Endocrinology 8 - Type 2 Diabetes Flashcards
3 non modifiable and 3 modifiable risk factors type 2 diabetes
old age, ethnicity, family Hx
obesity, exercise, carb diet
6 features of T2DM presentation
polyuria, polydipsia fatigue unintentional weight loss opportunistic infections slow healing glucose on dipstick
give the pre-diabetic levels for
fasting glucose
HbA1c
OGTT at 2 hours
impaired fasting if 6-7
impaired tolerance if 7-11
impaired HbA1c if 42-47
give the diabetic levels for
fasting glucose
HbA1c
OGTT at 2 hours
impaired fasting if 11+
impaired tolerance if 11+
impaired HbA1c if 48+
non drug management for type 2 diabetes
modify diet to low carb high fibre exercise, lose weight stop smoking optimise risk factors monitor complications (eye, kidney, foot)
summarise the treatment pathway for type 2 diabetes
- metformin 500mg to 1g daily
- add any one of: sulfonylurea (gliclazide)
thiazolidinedione (pioglitazone)
DPP-4 inhibitor (sitagliptin)
GLP1 mimetic (exenatide)
SGLT2 inhibitor (dapagliflozin) - metformin + 2 OR metformin + insulin
metformin action and side effects
increased sensitivity to insulin and reduced liver glucose production
diarrhoea, lactic acidosis
pioglitazone action and side effects
sensitivity up, glucose liver down
may inc bladder ca risk
fluid retention, heart failure, weight gain
sulfonylurea action and side effects
gliclazide increases insulin release
weight gain, hypoglycaemia
DPP-4 inhibitor action and side effects
sitagliptin
stops incretin inhibition
incretin increase insulin secretion
GI upset, pancreatitis
GLP mimetic action and side effects
exenatide
increase insulin secretion, slow gut transit
GI upset, weight loss
SGLT-2 inhibitor action and side effects
empagliflozin
stop proximal tubule glucose reabsorption
glycosuria, UTI, weight loss
one example each of rapid / short / intermediate / long acting insulins
rapid - novorapid (acts in 10 min, lasts 4 hours)
short - actrapid (30 mins, 8 hours)
int - insulatard (1 hour, 16 hrs)
long - lantus (1 hrs, 24 hrs)
