QuestionSBA
QuestionChoice
In treating type 2 diabetes, it is recommended that a second antidiabetic drug be added following an inadequate response to maximal therapy with metformin
34055
a
Add gliclazide 40mg PO OD to his current prescription
QuestionChoice
Repaglinide is an oral antidiabetic medication used to treat type 2 diabetes. It is less preferred than sulfonylureas
34057
c
Add repaglinide 500 micrograms PO with meals to his current prescription
QuestionChoice
This prescription would exceed the recommended maximum dose of metformin which is 2g per day
34058
d
Change his prescription to metformin hydrochloride 1g PO TDS
QuestionChoice
The patient is already receiving 2g of metformin hydrochloride and as such this prescription would not effect any significant change to the overall medical treatment this patient is currently receiving
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e
Change his prescription to metformin hydrochloride modified release 2g PO OD
QuestionChoice
This is a GLP-1 mimetic that is used to treat type 2 diabetes. It should not be prescribed in the primary care setting and is usually only considered failing treatment with more preferred oral antidiabetic medications
34056
b
Add exenatide 5 micrograms SC BD to his current prescription
QuestionComment
but isn't his glucose control improving?

19971
QuestionComment
HbA1c >58mmol/L warrants the addition of another diabetic medication
61093
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Lines of Zahn 
QuestionComment
I don't think it's as black and white as that. The point is that after 3 months his glucose has barely improved at all. Were it 59 mmol/L, I suspect you wouldn't add another drug. Someone can correct me if I'm wrong though.
61269
User
subscriber
Retake Prophylaxis 
User
subscriber
Chronic Metabolism
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2755
Diabetes management
Topic
92
General Practice
6822
Case Presentation: A 54 year old man attends a follow-up appointment at his GP. Six months ago, he was previously diagnosed with type 2 diabetes and started on metformin hydrochloride 500mg PO OD. This has since been up-titrated to 500mg PO TDS, then 500mg PO QDS.


**Investigations**

HbA1C (3 months ago): 64 mmol/mol

HbA1C (now): 61 mmol/mol

Urine dipstick: NAD

Question: Select the most appropriate management at this stage.
a