 inhibitors (gliptins) •Saxagliptin, Sitagliptin and Vitagliptin•Acarbose - Alpha glucosidase inhibitor •Glucobay•Prandial glucose regulator •Repaglinide Diabetes Education Services
  11. 11. Insulin•Insulin is a hormone made by an organ in our bodies called the pancreas.•The pancreas lies just behind the stomach.•The function of insulin is to help our bodies use glucose for energy.•For all people with Type 1 diabetes and for some people with Type 2 diabetes,insulin is essential to keep blood glucose levels under control.
  12. 12. Basal once Humana day AnalogueMeal time HumanInsulin AnaloguePre mixed HumanInsulin Analogue
  13. 13. InsulatardBasal once Humana day AnalogueMeal time HumanInsulin AnaloguePre mixed HumanInsulin Analogue
  14. 14. Insulatard Humulin IBasal once Humana day AnalogueMeal time HumanInsulin AnaloguePre mixed HumanInsulin Analogue
  15. 15. Insulatard Humulin IBasal once Human Levemira day Analogue DetermirMeal time HumanInsulin AnaloguePre mixed HumanInsulin Analogue
  16. 16. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir GlargineMeal time HumanInsulin AnaloguePre mixed HumanInsulin Analogue
  17. 17. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine ActrapidMeal time HumanInsulin AnaloguePre mixed HumanInsulin Analogue
  18. 18. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time HumanInsulin AnaloguePre mixed HumanInsulin Analogue
  19. 19. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time Human NovorapidInsulin AnaloguePre mixed HumanInsulin Analogue
  20. 20. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time Human Novorapid HumalogInsulin Analogue LisproPre mixed HumanInsulin Analogue
  21. 21. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time Human Novorapid Humalog ApidraInsulin Analogue LisproPre mixed HumanInsulin Analogue
  22. 22. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time Human Novorapid Humalog ApidraInsulin Analogue Lispro Mixtard 30Pre mixed HumanInsulin Analogue
  23. 23. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time Human Novorapid Humalog ApidraInsulin Analogue Lispro Mixtard 30 Humulin M3Pre mixed HumanInsulin Analogue
  24. 24. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time Human Novorapid Humalog ApidraInsulin Analogue Lispro Mixtard 30 Humulin M3 InsumanPre mixed Human Comb. 15 Comb 25Insulin Analogue
  25. 25. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time Human Novorapid Humalog ApidraInsulin Analogue Lispro Mixtard 30 Humulin M3 InsumanPre mixed Human Comb. 15 Comb 25 Novomix 30Insulin Analogue
  26. 26. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time Human Novorapid Humalog ApidraInsulin Analogue Lispro Mixtard 30 Humulin M3 InsumanPre mixed Human Comb. 15 Comb 25 Novomix 30 HumalogInsulin Analogue Mix 25
  27. 27. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time Human Novorapid Humalog ApidraInsulin Analogue Lispro Mixtard 30 Humulin M3 InsumanPre mixed Human Comb. 15 Comb 25 Novomix 30 HumalogInsulin Analogue Mix 25 Humalog Mix50
  28. 28. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time Human Novorapid Humalog ApidraInsulin Analogue Lispro Mixtard 30 Humulin M3 InsumanPre mixed Human Comb. 15 Comb 25 Novomix 30 HumalogInsulin Analogue Mix 25 Humalog Mix50
  29. 29. •Hypoglycaemia •Reduction in the amount of carbohydrate eaten by patient •Patients actually now taking medication •Medications being given in the correct manner •Prescription errors •Incorrect timings of medications •Inappropriate use of stat/PRN insulin •Enteral feed stopped •Diarrhoea and Vomiting Diabetes Education Services
  30. 30. •Hyperglycaemia •Physical stress from infection, pain •Anxiety or emotional •Immobility •Raised awareness of continued hyperglycaemia •Prescription errors •Addition of oral or IV steroids Diabetes Education Services
  31. 31. And finallyVictoza and Exenatide Diabetes Education Services
  32. 32. GLP-1: Multiple physiological Increased effects glucose-dependent Promotes satiety and insulin secretion* reduces appetite Increased insulin Decreased gastric synthesis emptying Decreased glucagon secretion Increased beta-cell proliferation† Reduced hepatic glucose output Decreased beta-cell apoptosis†*GLP-1 only stimulates insulin secretion when †Inglucose is raised, thereby reducing the risk of in vitro studies hypoglycaemia Drucker DJ, Nauck M. Lancet 2006;368:1696–705 Baggio LL, Drucker DJ. Gastroenterol 2007;132:2131–57
  33. 33. • Prior to first use, store in fridge (2–8°C)• Do not freeze• After first use, store below 25°C• Do not store with needle attached Diabetes Education Services

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