Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

endocrine > diabetes type 2 > Flashcards

diabetes type 2 Flashcards

1
Q

whats the simplified pathophysiology of diabetes type 2?

A
  • repeated glucose and insulin exposure make the cells resistant to insulin
  • more insulin is required
  • pancreas becomes fatigued and damage from overworked
  • insulin output is reduced
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how is hyperglaecemia in patients with type 2 diabetes caused, and what complications can it lead to?

A
  • high carb diet
  • insulin resistance
  • reduced pancreatic function
    ALL CAUSE CHRONIC HYPERGLAEMEMIA
  • this leads to microvascular, macrovascular and infectious complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the non-modifiable risk factors

A
  • Older age
  • Ethnicity (Black African or Caribbean and South Asian)
  • Family history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the modifiable risk factors

A
  • Obesity
  • Sedentary lifestyle
  • High carbohydrate (particularly sugar) diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the typical clinical presentation of someone with type 2 diabetes?

A
  • Tiredness
  • Polyuria and polydipsia (frequent urination and excessive thirst)
  • Unintentional weight loss
  • Opportunistic infections (e.g., oral thrush)
  • Slow wound healing
  • Glucose in urine (on a dipstick)
  • (acanthosis nigricans - thickening and darkening of skin - insulin resistance)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what does a HbA1c of 42 – 47 mmol/mol indicate?

A

pre-diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the HbA1c is a blood test

A

reflects the average glucose level over the previous 2-3 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is pre-diabetes and what indicates it

A

Pre-diabetes is an indication that the patient is heading towards diabetes. They do not fit the full diagnostic criteria but should be educated about the risk of diabetes and lifestyle changes.

An HbA1c of 42 – 47 mmol/mol indicates pre-diabetes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is done to diagnose type 2 diabetes?

A

An HbA1c of 48 mmol/mol or above

The sample is typically repeated after 1 month to confirm the diagnosis (unless there are symptoms or signs of complications).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the treatment targets for diabetes?

A

HbA1c treatment targets:
- 48 mmol/mol for new type 2 diabetics
- 53 mmol/mol for patients requiring more than one antidiabetic medication

The HbA1c is measured every 3 to 6 months until under control and stable.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the medical management for type 2 diabetes?

A

1) first-line - metformin
2) if the patient has QRISK score above 10% consider SGLT-2 inhibitor
3) second-line - add a sulfonylurea, pioglitazone, DPP-4 inhibitor or SGLT-2 inhibitor
4) third-line options are:
- Triple therapy with metformin and two of the second-line drugs
- Insulin therapy (initiated by the specialist diabetic nurses)
5) Where triple therapy fails, and the patient’s BMI is above 35 kg/m2, there is the option of switching one of the drugs to a GLP-1 mimetic (e.g., liraglutide).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the role of metformin?

A
  • increases insulin sensitivity
  • decreases glucose production by the liver
  • doesn’t cause weight gain - can actually cause weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what class of medication is melformin?

A

biguanide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the side effects of metformin?

A
  • Gastrointestinal symptoms, including pain, nausea and diarrhoea (depending on the dose)
  • Lactic acidosis (e.g., secondary to acute kidney injury)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what would you suggest to patients on metformin who are experiencing gastrointinestinal side effects?

A

modified-release metformin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what suffix do SGLT-2 inhibitors end with?

A

-gliflozin

17
Q

what is the action of SGLT-2 inhibitors in terms of diabetes type 2?

A
  • the SGLT-2 inhibitor is on proximal tubules of kidneys which rebasorbs glucose from urine into blood
  • inhibitors block this to allow more glucose to go into the urine
  • reduces blood pressure, leads to weight loss, improves heart failure
18
Q

when do SGLT2-inhibitors cause hypoglycemia?

A

when used with insulin or sulfonylureas

19
Q

what are the side effects of SGLT-2 inhibitors?

A
  • Glycosuria (glucose in the urine)
  • Increased urine output and frequency
  • Genital and urinary tract infections (e.g., thrush)
  • Weight loss
  • Diabetic ketoacidosis, notably with only moderately raised glucose
  • Lower-limb amputation may be more common in patients on canagliflozin (unclear if this applies to the others)
  • Fournier’s gangrene (rare but severe infection of the genitals or perineum)
20
Q

what does pioglitazone do and what type of drug class is it?

A
  • its a thiazolindinedione
  • it increases insulin sensitivity
  • it decreases liver production of glucose
21
Q

what are the notable side effects of pioglitazone?

A
  • Weight gain
  • Heart failure
  • Increased risk of bone fractures
  • A small increase in the risk of bladder cancer
22
Q

which drugs used to manage diabetes type 2 can cause hypoglycemia?

A
  • metformin - NO
  • SGLT-2 - YES
  • pioglitazone - NO
  • sulfony;ureas - YES
  • DPP-4 inhibitors and GLP-1 mimetics - NO
23
Q

whats the role of sulfonyureas?

A
  • stimulate insulin release from the pancreas
24
Q

what are the side effects of sulfonylureas?

A
  • weight gain
  • hypoglycemia
25
Q

whats the role of and what type of drug are DPP-4 inhibitors and GLP-1 mimetics?

A

Incretins (GLP-1) are hormones produced by the gastrointestinal tract. They are secreted in response to large meals and act to reduce blood sugar by:

Increasing insulin secretion
Inhibiting glucagon production
Slowing absorption by the gastrointestinal tract

incretins are inhibited by DPP-4

so these drugs allow more incretins

26
Q

what are the side effects of DPP-4 inhibitors?

A
  • Headaches
  • Low risk of acute pancreatitis
27
Q

how do GLP-1 mimetics work and how is it administered?

A
  • imitate the action of GLP-1
  • subcutaneous injections
28
Q

what are the notable side effects of GLP-1 mimetics?

A
  • Reduced appetite
  • Weight loss
  • Gastrointestinal symptoms, including discomfort, nausea and diarrhoea
29
Q

what are the different types of insulin, wht ratio are they administrated at and after how much time do they begin working?

A

Insulin is usually initiated and managed by diabetic specialist nurses.

Rapid-acting insulins (e.g., NovoRapid) start working after around 10 minutes and last about 4 hours.

Short-acting insulins (e.g., Actrapid) start working in around 30 minutes and last about 8 hours.

Intermediate-acting insulins (e.g., Humulin I) start working in around 1 hour and last about 16 hours.

Long-acting insulins (e.g., Levemir and Lantus) start working in around 1 hour and last about 24 hours or longer.

Combinations insulins contain a rapid-acting and intermediate-acting insulin. In brackets is the ratio of rapid-acting to intermediate-acting insulin:

Humalog 25 (25:75)
Humalog 50 (50:50)
Novomix 30 (30:70)

30
Q

what are the key complications of type 2 diabetes?

A
  • Infections (e.g., periodontitis, thrush and infected ulcers)
  • Diabetic retinopathy
  • Peripheral neuropathy
  • Autonomic neuropathy
  • Chronic kidney disease
  • Diabetic foot
  • Gastroparesis (slow emptying of the stomach)
  • Hyperosmolar hyperglycemic state
31
Q

what is used to control hypertension in those with type 2 diabtees?

A

ACE inhibitors

32
Q

at what point are ACE inhibitors administered to type 2 diabetics?

A

ACE inhibitors are started in type 2 diabetics with chronic kidney disease when the albumin-to-creatinine ratio (ACR) is above 3 mg/mmol (as opposed to 30 mg/mmol in patients without diabetes).

33
Q

when are SGLT-2 inhibitors started on type 2 diabetics?

A

SGLT-2 inhibitors are started in type 2 diabetics with chronic kidney disease when the albumin-to-creatinine ratio (ACR) is above 30 mg/mmol (in addition to the ACE inhibitor).

34
Q

when are phosphodiesterase-5 inhibitors started on type 2 diabetics?

A

erectile dysfunction

35
Q

what are the 4 options for neuropathic pain?

A
  • Amitriptyline – a tricyclic antidepressant
  • Duloxetine – an SNRI antidepressant
  • Gabapentin – an anticonvulsant
  • Pregabalin – an anticonvulsant
36
Q

explain what is hyperosmolar hyperglycemic state, its presentation and how its treated?

A

It is characterised by hyperosmolality (water loss leads to very concentrated blood), high sugar levels (hyperglycaemia) and the absence of ketones, distinguishing it from ketoacidosis.

It presents with polyuria, polydipsia, weight loss, dehydration, tachycardia, hypotension and confusion.

It is a medical emergency with high mortality. Involve experienced seniors early. Treatment is with IV fluids and careful monitoring.

endocrine (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions