#Metformin
First-line treatment.
1. Rule out renal failure (RF) before starting Metformin.
2. Reassess HbA1c after 3 months.
If HbA1c is greater than 58 mmol/mol (7.5%), add a second drug.
#Dual_therapy
اختار واحد من الاثنين اهما
Metformin + Gliptin.
Metformin + Sulfonylurea.
Metformin + Pioglitazone.
Metformin + SGLT-2 inhibitor.
Reassess HbA1c after 3 months.
If HbA1c remains greater than 58 mmol/mol (7.5%), proceed to Triple therapy.
#Triple_therapy
اختار واحد من الثلاثة اهما
Metformin + Gliptin + Sulfonylurea.
Metformin + Pioglitazone + Sulfonylurea.Metformin + Sulfonylurea + SGLT-2 inhibitor.
Metformin + Pioglitazone + SGLT-2 inhibitor.
If HbA1c remains above 7.5% despite triple therapy → Insulin therapy.
لو كانت Triple therapy:
Not effective.
Not tolerated.
Contraindicated.
AND BMI greater than 35.
نستخدموا:
Metformin + Sulfonylurea + GLP-1 mimetic.
First-line treatment.
1. Rule out renal failure (RF) before starting Metformin.
2. Reassess HbA1c after 3 months.
If HbA1c is greater than 58 mmol/mol (7.5%), add a second drug.
#Dual_therapy
اختار واحد من الاثنين اهما
Metformin + Gliptin.
Metformin + Sulfonylurea.
Metformin + Pioglitazone.
Metformin + SGLT-2 inhibitor.
Reassess HbA1c after 3 months.
If HbA1c remains greater than 58 mmol/mol (7.5%), proceed to Triple therapy.
#Triple_therapy
اختار واحد من الثلاثة اهما
Metformin + Gliptin + Sulfonylurea.
Metformin + Pioglitazone + Sulfonylurea.Metformin + Sulfonylurea + SGLT-2 inhibitor.
Metformin + Pioglitazone + SGLT-2 inhibitor.
If HbA1c remains above 7.5% despite triple therapy → Insulin therapy.
لو كانت Triple therapy:
Not effective.
Not tolerated.
Contraindicated.
AND BMI greater than 35.
نستخدموا:
Metformin + Sulfonylurea + GLP-1 mimetic.
لو الـ Patients من البداية مايتحملش
Metformin is not tolerated or contraindicated (CI)
Initial monotherapy
اختار واحد:
Gliptin.
Sulfonylurea.
Pioglitazone.
Dual therapy
إذا HbA1c أكبر من (7.5%):
Gliptin + Pioglitazone.
Gliptin + Sulfonylurea.
Pioglitazone + Sulfonylurea.
Insulin
If HbA1c remains greater than 58 mmol/mol (7.5%)
نتنقلوا للـ Insulin.
Metformin is not tolerated or contraindicated (CI)
Initial monotherapy
اختار واحد:
Gliptin.
Sulfonylurea.
Pioglitazone.
Dual therapy
إذا HbA1c أكبر من (7.5%):
Gliptin + Pioglitazone.
Gliptin + Sulfonylurea.
Pioglitazone + Sulfonylurea.
Insulin
If HbA1c remains greater than 58 mmol/mol (7.5%)
نتنقلوا للـ Insulin.
Q1095. A 65-year-old man is admitted with an extensive anterior STEMI and undergoes successful primary PCI. On the third day, he suddenly develops severe breathlessness, hypotension and pulmonary oedema. His blood pressure is 82/54 mmHg, and a new harsh pansystolic murmur with a palpable thrill is heard along the lower left sternal border. Echocardiography identifies a new ventricular septal defect with left-to-right flow.
Which right-heart catheterisation finding would most strongly support this diagnosis?
A. Giant V waves in the pulmonary capillary wedge pressure trace without a right-sided oxygen saturation step-up.
B. Equalisation of diastolic pressures in all cardiac chambers with a dip-and-plateau pattern.
C. An oxygen saturation step-up between the right atrium and right ventricle.
D. A markedly reduced pulmonary capillary wedge pressure with no intracardiac shunt.
E. A prominent right atrial pressure waveform without increased right ventricular oxygen saturation.
Which right-heart catheterisation finding would most strongly support this diagnosis?
A. Giant V waves in the pulmonary capillary wedge pressure trace without a right-sided oxygen saturation step-up.
B. Equalisation of diastolic pressures in all cardiac chambers with a dip-and-plateau pattern.
C. An oxygen saturation step-up between the right atrium and right ventricle.
D. A markedly reduced pulmonary capillary wedge pressure with no intracardiac shunt.
E. A prominent right atrial pressure waveform without increased right ventricular oxygen saturation.