Outline the dietary recommendations given to patients with diabetes

MAJOR THEMES;DIABETES MELLIUS, TYPES 1 and 2.DIETARY MANAGEMENT ORAL HYPOGLYCAEMICS INSULIN THERAPY.

LEARNING OBJECTIVES

Following the workshop, directed and background reading, students should be able to:
1)    Outline the dietary recommendations given to patients with diabetes
2)    Discuss the place in therapy of the different oral hypoglycaemic agents
3)    Describe the different insulins available
4)    List the factors influencing choice of insulins and insulin delivery devices in diabetic patients.

DIRECTED READING

BNF Section 6.1.1-6.1.4 Drugs used in diabetes (Introduction and section headings)

National Institute for Health and Clinical Excellence. Clinical Guideline 87 Management of type 2 diabetes. May 2009.

Jacques N. New NICE guidelines for type 2 diabetes treatment. Br J Clin Pharmacy 2009;1:167-8.

Questions:

What devices/forms are insulins commonly available in?

What are the major types of insulin by onset/duration of action?

BACKGROUND READING
National Institute for Health and Clinical Excellence. Clinical Guideline 15. The diagnosis and management of type 1 diabetes in adults. July 2004. (Look at pages 5-

10)

Hackett E, Jacques N, Gallagher A. Type 1 Diabetes: Pathophysiology and diagnosis. Clinical Pharmacist 2013;5:69-72.

Hackett E, Jacques N. Type 1 Diabetes: Insulin management. Clinical Pharmacist 2013;5:69-72.

WORKSHOP EXERCISE
Example of medicine    Typical starting and maximum dose    Class    How it works to lower blood glucose    Any other notes (place in therapy, common adverse

events, contra-indications etc.)
Insulin

Metformin

500mg od-max 2g OD

.
Gliclazide

40mg OD-max 320mg in divided doses

.
Pioglitazone

15mg OD- max 45mg OD

Nateglinide

60mg TDS to max 180mg TDS

Exenatide

5mcg BD top max 10mcg BD

Sitagliptin

100mg OD

Dapagliflozin     10mg OD

ANSWER ALL THESE QUESTIONS IN DETAIL AND USE THE READING LIST ON THE PREVIOUS PAGE TO HELP ANSWER THESE QUESTIONS

Miss HH is a 65 yr old lady weighing 83kg who presents to a community pharmacy, where you regularly do a locum, asking for “something stronger for thrush which keeps

coming back”. On further questioning she is feeling increasingly lethargic recently and is complaining of going to the toilet more often. You suspect she may have

diabetes mellitus and refer her to a G.P.