An Introduction To Diabetes Flashcards
What are the four T’s to look out for in T1 diabetes?
The four T’s – toilet, thirsty, tired and thinner
What is DKA?
Diabetic Ketoacidosis:
where body completely switches to lipid metabolism – ketones = product
Presentation of T1 diabetes?
- Nearly a quarter of patients will present with Diabetic Ketoacidosis (DKA).
- The four T’s – toilet, thirsty, tired and thinner
- Community pharmacy = look out for signs, oral thrush, vitamins if child feeling run down
Presentation of T2 diabetes?
- Often not symptomatic
- Like type 1 but slower onset and less extreme
- Increased episodes of genital thrush
- Slow wound healing
- Routine checks are when it is usually picked up (blood sugar high)
- Complications e.g. stroke, infection not healing, heart problems etc
- Tends to be older patients
- Larger bmi
Compare T1 diabetes to T2 diabetes:
T1 =
- no insulin produced
- Quickly life threatening
- Usually diagnosed in childhood - they have no real risk factors (slightly genetic)
- Treatment = replace insulin
- No diet restrictions – just careful monitoring of carbs
- More likely to have complications
- No risk factors (slight genetic link)
T2= ▫ Insulin is usually produced but body doesn’t respond to it adequately ▫ Rarely life threatening unless left for a long time ▫ Much of treatments is via diet and exercise ▫ If you lose 20% of your body weight after being diagnosed, you can pretty much put that diabetes into recession. ▫ Insulin is last option ▫ Still have complications ▫ Often diagnosed in adulthood ▫ Lots of risk factors o Ethnicity o Age o Obesity o Genetics o Smoking/alcohol o Raised BP o PCOS o Poor sleep▫
Oral therapies for type 2 diabetes:
Reduce hepatic glucose out put (injectables)
- Metformin, Pioglitazone, DPP-4 inhibitors, GLP 1 agonists
- most drugs have a secondary effect on reducing how much glucose your liver produces – DDP-4 alagliptin
Oral therapies for type 2 diabetes:
Delay carbohydrate absorption
- acarbose popular in east (because of cheap) stops you digesting carbohydrates – unpleasant side effects
- Acarbose, GLP 1-agonists
Oral therapies for type 2 diabetes:
Enhance action of incretin
GLP 1 agonists require a high BMI (injectables) they slow gastric emptying so you feel fuller for longer, incretin is the hormone from the stomach that sends a signal to the pancreas to make insulin. DDP-4 is the enzyme and works on the same pathway,
Oral therapies for type 2 diabetes:
Enhance insulin secretions
Sulfonylureas, Meglitanides
Oral therapies for type 2 diabetes:
Reduce peripheral insulin resistance
- Pioglitazone, Metformin
- improbing muscles uptake of glucose (type 2)
Oral therapies for type 2 diabetes:
Reduce glucose re-uptake from glomerular filtrate
- SGLT-1 inhibitors
Advantages and disadvantages of metformin?
Advantages
• Cheap
• Weight neutral
• Low risk of hypo
Disadvantages
• Commonly causes GI side-effects – often started with meals.
• Rare but serious side-effect of lactic acidosis – cannot use in patients who have a high risk of lactic acidosis e.g. patients who have had a heart attack, sepsis, respiratory problems etc.
• Short t1/2 so TDS frequency. However, MR available but more expensive.
• Caution in egfr<45
• Contraindicated in egfr <30
Advantages and disadvantages of Sulfonylureas e.g. Glicalzide :
Advantages
• Can be OD or BD
• Quickly lowers cBG so improves symptoms
• Fewer GI side effects than metformin
Disadvantages
• Can cause hypos. Issue if you drive or live alone.
• Can cause weight gain
• Need residual pancreas function
• Can be un-predicatable in renal impairment and in the elderly (problem in elderly due to risk of falls caused by hypos)
Advantages and disadvantages of Pioglitazone:
Advantages
• OD dosing
• Low risk of hypo
• Suitable in renal impairment
Disadvantages
• Associated with heart failure. Because it causes fluid retention.
• Increased risk of bladder cancer and fractures. Not advisable for people with osteoporosis.
• Causes weight gain
• Rarely causes liver toxicity
• Can take 3-6 months to show benefit. Not a good choice for someone who is symptomatic.
Advantages and disadvantages of DPP-4 Inhibitors:
Advantages • Once a day • No weight gain • Low risk of hypo • Some can be used in renal impairment
Disadvantages
• Commonly causes GI side-effects, rash and UTI
• Rarely causes pancreatic inflammation
