Diabetes Type 2 Flashcards
What is the first-line treatment for type 2 diabetes?
Metformin (assess tolerability first).
What if metformin is contraindicated or not tolerated?
Consider SGLT2 inhibitor monotherapy.
What form of metformin may help with GI issues?
Metformin MR (modified release).
Name the main oral drug classes for type 2 diabetes.
Metformin, SGLT2 inhibitors, DPP-4 inhibitors, Pioglitazone, Sulfonylureas.
What are examples of SGLT2 inhibitors (‘flozins’)?
Canagliflozin, Dapagliflozin, Empagliflozin, Ertugliflozin.
Benefits of SGLT2 inhibitors?
Weight loss, low hypoglycaemia risk, cardiovascular and renal protection.
Examples of DPP-4 inhibitors?
Alogliptin, Linagliptin, Saxagliptin, Sitagliptin, Vildagliptin.
Key considerations of DPP-4 inhibitors?
Weight neutral, low hypoglycaemia risk, adjust dose in renal/hepatic impairment (except some).
What are GLP-1 mimetics indicated for?
If triple therapy fails and the patient is obese (BMI ≥35 or <35 with specific concerns).
When is insulin considered?
When dual therapy fails to achieve glycaemic targets.
Which medication is associated with weight gain and high hypoglycaemia risk in older people?
Sulfonylureas - glipizide, glimepiride, and gliclazide.
Which medication should be avoided in heart failure or bladder cancer?
Pioglitazone.
What is recommended for symptomatic hyperglycaemia?
Consider insulin or a sulfonylurea, and review once blood glucose is controlled.
Examples of GLP-1 receptor agonists?
Dulaglutide, Exenatide, Liraglutide, Lixisenatide, Semaglutide.
Which class is generally avoided or used cautiously in renal impairment?
SGLT2 inhibitors, Metformin, Sulfonylureas, and some DPP-4s.
Which class is safest in renal impairment?
DDP-4 inhibitors - especially linagliptin as no dose adjustment needed.
Which meds require caution or avoidance in hepatic impairment?
Most — especially SGLT2 inhibitors, Sulfonylureas, and Pioglitazone.
What defines Type 2 Diabetes Mellitus (T2DM)?
A metabolic disorder with persistent hyperglycaemia due to insulin resistance and deficient insulin secretion.
Diagnostic criteria for T2DM (adults)?
HbA1c ≥ 48 mmol/mol (6.5%)
OR random plasma glucose >11.1 mmol/L
OR fasting glucose ≥ 7.0 mmol/L
Name key risk factors for T2DM.
Obesity, inactivity, high-risk ethnicity (Asian, African, Afro-Caribbean), family history, gestational diabetes, corticosteroid use, poor diet.
Classic symptoms of T2DM?
Polyuria, polydipsia, weight loss, fatigue.
What skin sign may indicate insulin resistance?
Acanthosis nigricans - a condition that causes areas of dark, thick velvety skin in body folds and creases.
Macrovascular complications of T2DM?
CVD (heart disease, stroke, PAD).
Microvascular complications of T2DM?
Nephropathy, retinopathy, neuropathy.
What are the diabetic foot risks?
Ulcers, deformity, infection, Charcot arthropathy - a condition where bones and joints in the foot and ankle are damaged due to nerve damage (neuropathy).
Name a psychological complication of T2DM.
Depression, anxiety, eating disorders.
What can affect HbA1c accuracy?
Abnormal red cell turnover or haemoglobin types.
What lifestyle interventions help T2DM?
Diet, exercise, weight loss, stop smoking, limit alcohol/drugs.
HbA1c Targets for Type 2 Diabetics.
- Lifestyle only / metformin - 48 mmol/mol (6.5%).
- With sulfonylurea or insulin - 53 mmol/mol (7.0%)
- Escalate treatment if ≥ 58 mmol/mol (7.5%).
Targets be relaxed - in the elderly, frail, or at high hypoglycaemia risk.
When is an SGLT2 inhibitor added at initiation?
In patients with chronic heart failure or established atherosclerotic CVD.
hat should be considered for symptomatic hyperglycaemia - rescue therapy?
Insulin or sulfonylurea temporarily, then review treatment.
Who qualifies for GLP-1 receptor agonists?
BMI ≥ 35 + obesity complications
BMI < 35 with occupational impact or comorbidities
When is insulin therapy introduced?
After dual/triple therapy fails, or in acute symptomatic hyperglycaemia.
What defines hypoglycaemia?
Blood glucose < 3.5 mmol/L.
Which treatments most commonly cause hypoglycaemia?
Insulin and sulfonylureas.
What are mild symptoms of hypoglycaemia?
Hunger, tremor, sweating, tingling lips, palpitations, anxiety.
What are moderate symptoms of hypoglycaemia?
Headache, drowsiness, confusion, blurred vision, behavioural changes.
What defines severe hypoglycaemia?
Cognitive impairment, coma, convulsions — requires help from another person.
What is impaired hypoglycaemia awareness?
Inability to recognise or reduced perception of hypoglycaemia symptoms.
Managing Acute Hypoglycaemia?
First step if patient is conscious and able to swallow -
10–20 g of fast-acting carbohydrate (e.g., juice, glucose tablets, sugar water).
Recheck blood glucose after 10–15 minutes.
If glucose is restored - east a longer-acting carbohydrate (meal or snack) to prevent relapse.
If unconscious or unable to swallow - give IM glucagon:
500 mcg if <8 years or <25 kg
1 mg if older/larger
When to suspect DKA?
Hyperglycaemia >11 mmol/L + signs: abdominal pain, fruity breath, deep breathing (Kussmaul), ketones.
Classic symptoms of DKA?
Nausea, vomiting, weight loss, SOB, confusion, drowsiness.
Which medications should be stopped temporarily when unwell?
Metformin - Risk of lactic acidosis
Sulfonylureas - Risk of hypoglycaemia if not eating
GLP-1 analogues - Risk of dehydration side effects
SGLT2 inhibitors - Risk of ketoacidosis with dehydration
