MRCP 1 – Endocrinology exam review
titrate up metformin and encourage lifestyle changes to aim for a HbA1c of 48
mmol/mol (6.5%), but should only add a second drug if the HbA1c rises to 58
mmol/mol (7.5%) - titrate up metformin and encourage lifestyle changes to aim
for a HbA1c of 48 mmol/mol (6.5%), but should only add a second drug if the
HbA1c rises to 58 mmol/mol (7.5%)
HbA1c should be checked every 3-6 months until stable, then 6 monthly -
Metformin is still first-line and should be offered if the HbA1c rises to 48
mmol/mol (6.5%)* on lifestyle interventions.
the HbA1c has risen to 58 mmol/mol (7.5%) then a second drug should be added
from the following list:
→ sulfonylurea
→ gliptin
→ pioglitazone
→ SGLT-2 inhibitor
if despite this the HbA1c rises to, or remains above 58 mmol/mol (7.5%) then
triple therapy with one of the following combinations should be offered:
→ metformin + gliptin + sulfonylurea
→ metformin + pioglitazone + sulfonylurea
,MRCP 1 – Endocrinology exam review
→ metformin + sulfonylurea + SGLT-2 inhibitor
→ metformin + pioglitazone + SGLT-2 inhibitor
→ OR insulin therapy should be considered - Metformin is still first-line and
should be offered if the HbA1c rises to 48 mmol/mol (6.5%)* on lifestyle
interventions.
the HbA1c has risen to 58 mmol/mol (7.5%) then a second drug should be added
from the following list:
→ sulfonylurea
→ gliptin
→ pioglitazone
→ SGLT-2 inhibitor
if despite this the HbA1c rises to, or remains above 58 mmol/mol (7.5%) then
triple therapy with one of the following combinations should be offered:
→ metformin + gliptin + sulfonylurea
→ metformin + pioglitazone + sulfonylurea
→ metformin + sulfonylurea + SGLT-2 inhibitor
→ metformin + pioglitazone + SGLT-2 inhibitor
→ OR insulin therapy should be considered
,MRCP 1 – Endocrinology exam review
Criteria for glucagon-like peptide1 (GLP1) mimetic (e.g. exenatide)
if triple therapy is not effective, not tolerated or contraindicated then NICE advise
that we consider combination therapy with metformin, a sulfonylurea and a
glucagonlike peptide1 (GLP1) mimetic if:
→ BMI >= 35 kg/m² and specific psychological or other medical problems
associated with obesity or
→ BMI < 35 kg/m² and for whom insulin therapy would have significant
occupational implications or -
Addisonian crisis
N/V confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration,
decreased BP
Causes
sepsis or surgery causing an acute exacerbation of chronic insufficiency
(Addison's, Hypopituitarism)
adrenal haemorrhage eg Waterhouse-Friderichsen syndrome (fulminant
meningococcemia)
steroid withdrawal
The short synacthen test is the best test to diagnose Addison's disease
, MRCP 1 – Endocrinology exam review
Bloods : hyponatraemia , hyperkalaemia ,hypoglycaemia
Management of Addisonian crisis (medical emergency):
IV fluids +
corticosteroids (e.g iv dexamethasone) - Addisonian crisis
N/V confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration,
decreased BP
Causes
sepsis or surgery causing an acute exacerbation of chronic insufficiency
(Addison's, Hypopituitarism)
adrenal haemorrhage eg Waterhouse-Friderichsen syndrome (fulminant
meningococcemia)
steroid withdrawal
The short synacthen test is the best test to diagnose Addison's disease
Bloods : hyponatraemia , hyperkalaemia ,hypoglycaemia
titrate up metformin and encourage lifestyle changes to aim for a HbA1c of 48
mmol/mol (6.5%), but should only add a second drug if the HbA1c rises to 58
mmol/mol (7.5%) - titrate up metformin and encourage lifestyle changes to aim
for a HbA1c of 48 mmol/mol (6.5%), but should only add a second drug if the
HbA1c rises to 58 mmol/mol (7.5%)
HbA1c should be checked every 3-6 months until stable, then 6 monthly -
Metformin is still first-line and should be offered if the HbA1c rises to 48
mmol/mol (6.5%)* on lifestyle interventions.
the HbA1c has risen to 58 mmol/mol (7.5%) then a second drug should be added
from the following list:
→ sulfonylurea
→ gliptin
→ pioglitazone
→ SGLT-2 inhibitor
if despite this the HbA1c rises to, or remains above 58 mmol/mol (7.5%) then
triple therapy with one of the following combinations should be offered:
→ metformin + gliptin + sulfonylurea
→ metformin + pioglitazone + sulfonylurea
,MRCP 1 – Endocrinology exam review
→ metformin + sulfonylurea + SGLT-2 inhibitor
→ metformin + pioglitazone + SGLT-2 inhibitor
→ OR insulin therapy should be considered - Metformin is still first-line and
should be offered if the HbA1c rises to 48 mmol/mol (6.5%)* on lifestyle
interventions.
the HbA1c has risen to 58 mmol/mol (7.5%) then a second drug should be added
from the following list:
→ sulfonylurea
→ gliptin
→ pioglitazone
→ SGLT-2 inhibitor
if despite this the HbA1c rises to, or remains above 58 mmol/mol (7.5%) then
triple therapy with one of the following combinations should be offered:
→ metformin + gliptin + sulfonylurea
→ metformin + pioglitazone + sulfonylurea
→ metformin + sulfonylurea + SGLT-2 inhibitor
→ metformin + pioglitazone + SGLT-2 inhibitor
→ OR insulin therapy should be considered
,MRCP 1 – Endocrinology exam review
Criteria for glucagon-like peptide1 (GLP1) mimetic (e.g. exenatide)
if triple therapy is not effective, not tolerated or contraindicated then NICE advise
that we consider combination therapy with metformin, a sulfonylurea and a
glucagonlike peptide1 (GLP1) mimetic if:
→ BMI >= 35 kg/m² and specific psychological or other medical problems
associated with obesity or
→ BMI < 35 kg/m² and for whom insulin therapy would have significant
occupational implications or -
Addisonian crisis
N/V confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration,
decreased BP
Causes
sepsis or surgery causing an acute exacerbation of chronic insufficiency
(Addison's, Hypopituitarism)
adrenal haemorrhage eg Waterhouse-Friderichsen syndrome (fulminant
meningococcemia)
steroid withdrawal
The short synacthen test is the best test to diagnose Addison's disease
, MRCP 1 – Endocrinology exam review
Bloods : hyponatraemia , hyperkalaemia ,hypoglycaemia
Management of Addisonian crisis (medical emergency):
IV fluids +
corticosteroids (e.g iv dexamethasone) - Addisonian crisis
N/V confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration,
decreased BP
Causes
sepsis or surgery causing an acute exacerbation of chronic insufficiency
(Addison's, Hypopituitarism)
adrenal haemorrhage eg Waterhouse-Friderichsen syndrome (fulminant
meningococcemia)
steroid withdrawal
The short synacthen test is the best test to diagnose Addison's disease
Bloods : hyponatraemia , hyperkalaemia ,hypoglycaemia
