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Endocrine System > Lecture 17 Management of Type 2 Diabetes > Flashcards

Lecture 17 Management of Type 2 Diabetes Flashcards

1
Q

Name professionals involved in a diabetic management team

A
  • Diabetes doctors
  • GPs
  • The patient
  • Clinical psychologist
  • Other specialists
  • Specialist nurses
  • Dietitians
  • Podiatrists
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2
Q

What should a patient expect from their care

A
  • Blood glucose levels
  • Blood Pressure
  • Blood Lipids
  • Eyes Screened
  • Feet checked
  • Kidney function
  • Weight
  • Smoking Cessation Support
  • Individual Care plan
  • Education Course
  • Emotional and psychological support
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3
Q

What are the aims of diabetes treatment

A
  • Relief of primary symptoms
  • Prevention of complications
  • Preservation of quality of life
  • Damage minimalisation
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4
Q

Name defects of the pancreas that lead to diabetes

A

Beta cell dysfunction
Diminished incretin effect
Excess glucagon

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5
Q

Name defects of the periphery that lead to diabetes

A

Insulin resistance

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6
Q

Symptoms of uncontrolled type 2 diabetes

A
  • Polydipsia
  • Polyuria
  • Blurry vision
  • Increased hunger
  • Feeling drowsy or sleep
  • Tingling pain or numbness in hands and feet
  • Slow or improper healing of cuts and bruises
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7
Q

What else needs to be considered to prevent complications

A
  • Smoking
  • Statins
  • Mood
  • Blood pressure
  • Dietary change
  • Physical activity
  • Sedentary behaviour
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8
Q

Describe the 5 step framework for choosing a glucose lowering drug

A
  1. Set a target HbA1c
  2. “Take 5” Are there other risk factors that should be treated first?
  3. Are the current treatments optimised. Max dose? Tolerated? Taken?
  4. What are the glucose lowering options?
    • Remove any that are contraindicated
    • Of the remaining what are the pros and cons
    • Select the preferred choice.
  5. Agree a review date and the target HbA1c with the patient
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9
Q

When should the target HbA1c level be relaxed

A

Oder or frail people
Adults with reduced life expectancy, high risk consequences if they have hypoglycaemia
Multiple cormobidities

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10
Q

What is the first line treatment for type 2 diabetes

A

Metformin

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11
Q

What are the benefits of metformin

A 
–	Improves outcomes
–	Well tolerated
–	Cheap
–	Improves insulin action
–	Acts on liver and muscle
Used in pregnancy
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12
Q

How does Metformin work

A 
Acts on liver and muscle 
Biguanide
Improves insulin sensitivity
Improves receptor function
Inhibits gluconeogenic pathways
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13
Q

What is the half-life of Metformin

A

6 hours

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14
Q

What are the disadvantages of Metformin

A
  • GI side effects 20 – 30 %
  • Risk of lactic acidosis by inhibiting lactic acid uptake by liver
  • Hypoxia
  • Renal failure (CI if creat<150)
  • Hepatic failure
  • Alcohol abuse
  • Risk vitamin B12 malabsorption
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15
Q

Name 2nd line treatment for type 2 diabetes

A

Sulphonylureas
Thiazolidenediones- Pioglitazone,Gliatzone
GLP-1 agonist
SGLT-2 inhibitor

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16
Q

Whats the mechanism of Sulphonylureas

A

Increases insulin release
Binds to sulfonylurea receptors on functioning beta-cells
• Binding closes the linked ATP-sensitive potassium channels
• Decreased potassium influx depolarization of the beta-cell membrane.
• Voltage-dependent calcium channels open and result in an influx of calcium
• Translocation and exocytosis of secretory granules of insulin to the cell surface

17
Q

Advantages of Sulphonylureas

A
  • Used with metformin
  • Rapid improvement in control
  • Rapid improvement if symptomatic
  • Rapid titration
  • Cheap
18
Q

Disadvantages of Sulphonylureas

A
  • Risk of hypoglycaemia
  • Weight gain
  • Caution in renal and hepatic disease
  • Hypersensitivity and photosensitivity reactions
  • Blood disorders
19
Q

Whats the mechanism of Thiazolidenediones

A

Improves insulin action
Selectively stimulates PPAR gamma and PPAR alpha
Modulates transcription of the insulin-sensitive genes
Decreases withdrawal of glucose from the liver
Reduces quantity of glucose, insulin and glycated haemoglobin in the bloodstream

20
Q

Advantages of Thiazolidenediones (Pioglitazone)

A
  • Good for people if insulin resistance significant
  • HbA1c by 0.6-1.3%
  • Cheap
21
Q

Disadvantages of Thiazolidenediones (Pioglitazone)

A
  • Increase risk of bladder cancer
  • Caution in those of increased risk bladder cancer (Age, industry etc)
  • Fluid retention - CCF
  • Weight gain
  • Fractures in female
22
Q

What is the mechanism of SGLT-2 inhibitors

A

Work by preventing the kidneys from reabsorbing glucose back into the blood

23
Q

Whats the mechanism of GLP-1 analogues

A

This type of medication works by increasing the levels of hormones called ‘incretins’. These hormones help the body produce more insulin only when needed and reduce the amount of glucose being produced by the liver when it’s not needed. They reduce the rate at which the stomach digests food and empties, and can also reduce appetite

Endocrine System (26 decks)

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