Mr CHAN, an 80 year old man with diabetes, went to a pharmacy to refill his diabetes medications. He had been seeing the same general practitioner for 20 years and taking the same regimen for 20 years:

Metformin 1000mg twice a day

Glibenclamide 5 mg once a day

a) What type of diabetes is he likely to have? (1 mark)

b) Which drug classes do metformin and glibenclamide belong to? (2 marks)

c) Give TWO reasons why this regimen might no longer be suitable for him. (2 marks)

d) Give TWO reasons why he would benefit from referral. (2 marks)

Mr CHAN was assessed in a Diabetes Clinic. His haemoglobin A1c (HbA1c) was said to be 10%. He was given advice about diet. His diabetes medications were changed to:

Metformin 500 mg twice a day

Gliclazide 80 mg twice a day

Sitagliptin 50 mg once a day

Empagliflozin 10 mg once a day

e) Which drug classes do sitagliptin and empagliflozin belong to? (2 marks)

f) Give ONE reason for prescribing him additional drug treatment. (1 mark)

g) Name ONE advantage of treatment with empagliflozin. (1 mark)

Three months after the change in medications Mr CHAN went to the pharmacy again and was concerned that these new medications made him very sweaty in the middle of the night. 

h) Which of the above medications was most likely to cause this symptom? (1 mark)

i) Name TWO other symptoms he might experience besides sweating. (2 mark)

j) If these symptoms occurred at home, what simple remedy could be tried? (1 mark)

The doctor in the Diabetes Clinic mentioned that he might require insulin therapy

k) Give TWO reasons why he might need insulin (2 marks)

l) Name THREE practical problems associated with insulin therapy. (3 marks)