Diabetes- type 2 Flashcards
Pathophysiology
Repeated exposure to glucose and insulin make cells become resistant
Over time, pancreas becomes fatigued and produces less
Leads to chronic hyperglycaemia
Risk factors
Older age
Ethnicity
Family history
Obesity
Sedentary lifestyle
High carbohydrate diet
Presentation
Fatigue
Polydipsia/ polyuria
Unintentional weight loss
Opportunistic infections
Slow healing
Glucose in urine
OGTT
Performed in the morning prior to breakfast
Take baseline fasting plasma glucose result
Give 75g glucose drink
Measure plasma glucose 2 hours later
Pre-diabetes
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
Pre-diabetes diagnosis
HbA1c 42-47mmol/mol
Impaired fasting glucose 6.1-6.9mmol/L
Impaired glucose tolerance 7.8-11mmol/L at 2 hours on OGTT
Diabetes diagnosis
HbA1c >48mmol/mol
Random glucose >11mmol/L
Fasting glucose >7mmol/L
OGTT 2hour result >11mmol/L
Dietary modification
Vegetables and oily fish
Low glycaemic, high fibre diet
Optimise other risk factors
Exercise and weight loss
Stop smoking
Optimise treatment for other illnesses e.g. HTN, hyperlipidaemia, CVD
Monitor complications
Diabetic retinopathy
Kidney disease
Diabetic foot
Treatment targets
48mmol/mol for new T2DM
53mmol/mol for diabetics that have moved beyond metformin alone
First line medical management
Metformin titrated from initially 500mg once daily as tolerated
Second line medical treatment
Sulfinylurea
Pioglitazone
DPP-4 inhibitor
SGLT-2 inhibitor
Third line medical management
Triple therapy with metformin and two of the other drugs OR
Metformin and insulin
Which drugs preferred in patients with CVD?
SGLT2 inhibitors
GLP-1 mimetics
Metformin
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
Pioglitazone
Thiazolidinedione
Increases insulin sensitivity and decreases liver production of glucose
Side effects: weight gain, fluid retention, anaemia, heart failure
Doesn’t cause hypoglycaemia
Sulfonylurea
Most common one is gliclazide
Stimulate insulin release from pancreas
Side effects: weight gain, hypoglycaemia, increased risk of CVD and MI
Incretins
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
DPP-4 inhibitor
Most common is sitagliptin
Inhibits DPP4 enzyme so increases GLP1 activity
Side effects: GI tract upset, URTI, pancreatitis
GLP1 mimetics
Common one is SC exenatide
Mimic action of GLP1
Side effects: GI tract upset, weight loss, dizziness, low risk of hypoglycaemia
SGLT2 inhibitor
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
Rapid acting insulins
Start after around 10 minutes and last 4 hours
Novorapid
Humalog
Apidra
Short acting insulins
Start working around 30 minutes and last 8 hours
Actrapid
Humulin S
Insuman rapid
Intermediate acting insulins
Start working in around 1 hour and last 16 hours
Insulatard
Humulon I
Insuman basal
Long acting insulins
Start working in around 1 hour and last 24 hours
Lantus
Levemir
Degludec (lasts over 40 hours)
Combination insulins
Contain rapid acting and intermediate acting
