Diabetes Type 2

Question 1

What risk factors contribute to Type 2 Diabetes?

Answer 1

1st Degree Relative w/ DM
Age > 45 y/o

Obesity
Sedentary
HTN
Dyslipidemia

PCOS
Hx of IGT
Hx of Gestational Diabetes

Question 2

What is the Octet associated with Chronic Hyperglycemia?

Answer 2

1 - 4: Increased GLUCOSE Production
Glucagon Secretion
Glucose Reabsorption
Lipolysis
5-7: DECREASED: Insulin secretion
Glucose uptake
Incretin effect
8. Neurotransmitter dysfunction

Question 3

What is Diabetes Type 2 characterized by?

Answer 3

INSULIN RESISTANCE

REDUCED secretory capacity of Beta-cells
~~Low insulin as a result

Question 4

What is the mechanism of action for Metformin?

What are some potential side effects?

Answer 4

REDUCE HEPATIC GLUCOSE OUTPUT!

GI side effects
Macrocytic anemia (neuropathy w/ B12 malabsorption)
Lactic acidosis

Question 5

When would you stop Metformin Tx?

Answer 5

eGFR <45 ml/min

Should hold Metformin for 48 hours after procedures or given IV contrast (monitor PTs creatinine)

Question 6

When would Sulfonylureas be contraindicated?

What is their MOA?

What is the primary side effect you should advise your PTs of? (what about some less common SE?)

Answer 6

RENAL or Hepatic failure

STIMULATES PANCREATIC INSULIN RELEASE –> INSULIN SECRETAGOGUES
~~glucose independent~~

HYPOGLYCEMIA
(GI upset, Sulfa allergy, and / or weight gain)
CP450 metabolized

Question 7

What is the MOA of Meglitinides? What are two examples of this medication?

Answer 7

Insulin secretagogue –> from pancreas
~~Glucose dependent~~
Repaglinide (Prandin)
Nateglinide

Hypoglycemia but less likely than Sulfonylureas
WEIGHT GAIN