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afya
Type2Mx
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> progressive disease with abN relationship between increasing insulin resistance and decreasing beta cell function so relative insulin insufficiency 4.45% of Uk population are diabetic, 90% of which is type 2 Target of HbA1C - NICE 48mmol/l(6.5%), SIGN 53 (7.0%) QOF 59 (7.5%) - so set practical personal target First line if >48 after lifestyle advice - ''Metformin mono'' - Consider ''sulphonylurea'' if ... {{indent{not overweight {{indent{need for rapid Rx of hyperglyc Sx}}} {{indent{Metformin CI}}} If overweight and Metformin CI - use ''Glitazones'' ''If despite Metformin mono, HbA1C remains high'', Add in Sulphonylurea eg Gliclazide If risk of hypo or SE to sulphonylurea, add in Pioglitazone or Sitagliptin If despite Metformin plus sulphonylurea, HbA1C remains high.... add insulin, sitagliptin or exenatide depending on weight and social/recreational/employment issues (or Pioglitazone) ''Acarbose'' - oral agent but use limited by GI SE ''Statins'' If <40 yr and no other risk factors then no If >40yr and CVS risk <20% then no both unlikely so normally will need risk factors - overweight, HT, microalbuminuria, smokes, high risk lipids, FH, CVD
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Diabetes