1.1 MTB Step 3 - Type 2 Diabetes Mellitus Flashcards
Cards Complete:
GENERAL
What are (4) Differences between Diabetes Type 1 & Diabetes Type 2?
DM Type 1:
- Onset = Juvenile
- Body Type = Thin
- DKA = Frequent
- Treatment = Insulin
DM Type 2:
- Onset = Adult
- Body Type = Obese
- DKA = Rare
- Treatment = Lifestyle changes, Oral agents, Insulin
GENERAL
DIAGNOSIS
What are the (4) ways to Diagnose Diabetes Mellitus?
- TWO Fasting Glucose > 125
- ONE Random Glucose > 199 + Symptoms (polyuria, polydipsia, polyphagia)
- Abnormal Glucose Tolerance Test (2hr GTT with 75g Glucose Load)
- HgA1c > 6.5%
GENERAL
SCREENING
What is the Strongest Indication for Screening for Diabetes?
HgA1c > 6.5%
TYPE 2 DM
TREATMENT
What are the (3) Best INITIAL Therapies for Type 2 DM?
Diet
Exercise
Weight Loss
Of patients with Type 2 DM, 25% can be controlled with exercise and weight loss alone.
TYPE 2 DM
TREATMENT
What is the Best INITIAL Medical Therapy for Type 2 DM?
METFORMIN
TYPE 2 DM
TREATMENT
- What is the Mechanism of Action (MOA) for Metformin?
- What are (2) Benefits of Metformin?
- MOA = Blocks Gluconeogenesis
-
Benefits:
- No risk of Hypoglycemia
- No added weight gain because it doesn’t increase the release of endogenous insulin
TYPE 2 DM
TREATMENT
Metformin is Contraindicated for which (2) situations?
- Renal Insufficiency: Metformin may accumulate and increase the risk of Lactic Acidosis.
- Use of Contrast Agents: Contrast may lead to Acute Renal Failure (ARF) and, therefore, to the accumulation of Metformin.
TYPE 2 DM
TREATMENT
What are the names of (3) Sulfonylurea medications used for Type 2 DM?
- Glyburide
- Glimepiride
- Glipizide
TYPE 2 DM
TREATMENT
- What is the Mechanism of Action (MOA) for Sulfonylureas? (e.g., glyburide, glimepiride, glipizide)
- What are (2) Adverse Effects of Sulfonylureas?
- MOA = Increase Release of Insulin from the Pancreas.
-
Adverse Effects:
- Hypoglycemia
- SIADH
TYPE 2 DM
TREATMENT
What are (4) Dipeptidyl Peptidase IV (DPP-IV) Inhibitors used to treat Type 2 DM?
- Sitagliptin
- Linagliptin
- Alogliptin
- Saxagliptin
TYPE 2 DM
TREATMENT
- When can you use Dipeptidyl Peptidase IV (DPP-IV) Inhibitors for treating Type 2 DM?
- (Sitagliptin, Linagliptin, Alogliptin, Saxagliptin)
- What is the Mechanism of Action (MOA) for DPP-IV medications?
- DPP-IV Inhibitors can be added as a second agent to Metformin.
-
MOA:
- Block metabolism of Incretins (e.g., GLP)
- Increase Insulin Release (causes weight gain)
- Block Glucagon
TYPE 2 DM
BASIC SCIENCE CORRELATE
- What are (2) Types of Incretins?
- What is the Mechanism for Incretins?
- Glucagon-Like Peptides (GLPs) & Glucose Insulinotrpic Peptides (GIPs)
-
MOA:
- Increase Insulin Release and Decrease Glucagon Secretion from the Pancreas.
- DPP-IV metabolizes GLP & GIP.
- Inhibiting DPP-IV maintains high levels of GLP & GIP.
TYPE 2 DM
TREATMENT
What are (2) Thiazolidinedione medications used to treat Type 2 DM?
Rosiglitazone
&
Pioglitazone
TYPE 2 DM
TREATMENT
- What is the Mechanism of Action (MOA) for Thiazolidinediones?
- When are Thiazolidinediones contraindicated?
- MOA = Increase peripheral Insulin sensitivity
- Congestive Heart Failure (CHF) - may worsen CHF
TYPE 2 DM
TREATMENT
What are (2) Alpha-Glucosidase Inhibitor medications used to treat Type 2 DM?
Acarbose
&
Miglitol
TYPE 2 DM
TREATMENT
- What is the Mechanism of Action (MOA) for Alpha-Glucosidase Inhibitors?
- What are (4) Adverse Effects of Alpha-Glucosidase Inhibitors?
- MOA = Block the absorption of Glucose at the Intestinal lining.
-
Adverse Effects:
- Diarrhea
- Abdominal pain
- Bloating
- Flatulence
TYPE 2 DM
BASIC SCIENCE CORRELATE
What is the Mechanism of Diarrhea with Alpha-Glucosidase Inhibitors?
- When Acarbose and Miglitol block glucose absorption, the sugar remains in the bowel, available to bacteria.
- When bacteria eat the glucose, they cast off gas and acid.
- Using Alpha-Glucosidase Inhibitors is like making a person Lactose Intolerant.
TYPE 2 DM
TREATMENT
What are (2) Insulin Secretagogue medications used to treat Type 2 DM?
Nateglinide
&
Repaglinide
TYPE 2 DM
TREATMENT
- What is the Mechanism of Action (MOA) for Insulin Secretagogues?
- What is an Adverse Effect of Insulin Secretagogues?
- MOA = Increase Release of Insulin from the Pancreas.
- Hypoglycemia
**These are very similar to Sulfonylureas**
TYPE 2 DM
TREATMENT
- What are (3) SGLT Inhibitor medications used to treat Type 2 DM?
- What are (2) Adverse Effects of SGLT Inhibitors?
- Canagliflozin, Dapagliflozin, Empagliflozin
- Urinary Tract Infections (UTIs) and Vulvovaginal Candidiasis
TYPE 2 DM
TREATMENT
- What are (4) GLP Analog medications used to treat Type 2 DM?
- What is the Mechanism of Action (MOA) for GLP Analogs?
- How are GLP Analogs administered?
- Dulaglutide, Exenatide, Liraglutide, Lixisenatide
- MOA = slow Gastric Emptying, promote Weight Loss, and Lower Glucose
- GLP Analogs are INJECTED
TYPE 2 DM
TREATMENT
If none of the Type 2 DM medications sufficiently control the level of Glucose, what should you switch to?
INSULIN
TYPE 2 DM
TREATMENT
What are (4) Long-acting Insulins used to treat Type 2 DM?
- Insulin Glargine (Lantus):once a day injection with an extremely steady-state level of insulin, used in combination with a very short-acting insulin at mealtime.
- NPH: twice a day
- Degludec:extremely long half-life; less frequent hypoglycemic episodes
- Detemir
TYPE 2 DM
TREATMENT
- What are (3) Short-acting Insulin medications used to treat Type 2 DM?
- When are they given during the day?
- How long do they last?
- Lispro, Aspart, Glulisine
- Mealtime
- ~ 2 hours
TYPE 2 DM
TREATMENT
What should you do when Insulin Monotherapy is not effective in controlling Type 2 DM?
Add METFORMIN
“start again with Metformin”
