1st and 2nd line treatment - Oral Hypo, Insulin and laxatives
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Are Bulk Forming laxatives suitable for children?
No
What is first line treatment for children suffering constipation/impaction?
Polyethylene glycol 3350 (PEG or Macrogol) OR Lactulose + dietary modifications
What if Osmotic laxative or Macrogol is not tolerated in children?
Switch to a stimulant laxative
What is the second line treatment for children with constipation/impaction?
Stimulant laxative
What stimulant laxatives are appropriate for children?
Sodium picosulfate Senna Docusate Sodium Bisacodyl
What is first line treatment for insulin therapy in an adults or children with T1DM?
Multiple daily injection basal–bolus insulin regimens
What is the recommended long acting insulin for adults with T1DM and how often should it be injected?
Twice daily Insulin detemir
What is the alternative long acting insulin for adults if twice daily insulin detemir is not tolerated?
Once daily Insulin detemir or Insulin Glargine
What is the alternative to a multiple daily injection basal bolus insulin regime for adults?
Twice daily human mixed insulin regime
What is the ideal Hb1AC target for children with T1DM?
48mmol/mol (6.5%)
How frequently should children with T1DM have their Hb1AC checked?
4 times per year and more frequently if unstable Blood sugars
What does a multiple daily injection basal-bolus insulin regime consist of?
Injections of short‑acting insulin or rapid‑acting insulin analogue before meals, together with 1 or more separate daily injections of intermediate‑acting insulin or long‑acting insulin analogue.
What does a mixed insulin regime consist of?
One, two or three insulin injections per day: these are usually injections of short‑acting insulin or rapid‑acting insulin analogue mixed with intermediate‑acting insulin.
How often should Hb1Ac be checked in children with T2DM?
Every 3 months
How often should adults with T1DM have their Hb1AC checked?
Every 3-6 months
What is the ideal Hb1AC target for adults with T1DM?
48mmol/mol (6.5%)
What is first line treatment for T2DM in children
Diet and lifestyle Standard release metformin
How often should adults with T2DM have their Hb1AC checked?
Every 3 to 6 months until stable Every 6 months once stable
What are Hb1AC targets for adults with T2DM?
Metformin or similar - 48mmol/mol Drug that can cause hypoglycaemia (SU) - 53mmol/mol
What is first line treatment for adults with Hb1AC of 48mmol/mol or above?
Metformin standard release or if not tolerated modified release
If metformin is contra-indicated what is the alternative first line treatment?
DPP-4i Pioglitazone Sulfonylurea or if above not tolerated SGLT-2i
If HbA1C rises to 58mmol/mol what is the 2nd line treatment?
Metformin \+ either DPP-4i Pioglitazone Sulfonylurea SGLT-2i
If metformin is contraindicated what is the intensification (2nd line treatment)?
DPP-4i + Pioglitazone DPP-4i + SGLT-2i DPP-4i + SU
What is first line treatment with laxatives for non-opioid chronic constipation?
Bulk forming laxatives - plus plenty of fluids