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Medicine- endocrine > Diabetes- type 2 > Flashcards

Diabetes- type 2 Flashcards

1
Q

Pathophysiology

A

Repeated exposure to glucose and insulin make cells become resistant

Over time, pancreas becomes fatigued and produces less

Leads to chronic hyperglycaemia

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2
Q

Risk factors

A

Older age

Ethnicity

Family history

Obesity

Sedentary lifestyle

High carbohydrate diet

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3
Q

Presentation

A

Fatigue

Polydipsia/ polyuria

Unintentional weight loss

Opportunistic infections

Slow healing

Glucose in urine

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4
Q

OGTT

A

Performed in the morning prior to breakfast

Take baseline fasting plasma glucose result

Give 75g glucose drink

Measure plasma glucose 2 hours later

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5
Q

Pre-diabetes

A

Don’t fit full diagnostic criteria

Should be educated regarding diabetes and implement lifestyle changes to reduce risk of progressing

Don’t need medical treatment

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6
Q

Pre-diabetes diagnosis

A

HbA1c 42-47mmol/mol

Impaired fasting glucose 6.1-6.9mmol/L

Impaired glucose tolerance 7.8-11mmol/L at 2 hours on OGTT

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7
Q

Diabetes diagnosis

A

HbA1c >48mmol/mol

Random glucose >11mmol/L

Fasting glucose >7mmol/L

OGTT 2hour result >11mmol/L

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8
Q

Dietary modification

A

Vegetables and oily fish

Low glycaemic, high fibre diet

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9
Q

Optimise other risk factors

A

Exercise and weight loss

Stop smoking

Optimise treatment for other illnesses e.g. NTH, hyperlipidaemia, CVD

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10
Q

Monitor complications

A

Diabetic retinopathy

Kidney disease

Diabetic foot

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11
Q

Treatment targets

A

48mmol/mol for new T2DM

53mmol/mol for diabetics that have moved beyond metformin alone

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12
Q

First line medical management

A

Metformin titrated from initially 500mg once daily as tolerated

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13
Q

Second line medical treatment

A

Sulfinylurea

Pioglitazone

DPP-4 inhibitor

SGLT-2 inhibitor

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14
Q

Third line medical management

A

Triple therapy with metformin and two of the other drugs OR

Metformin and insulin

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15
Q

Which drugs preferred in patients with CVD?

A

SGLT2 inhibitors

GLP-1 mimetics

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16
Q

Metformin

A

Biguanide

Increases insulin sensitivity and decreases liver production of glucose

Doesn’t change weight or cause hypoglycaemia

Side effects: diarrhoea and abdo pain, lactic acidosis

17
Q

Pioglitazone

A

Thiazolidinedione

Increases insulin sensitivity and decreases liver production of glucose

Side effects: weight gain, fluid retention, anaemia, heart failure

Doesn’t cause hypoglycaemia

18
Q

Sulfonylurea

A

Most common one is gliclazide

Stimulate insulin release from pancreas

Side effects: weight gain, hypoglycaemia, increased risk of CVD and MI

19
Q

Incretins

A

Hormones produces by the GI tract

Secreted in response to large meals and act to reduce blood sugar
- increase insulin secretions
- inhibit glucagon production
- slow absorption by the GI tract

Main incretin is GLP1

Incretins inhibited by DPP4

20
Q

DPP-4 inhibitor

A

Most common is sitagliptin

Inhibitrs DPP4 enzyme so increases GLP1 activity

Side effects: GI tract upset, URTI, pancreatitis

21
Q

GLP1 mimetics

A

Common one is SC exenatide

Mimic action of GLP1

Side effects: GI tract upset, weight loss, dizziness, low risk of hypoglycaemia

22
Q

SGLT2 inhibitor

A

All end with -gliflozin

SGLT2 protein responsible for reabsorbing glucose from urine in proximal tubules

Side effects: glucoseuria, UTI, weight loss, DKA, lower limb amputation

23
Q

Rapid acting insulins

A

Start after around 10 minutes and last 4 hours

Novorapid

Humalog

Apidra

24
Q

Short acting insulins

A

Start working around 30 minutes and last 8 hours

Actrapid

Humulin S

Insuman rapid

25
Q

Intermediate acting insulins

A

Start working in around 1 hour and last 16 hours

Insulatard

Humulon I

Insuman basal

26
Q

Long acting insulins

A

Start working in around 1 hour and last 24 hours

Lantus

Levemir

Degludec (lasts over 40 hours)

27
Q

Combination insulins

A

Contain rapid acting and intermediate acting

Medicine- endocrine (29 decks)

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