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Precautions of Gliclazide/glimepramide?
- Type 1 Diabetes
- Renal impairment
Adverse Effects of gliclazide/glimeparide??
- weight gain
- Nausea, diarrhoea, metallic taste
Dose of gliclazide?
- 40-320mg once or twice daily
- Start with 20mg once daily if 12-18y
- Controlled release: 30mg once daily initially
Counselling of Gliclazide/Glimepramide??
- Take with food to minimise risk of hypos
- Avoid binge drinking since it can lower blood glucose levels.
- Eat when you drink also.
- Make sure you and
- family members know how to treat hypos
Dose of glimepramide?
1mg once daily initially increase by 1mg every 1-2 weeks, max 4mg daily
Contraindications of metformin??
- Type 1 diabetes—contraindicated.
- Respiratory failure—contraindicated.
- Severe infection or trauma—contraindicated.
- Alcohol misuse—contraindicated.
Adverse effects of metformin?
malabsorption of vitamin B12, nausea, vomiting, anorexia, diarrhoea
cramps, malaise, weightloss, anorexia - lactic acidosis
dose of metformin?
Iinitially 500 mg 1–3 times daily; may be increased up to 850 mg 2 or 3 times daily according to response. Maximumdaily dose 3 g.
Controlled release tablet, initially 500 mg once daily with the evening meal; may be increased up to 2 g once daily.
dose of metformin in renal impairment?
60–90 mL/minute, 2 g daily.
30–60 mL/minute, 1 g daily.
Counselling of metformin?
Take with meals to reduce stomach upset.
Tell your doctor immediately if you have loss of appetite, nausea, vomiting, abdominal pain, cramps, fatigue, diarrhoea or weight loss.
- Drinking alcohol can affect control of your diabetes. It can also increase the risk of serious side effects. Limit your alcohol intake, avoid binge drinking
- and have something to eat when you drink alcohol.
Lifestyle and monitoring of glucose levels!
Indications for pioglitazone?
- Type 2 diabetes, alone or with metformin and/or a sulfonylurea
precautions of pioglitazone?
- heart failure - may worsen
Adverse effects of pioglitazone?
peripheral oedema, weight gain, headache, dizziness,
dosage of pioglitazone?
- 15–30 mg once daily; may be increased to a maximum dose of 45 mg once
- daily after 6–8 weeks of treatment if effect is inadequate.
with insulin: start with 15mg daily
counselling of pioglitazone?
Tell your doctor immediately if you have swollen feet or ankles, breathlessness, nausea, vomiting, abdominal pain, fatigue, loss of appetite or dark urine.
Precautions of using insulin?
Actute t rauma - higher doses may be needed
Adverse effects of insulin?
hypoglycaemia (sweating, hunger, faintness, palpitations, tremor, headache, visual disturbance and altered mood.), weight gain, allergic reactions,
Counsilling for insulin?
- Drinking alcohol decreases your blood glucose. It can also mask warning symptoms of hypoglycaemia.Avoid binge drinking and have something to eat when you drink alcohol.
- Make sure that you, and your friends and family, know how to recognise and treat hypoglycaemia;
- ask your doctor or diabetes educator if you are unsure.
- Insulin is injected under the skin usually in the
- abdomen, or less commonly in the thigh, upper arm or buttock. Pinch the skin to reduce the chance of injecting into a blood vessel.
- Rotate injection sites in the same general area to avoid swelling of fatty tissue (called lipodystrophy).
- Use short-acting insulin 30 minutes
- before meals.
- Use ultra-short-acting insulin immediately before or soon after meals when necessary.
- Gently rotate vials and cartridges of cloudy insulin in hands before use to ensure resuspension.
- mixing insulins, draw up short-acting insulin into the syringe first to avoid contaminating the vial with long-acting insulin.
- Do not mix insulin glargine with other insulins.
Indications for exenatide?
Type 2 diabetes, with metformin and/or a sulfonylurea when these are inadequate
Precautions of exenatide?
- Severe GI disease, eg gastroparesis, dumping syndrome
- Treatment with a sulfonylurea—increases risk of hypoglycaemia
- History of pancreatitis with exenatide—contraindicated.
Adverse effects of exenatide?
nausea and/or vomiting, diarrhoea, dyspepsia, GORD, abdominal pain,
Dose of exenatide?
SC initially 5 micrograms twice daily, increase after 1 month to 10 micrgrams
Counselling of exenatide?
- Inject exenatide in the 60 minutes before breakfast and dinner
- Do not use it after a meal.
- This medicine slows stomach emptying, which occasionally affects the absorption of some
- other medicines; antibiotics should be taken at least one hour before, or 4 hours after, injecting exenatide.
- Tell your doctor immediately if you develop unexplained severe abdominal pain.
Indications for sitagliptin?
Type 2 diabetes, dual therapy with metformin, a sulfonylurea or a thiazolidinedione
Adverse effects of sitagliptin?
- nausea, hypoglycaemia,
dose of sitagliptin?
- 100mg once daily with or without food
- reduce in renal impairment