Clinical (Weeks 1 + 2 - Diabetes) Flashcards
What antibodies might be present in T1DM?
Anti-GAD
Anti-islet cell
When is a person though to have T2DM?
When they don’t have:
- T1DM - Monogenic DM - Other condition/Treatment causing secondary DM
What are some risk factors for T2DM?
Central obesity FHx Gestational DM Age Ethnicity: - Asian - African - Afro-Caribbean PMHx of MI/CVA Medications IGT/IFG
What are some symptoms of DM?
Thirst Polyuria Thrush Weakness Blurred vision Infections Weight loss
What pancreatic diseases can cause secondary DM?
Chronic/Recurrent pancreatitis
Haemochromatosis
CF
What endocrine diseases can cause secondary DM?
Cushing’s
Acromegaly
Phaeochromocytoma
Glucogonoma
What drugs can induce DM?
Glucocorticoids
Diuretics
β-blockers
What genetic disorders can result in DM?
CF
Monogenic dystrophy
Turner’s
What are the principles of T2DM treatment?
Alleviate hyperglycaemia symptoms Improve glycaemic control Minimise: - Hypoglycaemia - Weight gain Reduce complications
What do biguanides do?
Increase insulin sensitivty
What dose of biguanide do we usually start with?
500mg once/twice daily
Give an example of a biguanide
Metformin
Does metformin cause weight loss/no change/weight gain?
No change
How much can metformin reduce a patient’s HbA1c?
15-20 mmol/L
Does metformin cause hypoglycaemia?
Not if used as monotherapy
What effect does metformin have on a patient’s lipid status?
Decreased triglycerides and LDL
Is metformin safe in pregnancy?
Yes
What are some side effects of metformin?
Anorexia Nausea/Vomiting/Diarrhoea/Abdo. pain Anaemia Lactic acidosis: - If in renal failure - If in cardiac/liver failure
In what patient’s should metformin be stopped?
Renal failure: - If eGFR 150 micromol/L Liver: - Advanced cirrhosis - Liver failure
When might metformin be beneficial?
NAFLD
In what patient’s should metformin be used with caution due to the increased risk of lactic acidosis?
Acute CHF Sepsis Acute MI Respiratory failure Hypotension
How do sulphonylureas work?
Insulin secretagogues
Give examples of SUs
Glicazide
Glipizide
Glimeparide
What complications can metformin prevent?
Microvascular
Macrovascular
What complications can SUs prevent?
Microvascular
How do SUs manage hyperglycaemia?
Decrease HbA1c by 15-20 mmol/mol
Increased insulin secretion
More rapid action than metformin
When are SUs used?
1st line in underweight T2DM
2nd line as add-on to metformin/intolerant to metformin
What are some side effects of SUs?
Hypoglycaemia:
- Caution in elderly/alcoholics/liver disease
GI upset
Headache
What is the only available thiazolidinedione?
Pioglitazone
How do TZDs work?
They are PPARγ agonists - Increase insulin sensitivity
What effect do TZDs have on weight?
Increase is common:
- Due to increased S/C fat and fluid retention
Why can TZDs increase the risk of CHF?
Fluid retention
What other effects do TZDs have?
Improve microalbuminaemia
Prevent macrovascular complications
Increase hip fracture risk
How dies Dapaglifozin work?
Act on the incretin pathway:
- SGLT2 inhibitor
What are the incretins?
Stimulate intestinal secretion of insulin:
- GIP from K cells - GLP-1 from L cells
What type of drug is exenatide?
GLP-1 receptor agonist
How does exenatide work?
Increased insulin secretion (no hypos) Suppress glucagon Decrease gastric emptying -> Early satiety Reduce appetite Weight loss
What are some side effects of exenatide?
Nausea
Pancreatitis
Give some examples of DPP-IV inhibitors
Vildagliptin
Sitagliptin
Saxagliptin
Linagliptin
What drugs are less potent; GLP-1 receptor agonist, DPP-IV inhibitors?
DPP-IV inhibitors:
- Only work on what's present - DLP-1 decreased in T2DM
What are some benefits of DPP-IV inhibitors?
Increase insulin secretion (no hypos)
Decrease glucagon
Weight neutral
How do SGLT2 inhibitors work?
Decrease sugar uptake by ~25%:
- Glycosuria (~80g/day) - ~1lb decrease in weight/week
What side effects are common with SGLT2 use?
Sugar in urine:
- Thrush - UTIs
What type of insulin is used in T2DM?
Basal insulin
When is bariatric surgery considered?
When 30
What is acanthosis nigricans?
Skin becomes: - Hyperpigmented - Velvety Found at: - Axilla - Neck