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GLP-1
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> ''glucagon-like peptide-1 (GLP-1)'' released by small intestine in response to oral glucose load mediates //incretin effect// oral glc results in greater release of insulin than IV can inc GLP-1 by either giving analogue or inhibiting breakdown (dipeptidyl peptidase 4 inhibitor) ''GLP-1 mimetics'' - exenatide increase insulin secretion and inhibit glucagon secretion licensed for use in T2DM sub-cut <1hr BEFORE food may be combined with metformin, sulfonylurea or thiazolidinedione typically results in weight loss major SE - n/v NICE 2009 guidelines GLP-1analogue use exenatide when need insulin (no need to have already tried) but BMI >35 (so would need high dose insulin) continue if responds and is maintained - >1% HbA1C loss and >3% wt loss over 6/12 BEWARE - inc risk of severe pancreatitis and renal impairment ''DPP-4 inhibitors'' - Vildagliptin, sitagliptin oral well tolerated - no inc hypoglyc do not cause weight gain NICE 2009 guidelines DPP-4 inhibitors continue only if > 0.5% dec HBA1c in 6/12 ?preferable to thiazolidinedione if wt gain problem, is CI, os has had poor response
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DiabeticMeds