diabetes mellitus Flashcards
what is definition of diabetes?
chronic disease characterized by elevated level of blood glucose which lead to serious damage to heart, blood vessels, eyes , kidneys and nerve
what type of diabetes ?
- type 1 diabetes mellitus
- type 2 diabetes mellitus
- gestational diabetes mellitus ( in pregnancy )
- idiopathic diabetes mellitus ( unknown cause )
what is pathophysiology for T1DM ?
autoimmune reaction where own immune cell attack beta cells result in zero insulin production
what is pathophysiology of T2DM ?
progressive decline of beta cells function associated with low level of insulin secretion and insulin resistance in muscle’s and adipose tissue
what is symptoms of diabetes?
- always tired
- always hungry
- numbness and tingling
- always thirsty
- blurry vision
- sudden weight loss
- frequent urination
what is the risk factor of diabetes?
- increased age
- obese
- history of cardiovascular disease
- genetic
- smoking
- being asian
- physical inactivity
- long term of drug use
what acute complication that can occur ?
- hypoglycaemia
- hyperglycaemia
- diabetic ketoacidosis
- hyperosmolar hyperglycemic state
what chronic complications that can occur ?
- cardiovascular disease
- stroke
- peripheral arterial disease
- diabetic retinopathy
- diabetic nephropathy
- diabetic neuropathy
what non pharmacological treatments can be do for patients?
- diet
- do some physical activity
- stop smoking
- loss some weight
what drug classification and example ?
- biguanides : metformin
- sulphonylureas : gliclazide , glibenclamide , glimepiride
- SGLT 2 - i : empagliflozin , canagliflozin , dapagliflozin
- DPP4 - i : sitagliptin , vildagliptin , linagliptin
- AGI : acarbose
- GLP1- RA : exenatide , liraglutide , lixisenatide
- insulin : levemir
what is moa of biguanides ?
reducing gluconeogenesis , increase insulin sensitivity in cells and reduce absorption of glucose in small intestine
what is the side effect of biguanides ?
common : nausea , vomiting , GI discomfort
long term : decrease absorption of B12 deficiency cause peripheral neuropathy /
lactic acidosis
how to take metformin ?
taken together with meals or after meals ,
change MTF to XR formulation ( swallow whole and do not crush ) , low dose or increase dose of metformin gradually
what is moa of sulphonylureas and side effects?
moa : increase insulin production in pancreas
side effects: hypoglycaemia and weight gain
when best to take gliclazide ( sulphonylureas ) ?
- taken 30 min before breakfast and dinner to avoid hypo
- gliclazide MR may be taken immediately before or after breakfast
- suitable for non obese patients
what is moa of acarbose and side effects?
moa : delay digestion of carbohydrates and slow down glucose absorption in small intestine
side effects
- bloating
- diarrhea
- flatulence
when to take acarbose ?
- taken orally with little liquid or chewed with first mouthful of food every heavy meal
- need to use sanitary pad
what is moa of DPP4 - i and side effects?
moa : inhibits breakdown if incretin secreted during meals
incretin function :
- slow gastric emptying
- promotes satiety
- increase insulin secretion
- reduce glucagon secretion
side effects :
- GI discomfort
- diarrhea
- hypoglycaemia
what is moa of GP1- RA and side effects?
moa : mimic effects of incretin
side effects:
- nausea
- vomiting
- diarrhea
- weight loss
what is moa of SGLT -2 inhibitor and side effects ?
moa : inhibit glucose reabsorb into blood vessel and remains glucose in urine for excretion.
side effects:
- increased risk of UTI
- weight loss
- dehydration and mild hypotension
- frequent urination
what is additional of SGLT 2 inhibitor ?
can act as cardiovascular drug and renopathy drug too
what is moa of insulin and side effects?
moa : facilitate glucose reuptake by body cell from blood vessels
side effects:
- lipodystrophy
- weight gain
- hypoglycaemia
how to manage hypoglycaemia and hyperglycaemia?
hypoglycaemia
- treat with half of juice , 1 spoonful of sugar mix with water and 1 spoonful of honey
- can use sweet or candy too
hyperglycaemia
- drink water
- administered insulin
