Diabetes Flashcards
What is the cut off value to diagnose diabetes if symptomatic?
Random plasma glucose of 11.1 or over
Oral glucose tolerance test over 11.1 at 2 hours
Fasting plasma glucose over 6.9
What gene is mutated in maturity onset diabetes of the young?
Single gene mutation of Hepatic nuclear factor (HNF1A ) a transcription factor found in the pancreas which regulates insulin secretion and B cell numbers . It is diagnosed in adolescence or early adulthood before age 25
What type of MODY is most common?
MODY3 from mutation in HNF1A which regulates insulin production , with very high blood sugars.
It has a high sensitivity to sulhponylureas like gliclazide
What is the cause of MODY2?
MODY 2 is the second commonest cause, occurring due to a glucokinase mutation. Glucokinase is important for recognising glucose sensor in the pancreas for insulin production. Blood sugars rarely rise above 7-8, over many years. Patients are generally well with few complications and the diabetes often responds to diet alone.
Which type of MODY is associated with pancreatic atrophy?
MODY5 due to HNF1 beta atrophy
What is the cut off value to diagnose diabetes if asymptomatic?
Two results required from two different days:
Random plasma glucose of 11.1 or over
Oral glucose tolerance test over 11.1 at 2 hours
Fasting plasma glucose over 6.9
What is the initial drug treatment for type 2 diabetes?
Metformin reduces gluconeogenesis n liver, decreases intestinal absorption of glucose and increasing peripheral glucose uptake.
What is the ideal diabetic drug for patients with established atherosclerotic cardiovascular disease?
SGLT2 inhibitors, ideal for those at risk and with heart failure in addition to Metformin
-> improves weight loss by losing glucose through urine but increases risk of UTI
What is the typical dual therapy if Metformin alone is ineffective?
Metformin with
DPP-4 inhibitor
OR
Pioglitazone
OR
Sulphonylureas
What is the triple therapy for type 2 diabetes?
Metformin with either of the following:
DPP-4 inhibitor
Pioglitazone
Sulphonylureas
Which diabetic drug is used when ulphonyureas are not tolerated?
SGLT2 inhibitors
What drug should be used if standard triple therapy is ineffective?
GLP-1 agonist When triple therapy with merformin is ineffective, for patients who must have BMI over 35
Which GLP-1 has cardiovascular benefit?
GLP-1 receptor agonists
-> increases risk of pancreatitis and delays gastric emptying and causes nausea, vomiting and constipation
Which drug is used first line when Metformin is contraindicated/not tolerated?
DPP4 inhibitor
OR
Pioglitazone
OR
Sulphonylurea
What are sick day rules for Type 2 diabetes if at risk of dehydration?
For risk of dehydration, stop
Metformin -> actic acidosis
GLP-1 agonists
What are the adverse effects of Sulphonylureas?
Weight gain
Hypoglycaemia
Which diabetic drug increases risk of pancreatitis?
GLP1 agonists like executive and sitagliptin are most strongly associated
DPP-4 inhibitors
Sulphonylureas have a lesser risk
How do Sulphonylureas work?
Stimulates pancreatic beta cells to secrete insulin and can cause hypoglycaemia and weight gain
How does Pioglitazone work?
Thiazolidinedione that improves insulin sensitivity in peripheral tissues
When is Metformin contraindicated?
Severe renal or hepatic impairment
When are Sulphonylureas ontraindicated?
Type 1 diabetes
Diabetic ketoacidosis
Severe renal or hepatic impairment
How does Pioglitazone act?
Thiazolidinedione which increases peripheral insulin sensitivity
Causes weight gain, fluid retention and increases risk of BLADDER CANCER
When is Pioglitazone contraindicated?
Heart failure
Hepatic impairment
Bladder cancer or suspected
