PHRM4012 Lecture Notes - Lecture 6: Edema, Apple Juice, Biguanide
25 Jul 2018
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Second line: glp1 agonist (exanatide), dpp4i (-gliptin), sulfonylureas, sodium glucose cotransporter inhibitor (dapaglifozin), insulin. Acute illness increased glucagon increased insulin increase insulin: glucocorticoid, antipsychotics, thiazide diuretics. Counseling: avoid alcohol/bb inhibits hepatic glucagon/mask hypos, exercise, diet low in salt/fat, smoking cessation, weight loss, check bsl regularly, educate about hypos tired, clammy, weak, pale, can be severe, have apple juice, jelly beans. Metformin biguanide increased glucose utilisation in periphery/decreased hepatic glucose production. Reduce dose in crcl<90ml/min max 2g, crcl 30-60 ml/min max 1g, not recommended in crcl <30ml/min unless stable max 500mg. Go to doctor immediately if vomiting, diarrhea, weight loss. D same hba1c efficacy as multiple doses. Basal insulin d ultrarapid/mixed (ultrarapid+basal) multiple d injections. Acarbose alpha glucosidase inhibitor delays carb digestion glucose absorption. Glp1 agonist exanatide decreases appetite/slow gastric. Se nausea, vomiting, alopecia, hypoglycaemia (usually with sulfonylurea/insulin), weight loss. Use 1 hour before food do not use it after food. Exercise, diet low in fat and salt, smoking cessation.
