QuestionSBA
QuestionChoice
This option is less ideal for the reason mentioned above with regards to risk involved in patients with acute pancreatitis and as he is only on metformin, he should be started on dual therapy before moving on to triple therapy
34499
e
Triple therapy consisting of metformin 500mg TDS, sitagliptin 100mg OD, gliclazide 40mg OD
QuestionChoice
This patient has poorly controlled hyperglycaemia (HbA1c 65) and is already on the maximum tolerable dose of metformin. Due to his background of pancreatitis, an alternative to GLP-1 (liraglutide) and DPP4 inhibitor (sitagliptin) should be considered. DPP4 inhibitor reduces the degradation of GLP-1 by inhibiting the activity of serum DPP-4. An increase in GLP-1 results in an increased availability of incretins, stimulating insulin secretion from pancreatic β-cells. Although the exact causal relationship between DPP-4 inhibitors and GLP-1 analogues with pancreatitis is not well-established, it is generally advised to avoid these classes of medication amongst patients with increased risk of acute pancreatitis due to the significant implication of the risk involved
34495
a
Add gliclazide 40mg OD
QuestionChoice
Although the exact causal relationship between DPP-4 inhibitors and GLP-1 analogues with pancreatitis is not well-established, it is generally advised to avoid these classes of medication amongst patients with increased risk of acute pancreatitis due to the significant implication of the risk involved
34496
b
Add sitagliptin 100mg PO OD to metformin
QuestionChoice
Although the exact causal relationship between DPP-4 inhibitors and GLP-1 analogues with pancreatitis is not well-established, it is generally advised to avoid these classes of medication amongst patients with increased risk of acute pancreatitis due to the significant implication of the risk involved
34497
c
Add liraglutide 0.6mg OD SC
QuestionChoice
This patient is currently on maximal tolerable dose of metformin, there are other oral hypoglycaemic agents that should be considered prior to starting someone on insulin
34498
d
Switch to biphasic insulin detemir 20 units SC
QuestionComment
Doesn't Gliclazide also act on cells of the pancreas and therefore also be unsuitable for use in someone with Pacreatitis?
8228
QuestionComment
I just checked the BNF for all of these drugs + associations with pancreatitis - gliclazide was the only one that had no published information to contradict treatment
60277
User
subscriber
Embolism Bladder
User
subscriber
Axillary JAK
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
2842
Diabetes Mellitus
Topic
75
GP
6910
Case Presentation:




A 65-year-old man presents to his GP for review of his blood glucose. He was started on metformin a year ago when his HbA1c was found to be 55 and 58mmol/mol when tested on two separate occasions. PMH Type 2 Diabetes mellitus, Hypertension, Hypercholesterolemia, Chronic pancreatitis. DH Atorvastatin 20mg PO daily, Ramipril 2.5mg PO daily, Metformin 1g BD PO.


 **On Examination**
BP 125/85 mmHg


HR 90/min


RR 16


O2 sats 94% RA


 **Investigations**
HbA1c 65mmol/mol (normal range 20-48 mmol/mol)


Capillary blood glucose 15.3 mmol/L (normal <6.1 mmol/L)


Question:
Select the most appropriate decision option with regard to the treatment of his hyperglycaemia based on these data
a