QuestionSBA
QuestionChoice
This patient has poorly controlled hyperglycaemia (HbA1c 60) despite being started on metformin 500mg TDS. The maximum tolerated dose of metformin is 2g a day. His metformin can be up titrated to the maximum before starting on dual therapy
34480
a
Metformin 1g BD PO
QuestionChoice
His metformin can be up titrated to the maximum before starting on dual therapy
34483
d
Add sitagliptin 100mg PO OD to metformin
QuestionChoice
His metformin can be up titrated to the maximum before starting on dual therapy. If the patient fails to respond to dual oral hypoglycaemic agents, triple therapy can then be considered
34484
e
Triple therapy consisting of metformin 500mg TDS, sitagliptin 100mg OD, gliclazide 40mg OD
QuestionChoice
Patients with T2DM are often trialled on different combination of oral hypoglycaemic agent prior to initiation of insulin. In this case, uptitrating his metformin should be considered prior to changing his medication to insulin
34482
c
Switch to biphasic insulin detemir 20 units SC
QuestionChoice
The maximum tolerated dose of metformin is 2g a day
34481
b
Metformin 1g TDS PO
QuestionComment
from my understanding, 
Metformin immediate release:
- Can titrate up metformin e.g. from 500mg BD -> TDS but only if HbA1c below 58 mmol
- Max dose is 2g daily 
- If not tolerated, try moderate release first
- If HbA1c rises to 58 (7.5%) on metformin: (should only add a second drug if the HbA1c rises to 58 mmol/mol (7.5%))

we should go straight for another drug as it is >58...??

37302
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Serotonin Dorsal
QuestionComment
jg diff
40262
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Sclerosis Biopsy
QuestionComment
It doesnt say his metformin dose in the beginning

59793
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Versicolor Neoplasia
QuestionComment
i want to give him empagliflozin >.<
61350
QuestionComment
Don't we all
61741
User
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Myotonia Stasis
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Vaccine Complement
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
2839
Metformin 
Topic
75
GP
6907
Case Presentation:


A 52-year-old man presents to his GP for review of his blood glucose. He was started on metformin 3 months ago when his HbA1c was found to be 52 and 56mmol/mol when tested on two separate occasions. PMH Type 2 diabetes mellitus, Hypertension, Hypercholesterolemia. DH Atorvastatin 20mg PO daily, Ramipril 2.5mg PO daily, Metformin 500mg TDS PO.
 **On Examination**
BP 125/85 mmHg


 **Investigations**


||||
|---------------------------|:-------:|------------------------------|
|Non-fasting Glucose|13.1 mmol/L|< 6.1|
|HbA1c (Glycated Haemoglobin)|60 mmol/mol or %|20 - 42 or 4-6%|
|Urea|6 mmol/L|2.5 - 7.8|
|Creatinine|85 µmol/L|60 - 120|


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