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Endocrinology > Diabetes type 2 > Flashcards

Diabetes type 2 Flashcards

1
Q

What are the main glucose stores?

A

Liver
Fat
Muscle

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2
Q

What happens in T2D?

A

Insulin resistance and beta-cell dysfunction

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3
Q

What does insulin normally do?

A

Binds to receptors triggering production of glucose transport proteins to allow glucose to enter cell

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4
Q

What happens in insulin resistance?

A

Receptor is not as responsive to the insulin molecule

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5
Q

What can cause insulin resistance?

A

Ectopic Fat Accumulation
Increased FFA circulation
Reduction in insulin-stimulated glycogen syntheses

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6
Q

What is beta-cell dysfunction?

A

Reduced ability of beta-cells to secrete insulin in response to hyperglycaemia

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7
Q

What does insulin resistance lead to?

A

Glucotoxicity (hyperg)

Lipotoxicity (elevated FFA, TG)

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8
Q

What body shape is more likely to get type 2 diabetes?

A

Apple as opposed to pear

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9
Q

What does Central Adiposity associated with?

A

High blood pressure
High triglycerides
Low HDL
Insulin resistance

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10
Q

How long does the average person have diabetes T2 before they are diagnosed?

A

9-12 years

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11
Q

What are DT2 complications are present at diagnosis?

A

Retinopathy - 21%
ED - 20%
Neuropathy - 18%
nephropathy - 12%

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12
Q

Describe the therapy staircase of DT2?

A
  1. Diet % Exercise
  2. Oral monotherapy
  3. Oral combination
  4. Injectable & oral therapy
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13
Q

What changes in lifestyle play a part in diabetes treatment?

A

Weight loss
Exercise
Smoking cessation
Improve diet

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14
Q

What is Metformin?

A

A biguanide,
derived from guanidine
Improves sensitivity to insulin

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15
Q

What is the starting metformin does?

A

500mg Od or BD

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16
Q

What are the effects of metformin?

A

Reduces HbA1c by 15-20
Doesnt cause hypos
Prevents macro and micro vascular complications

17
Q

What are the additional effects of metformin?

A

Reduces triglycerides and LDL
reduction in BP
Safe in pregnancy

18
Q

What are side effetcs of metformin?

A 
GI effects 
Interferes with vitamin B12 and folic acid absorption (anaemia is rare)
Lactic acidosis 
Liver failure
Rash
19
Q

Describe sulphonylureas (SU)

A

Glicazide 40mg -160mg OD

Glipizide 2.5mg-15mg

20
Q

What are the effects of SU’s?

A

Reduces HbA1c by 15-20
Increasing insulin secretion
More rapidreduction in hyperg
Prevents micro but not macro

21
Q

What are side effects of SU’s?

A

Hypog
Weight gain
GI

22
Q

What are thiazolidinediones? (TZDs)

A

Only available agent is pioglitazone 15-45mg OD

23
Q

What are the TZDs effects?

A

Hyperg - HbA1c down by 15-20
Weight gain
HF
prevention of macro but not micro

24
Q

Give an example of an SGLT2 inhibitor

A

Dapagliflozin (aka Forxiga)

25
Q

What do SGLT2 inhibitors act upon?

A

Incretin pathway

26
Q

Where is Exenatide (Byetta) from?

A

Exandin found in Gila Monsters

27
Q

What are some benefits of GLP-1 receptor agonists?

A

Promote insulin secretion from pancreas without hypoglycaemia
Suppress glucagon (which is increased in T2DM)
Decrease gastric emptying – early satiety
Act on hypothalamus – reduce appetite – resulting weight loss (~3kg)

28
Q

What are some of the dis-benefits of GLP-1 receptor agonsists?

A

Nausea – usually resolves in most by 6-8 weeks

Injectable

Pancreatitis, Pancreatic Cancer

29
Q

Describe the DPP-IV inhibitors?

A

Orally active

Less potent than GLP-1 mimetics – can only work on what’s there and GLP-1 levels are low in T2DM

30
Q

What are examples of DPP-IV inhibitors?

A

Vildagliptin, Sitagliptin, Saxagliptin, Linagliptin

31
Q

What are some benefits of DPP4 inhibitors?

A

Promote insulin secretion from pancreas without hypoglycaemia

Suppress glucagon (which is increased in T2DM)

Weight neutral

32
Q

What are some dis-benefits of DPP4 inhibitors?

A

Very limited side effects

Not that potent

No weight loss – No weight gain

Pancreatitis, Pancreatic Cancer

33
Q

What are some examples of SGLT2 inhibtors?

A

DAPAGLIFLOZIN (ForxigaTM)

CANAGLIFLOZIN (Invokana)

EMPAGLIFLOZIN (Jardiance

Endocrinology (21 decks)

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