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Block 2 - non communicable diseases > Diabetes and Impaired glucose tolerance > Flashcards

Diabetes and Impaired glucose tolerance Flashcards

1
Q

When is a diagnosis of diabetes made?

A

Fasting glucose >7mmol/L

Two hour plasma glucose OR Random plasma glucose >11.1 mmol/L

HbA1c >48 mmol/mol

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2
Q

What two criteria have to both be met for diagnosis of impaired glucose tolerance?

A

Fasting plasma glucose < 7 mmol/L
AND
>7.8 but <11.1 two hour plasma glucose

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3
Q

Impaired fasting glucose when can diagnose

A

If first or both of following criteria are met
Fasting plasma glucose between 6.1-6.9
AND (if measured
<7.8 two hour plasma glucose

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4
Q

What HbA2c is prediabetes / IFG or IGT

A

42-47

Fasting glucose 6.1-6.9

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5
Q

What is the target for HbA1c if diabetes is being managed with any drug that may cause hypoglycaemia eg sulfonylurea?

A

53 mmol/mol

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6
Q

Autoantiboides in T1DM

A

Glutamic acid decarboxylase (GAD 65)
Islet cells (not specific or sensitive)
insulin
Tyrosine phosphatase (IA2 +IA2B)
Zinc transporter (ZnT8)
>80% + for GAD, IA2 or AnT8 n

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7
Q

% of T1DM with HLA

A

90% DR3 or DR4

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8
Q

Type 1 vs type 2 diabetes genes

A

type 1 - HLA
tyoe 2 - TCF7L2
May deevlop insulin resitance but may not

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9
Q

What is the most powerful genes in terms of causing T2DM

A

tcf7l2
polygenic (50 genes w small effects)

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10
Q

Secondary diabetes mellitus

A

Pancreatic disease and pancreatitis
Cystic fibrosis
Haemochromatosis (iron deposition)
Drug induced

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11
Q

Types of diabetes

A

1 and 2
Secondary
Monogenic
Congenital and neonatal
Syndromic
Chromosomal - increased risk
Mitochondiral

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12
Q

Syndromic diabetes causes

A

Lipodystrophies, prader-willi syndrome, myotonic dystrophy, wolfram (DIDMOAD)

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13
Q

Features of mitochondrial disease causing T1DM

A

Deafness and cardio-neural problems

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13
Q

What drugs can cause diabetes

A

Chronic steroid use

Calcineurin inhibitors

Statins

Major antipsychotic agents

HAART

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13
Q

Ass endocrinopathies with diabetes and the hormone in excess that causes that in each

A

Cushings including iatrogenic - glucocorticoids
Acromegaly - growth hormones
Phaeochromocytoma - catecholamines
Glucagonomas
Somatostatinomas
Hyperthyroidism - autoimmune link w type 1

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14
Q

What drugs to offer when patient symptomatically hyperglycaemic

A

Insulin or sulonylurea

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14
Q

What do you use if metformin standard release is not tolerated?

A

Metformin modified release

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15
Q

Alternatives to metformin

A

DPP4 inhbitor
Pioglitzone
Sulgoylurea
SGLT2 inhibitor

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16
Q

When to consider insulin based treatemnet

A

After triple therapy with metformin
After dual therapy if metformin not tolerated
Combinations:
Metformin + DPP4i + sulfonylurea
M +pioglitazone + sulfonylurea
M +pioglitazone/sulfonylurea + SGLT2i

17
Q

When consider metformin + sulfonylurea + GLP-1 agonist if

A

Triple therapy ineffective, contraindicated OR
BMI >35 in europeans who have comorbidites ass
BMI < 35 w significant occupational implications or weight loss would beneift other comorbidities

18
Q

Treatment lines of HbA1c

A

<48
<58 - increase medication from dual to triple therapy

19
Q

What to do if o triple therapy weight decline >3% and HbA1c >3% in 6 months

A

Continue with only GLP-1 analogue

20
Q

What does insulin based treatment consist of

A

Continue metfrmin if tolerated
Offer NPH insulin once or twice daily, consider offering short actin insulin also or biphasic esp if HbA1c >75

21
Q

When consider offering biphasic preps containing short acting insulin

A

Prefers injecting immerdiately before a meal
Hypoglycaemic
Blood glucose levels markedly raised after meals

22
Q

Cause of diabetes

A

Decreased beta cell function and insulin function in muscle and liver

23
Q

What is importnat to also consider in diabetes

A

Lipid levels and Qrisk score, other cardiac risk factors and how to control them
Weight loss, education about remission

24
Q

Mechanism of action of metformin

A

Reduced hepatic glucose output
Increased insulin sensitivity

25
Q

What diabetic medication can help weight loss?

A

Metformin
GLP-1 analogues nad DPP4-inhibitors
SGLT2 inhibitors

26
Q

Side effects of metformin

A

GI upset - try modified release and start on low dose, titrate up
RARE - lactic acidosis

27
Q

MOA of DPP4 inhibitors

A

sTOP glp-1 BREAKDOwn, increase GLP-1 to act on beta cells in pancreas to increase insulin release
Incretin based

28
Q

Examples of SGLT2 inhibitors

A

Dapagliflozin, canagliflozin, empagliflozin

29
Q

MOA of SGLT2 inhibitors

A

Block reabsorption of glucose at proximal tubule - increase excretion in urine

30
Q

Side effect of SGLT2 inhibitors

A

UTI due to increase glucose in urine

31
Q

What extra benefits do SGLT2 inhibtiors have

A

Cardiovascular risk reduction, reduced HF hosptialisation

32
Q

MOA of sulfonylureas

A

Stimulates insulin secretion from beta cells
V fast onset - fast reduction of glucose

33
Q

Negative of sulonylureas

A

Weight gain
cause hypos because of speed

34
Q

Piaglitazone MOA

A

Improves tissue sensitivity to insulin

35
Q

Porblems with piaglitazone

A

Fluid retnetion
Weight gain
HF - increased straing on the heart esp if preexisitng conditions

36
Q

GLP 1 advantages

A

Weight reduction, CVS risk reduction (Semaglutide, dulaglutide, liraglutide)
Less hypoglycaemia when used on own than dual therapy but as effective - occupational beenfits eg drivers
Semaglutide can be taken orally
GI side effects

37
Q

What diabetic drugs reduce cardiac risk

A

SGLT2 inhibtors and GLP-1 analogues

38
Q

Daily vs weekly GLP-1 analogues

A

Liraglutide (once), exenatide (twice) = daily
Exenatice LAR, dulaglutide, semalgutide - once a week injection

39
Q

Advantages of insulin

A

Direct effect on blood glucose
Improves glycaemic control

40
Q

Drawbacks of insulin

A

Hypo riskk
Weight gain
Occupational concerns
INjection

41
Q

Intermediate acting insulins

A

NPH insulin - insulatard, humilin I

42
Q

Long acting insulins

A

Glargine, degludec

43
Q

Short acting insulins

A

Actrapid, insulin aspart, inulin lispro

44
Q

Mixed insulins

A

Novomix 30 (30% short acting)
Humulag mix 25 (25% SA)

Block 2 - non communicable diseases (8 decks)

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