Diabetes Flashcards
Exposure to __1__ and __2__ makes the cells in the body become resistant to the effects of __3__. With an increased __4__ requirement, beta cells in the pancreas have to work harder and become fatigued, therefore produce less.
- glucose
- insulin
- insulin
- insulin
True or false: In type 2 diabetes, pancreatic fatigue leads to chronic hypoglycaemia.
False.
In type 2 diabetes, pancreatic fatigue leads to chronic hypERglycaemia.
What risk factors are associated with type 2 diabetes?
Non-Modifiable:
- Older age
- Ethnicity (black, chinese, South Asian)
- Family History (genetics)
Modifiable:
- Obesity
- Sedentary lifestyle
- High carb diet
How does Type 2 Diabetes present?
Consider type 2 diabetes in any patient fitting the risk factors.
Additional features:
- Fatigue
- Polydipsia and polyuria
- Unintentional weight loss
- Opportunistic infections (e.g. oral candida)
- Slow healing wounds
- Glucose in urine (dipstick)
What is an Oral Glucose Tolerance Test (OGTT)?
Performed in the morning prior to breakfast (fasting).
Take a baseline fasting plasma glucose, then give the patient a 75g glucose drink. 2 hours later, check the plasma glucose again to see how the body coped with the carbohydrate meal.
What studies might suggest a patient has ‘pre-diabetes’?
Raised HbA1c: 42-47 mmol/mol
Impaired fasting glucose: 6.1-6.9 mmol/L
Impaired glucose tolerance: OGTT plasma glucose of 7.8-11.1 after 2 hours.
What studies can diagnose a patient with diabetes?
HbA1c > 48 mmol/mol
Random Glucose > 11 mmol/l
Fasting Glucose > 7 mmol/l
OGTT 2 hour result > 11 mmol/l
What is the general approach towards treatment and management of type 2 diabetes?
- Lifestyle modification
- Diet, exercise, smoking cessation, optimise comorbidities. - Monitoring for complications:
- Diabetic retinopathy, kidney function, diabetic foot - Medical management:
First line: Metformin
Second line:
Add second drug: sulfonylurea, pioglitazone, DPP-4 inhibitor, SGLT-2 inhibitor.
Third line:
Add third drug (metformin + 2 second-line drugs OR metformin + insulin)
What effect does metformin have on weight?
Metformin is ‘weight neutral’ - it may help prevent weight gain, but doesn’t cause weight loss.
How does metformin help patients with type 2 diabetes?
Increases insulin sensitivity and decreases both intestinal absorption and liver production of glucose.
Which diabetes drug is a biguanide?
Metformin
What are the notable side effects of metformin?
GI problems: diarrhoea and abdo pain (reducing dose often resolves the problem)
Lactic acidosis (high lactate may show on ABG)
*Does not cause hypoglycaemia
Which diabetes drug is a thiazolidinedione?
Pioglitazone
How does pioglitazone help patients with type 2 diabetes?
Pioglitazone increases insulin sensitivity and decreases liver production of glucose.
What are the notable side effects of pioglitazone?
Weight gain
Fluid retention
Anaemia
Heart failure
*extended use may increase risk of bladder cancer
**does NOT cause hypoglycaemia
Which common diabetes drug is a sulfonylurea?
Gliclazide
How does gliclazide work?
Sulfonylureas stimulate insulin release from the pancreas
What are the notable side effects of gliclazide?
Weight gain
Hypoglycaemia
*Increased risk of CV disease and MI when used as monotherapy
What is the most common DPP-4 inhibitor?
Sitagliptin
How do DPP-4 inhibitors help patients with type 2 diabetes
DPP-4 stands for dipeptidyl peptidase-4, an enzyme that inhibits incretins (such as GLP-1). Incretins (GLP-1) are released in response to a large meal and cause insulin secretion, inhibit glucagon production and slow absorption by the GI tract.
By inhibiting DPP-4, sitagliptin increases the activity of GLP-1.
What are the notable side-effects of DPP-4 inhibitors?
GI upset
Symptoms of URTI
Pancreatitis
What type of diabetes drug is ‘exanatide’?
GLP-1 mimetic
Exenatide and liraglutide are two commonly-used GLP-1 mimetics.
How do GLP-1 mimetics help patients with type 2 diabetes?
Incretins (GLP-1) are released in response to a large meal and cause insulin secretion, inhibit glucagon production and slow absorption by the GI tract.
These drugs work by mimicking the action of GLP-1.
What are the notable side effects of GLP-1 mimetics?
GI upset
Weight LOSS
Dizziness
*low risk of hypoglycaemia
