Diabetes Flashcards
How often should HBA1c be checked in Type 2 diabetes?
Every 3 - 6 months until stable and then every 6 months
What are the HbA1c targets for someone with type 2 diabetes who is on metformin or lifestyle alone treatment?
48mmol/mol
What are the HbA1c targets for someone with type 2 diabetes who is on any drug which may cause hypocalcaemia?
53mmol/mol
Describe the treatment pathway for type 2 diabetes?
- Lifestyle
- Metformin
3, Metformin + Gliptin OR sulfonylurea OR pioglitazone OR SGLT2 inhibitor - Metformin + Gliptin + Sulfonylurea
OR Metformin + Pioglitazone + Sulfonylurea
OR Metformin + Sulfonylurea + SGLT2 inhibitor OR metformiin + pioglitazone + SGLT@ inhibitor
If this is not tolerated and the bmi iv over 35 a GLP 1 mimetic can be used with metformin and a sulfonylurea. If not then insulin treatment
Do you continue or stop metformin when you start insulin?
Continue metformin
What is a hyperosmolar hyperglycaemic state?
A medical emergency where there is hyperglycaemia, dehydration and uraemia without ketosis or acidosis. It occurs in middle aged/elderly people with type 2 diabetes. This happens in type 2 diabetes becuase there is still some insulin being produced so there is no ketosis. This has a high mortality rate and can be complicated by thromboembolism or rhabdomyolisis
How do you manage a hyperosmolar hyperglycaemic state?
Fluid and electrolyte replacement.
Heparin is usually given due to high risk of thromboembolic events
What are the main categories of oral anti diabetic drugs and an example of each one.
- Insulin secretagogues
- Sulfonylureas - Insulin sensitisers
- Metformin
- Thiazolidinediones - Inhibitors of glucose absorption
- Acarbose - incretin bases theraoies
- DPP 4 inhibitors
How do sulfonylureas work?
Increase insulin release from the pancreatic beta cells by binding to the sulfonylurea receptor (SUR1) and leading to a rise in intracellular calcium and then insulin release.
What are the main side effects of sulfonylureas?
Hypoglycaemia
Weight gain
Hyponatremia
How does metformin work?
- Increases glucose uptake in skeletal muscle and adipocytes
- Supresses heapatic gluconeogenesis and glycogenolysis
- Reduces glucose absorption from the small intestine
Also supresses appetitie and helps with weight loss
What are the main side effects of metformin?
GI dise efefcts such as anorexia, nausea, abdominal discomfort and diaarrhoea
Lactic acidosis
When would you worry about lactic acidosis with metformin?
In situations where lactate clearance is impaired on anaerobic metabolism is increased for example in renal impairement, hepatic failure and cardiac failure.
How do glitazones work?
Bind to PPAR gamma receptor, mainly in adipose tissue. They enhance glucose and fatty acid uptake and utilization in adipocytes. They also reduce lipid levels As the effect of these is indirect then may take up to 3 months to reach there maximal effects.
What are the side effects of glitazones?
Weight gain
Fluid retention (may precipiate cardiac failure in those at risk)
Affects one formation leads
