**SUMMARY**
What’s up everybody dr. bonzo back again with another quick hitting high-yield review of a medical topic in five minutes or less but those of you are new to the channel i’ve been reviewing test questions for the past eight years and i noticed certain trends pop up over and over again and this is regardless of what field you’re in what level you’re in whether you’re
Nurse practitioner or medical student pa student pharmacy student whatever i’ve noticed a certain trends pop up over and over again and certain topics pop up over and over again so what i’ll do is i’ll present those frequent fliers or those common things so you can get a quick review of medical topic boost your medical knowledge and also improve exam performance but
Even if you’re not taking exams is just a quick way to review a topic and see what evidence is out there so today’s topic is going to be on diabetes medication specifically oral diabetic medications for type 2 diabetes and we’re not talking about our type 1 diabetics that are insulin dependent that have autoimmune divac diabetes type 2 diabetes we’re talking about
Today so your first line treatment they’re gonna ask about an ibanez – for years is metformin metformin is first month for multiple reasons one is that it’s been around for a long time we know a lot about it it’s cheap low side effect profile other than diarrhea maybe some gi upset that’s usually all you’re gonna get with metformin and the other big reason we love
Using that appointment for years is because it decreases macrovascular complications it decreases mortality or death rates so when you hear the word macrovascular you think big blood vessels right heart attacks strokes so those those are the things that kill you in diabetes and metformin has been the one that’s really consistently shown to decrease mortality now
Other diabetes meds will help you they’ll decrease microvascular complications so things like amputations blindness diabetic retinopathy ending up on dialysis those are things that we also want to prevent but metformin will prevent those things and also decrease the death as well so that’s why it’s always gonna be personalized main contraindication of metformin is
Kidney disease if you look at old tests or old guidelines they’ll say that for men don’t use metformin at the creta knees above 1.5 for women not above 1.4 but those guys are outdated now current guidelines say you can use metformin up until somebody’s gfr is less than 30 now there’s a little bit different you’re probably just using cratan and clearance we think
About adjusting medications or pharmacal there but in terms of metformin is a gfr based decision so once the gfr is less than 30 no metformin now once the gfr is less than 45 you should be very careful in what metformin and probably decrease that dose by half so you probably shouldn’t go above about a thousand milligrams per day once that gfr gets less than 45 you
Can just stop using it altogether once it’s below 30 now a few new medical education that come on the market are those sglt2 inhibitors and to think about those medications that those have actually been shown to decrease mortality as well so if you of those medications are indicated for cardiovascular risk reduction in people who have diabetes in type 2 diabetes
Specifically so you may have heard about impact of frozen which is the same thing as guardians that’s actually fda approved for decreasing macrovascular events in terms of type 2 diabetes type 2 diabetes other medicines in that class or pretty much any medicine in in flows and canagliflozin which is in volcana that’s also recently been fda approved as well to
Decrease macrovascular complications associated with diabetes now one other man that’s a newer man is well but in a different class is the gop one agonist so one specific one is also fda approved for decreasing macrovascular events and that’s the regular type which is also called victoza that’s one of those injectable gop one agnus now the last thing you need
To know about diabetes in terms of all that diabetes medications is which ones can cause hypoglycemia or low blood sugar this pops up a lot on tests as well so what they’re trying to do is make sure that you know the most likely complication and the most likely life-threatening complication of diabetes meds that you know what they are and which man to be careful
With especially in the elderly so insulin obviously will lower your blood sugar right and make you at risk for hypoglycemia always have to take it with food unless you’re taking one of those long-acting you know my glargine is the type of insulin injections but medications that make your body just secrete more insulin like so far maria’s those will also make you
Hypoglycemic those are things like slippers i and glad you ride now another group of medicine is the mcglinn and is also called glides those pretty much work through that same soap on when you read a channel so they do the same thing they put you at risk for having hypoglycemic so be careful with those the last trend i haven’t seen a whole lot yet but i bet is
Coming is they’re gonna probably want you to know which medications or weight neutral in other words which ones make you gain weight which ones make you lose weight the ones that gain weight make you gain weight typically are the same ones that can make you call it make you have hypoglycemia as well so in review metformin first-line no matter what unless they have
Kidney disease specifically gfr less than 30 the next class of medicines you think about are those sglt2 inhibitors cuz they also decrease mortality and also don’t forget which medication is lower your blood sugar and make your hypoglycemic insulin so funny areas and aglaia medicines alright i made it 5 minutes or less
Transcribed from video
Oral Diabetes Meds (Type 2 DM) By Doctor Bonzo