Diabetes

Question 1

Dx Type 2 diabetes? (3 ways)

Answer 1

FBG: >=7mmol/L fasting or >=11.1mmol/L random [x2 different days]

OGTT 75g glucose: >=7mmol/L and >=11.1mmol/L 2hrs after

HbA1c: >6.5% [2x separate occasions]

Question 2

Metformin

Answer 2

X hepatic gluconeogenesis + (up) peripheral sensitivity to insulin

Weight loss, GI upset

X>80 years, renal insufficiency eGFR<30, hepatic failure, heart failure

Question 3

Sulfonylureas (glipizide, glyburide, glimepiride)

Answer 3

(Up) endogenous insulin secretion

X hypoglycemia + weight gain

Question 4

Thiazolidinediones (pioglitazone, rosiglitazone)

Answer 4

(Up) insulin sensitivity

Weight gain, edema, hepatotoxicity, bone loss

X heart failure

Question 5

Alpha-glycosidase inhibitors

Answer 5

(Down) intestinal absorption of carbohydrates

Flatulence and hypoglycemia

Question 6

DPP-4 inhibitors (stigaliptin, linagliptin)

Answer 6

X degradation of GLP-1

Weight neutral.

Question 7

Incretins (exenatide, liraglutide)

Answer 7

GLP-1 agonists delay absorption of food, (up) insulin secretion, (down) glucagon secretion

Injected sub/cut weekly; nausea; pancreatitis, weight loss

Question 8

SGLT2 inhibitors (dapagliflozin)

Answer 8

X SGLT2 proximal tubule to (down) glucose reabsorption

UTIs, vulvovaginal candidiasis, weight loss, lower blood pressure

Question 9

Insulin (types)

Answer 9

Given alone or in conjunction with oral agents.

Weight gain, hypoglycemia.

Short acting (lispro, as part, glulisine)
Long acting (detemir, glargine)
Combination

Question 10

When to start mediation? Monotherapy? Escalation?

Answer 10

Start if: lifestyle, HbA1c>6.5%
1) Metformin
2) + SU/DPP4i/SGLT-2
3) metformin + DPP4i + SU OR
     Metformin + SU + SGLT-2
     Insulin