Diabetes Mellitus Type 2 Flashcards
How to diagnose diabetes
With clinical signs
Fasting glucose >7 mmol/L
Random plasma glucose >11 mmol/L
HbA1c > 6.5
Define DMT2
Insulin deficiency relative to the increased demand for insulin leads to a hypersecretion of insulin by a depleted beta cell mass. This progresses to an absolute insulin deficiency requiring insulin therapy.
Risks of gestational diabetes
Increased birthweight
Neonatal hypoglycemia
Sacral agenesis
50% of mothers with GDM develop DM later in life
How to do OGTT
Fast. Give 75g glucose in 300ml water. Measure 2 hours after. DM = >11.1 mmol/L
Common complication of DM
Vascular disease - MI and stroke Nephropathy - microalbuminuria Diabetic retinopathy Neuropathy Infections
Step 1 (lifestyle plus metformin) targets
Random blood glucose < 10
Fasting glucose 6-8
HbA1c 6-7.5
Metformin contraindicated in..
Chronic kidney disease (GFR < 30) Severe hepatic impairment Recent MI of heart failure Alcoholism Pregnancy
Initial dose of metformin
500mg daily
A/E of metformin
Anorexia
Metallic taste
Diarrhoea
Lactic acidosis
MOA of metformin
Inhibit intestinal absorption of glucose
Increase glucose utilization
Enhance action of insulin
Inhibit gluconeogenesis
Egs of sulphonylureas
Glibenclamide
Gliclazide
MOA of sulphonylureas
Stimulate the release of endogenous insulin
When not to use sulphonylureas
Type 1 DM
Severe liver disease
When to use sulphonylureas with caution
Older pts Hepatic or renal disease G6PD deficiency Lactation Porphyria
Starting dose of gliclazide
40 mg oral in morning with a meal
