Management of Diabetes D - Type 2 Diabetes Mellitus - Part 1 Flashcards
WHat are all the steps involved in the management of type 2 diabetes?
Where/who of the management of Type 2 diabetes - Gain an overview of the structure of care
Why does diabetes need treated? - Gain an overview of some of the challenges in diabetes treatments aims
How do we treat people with type 2 diabetes - Considering holistic care
What medications are used to treat diabetes – part 1 - To gain an understanding of pharmacological agents are used
diabetes is a disorder of the what?
older years and obese
who makes up the diabetes team?
What should a patient should expect from their care?
- 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
how is information shared between healthcare professionals?
SCI Diabetes
where is information avalible to patients?
mydiabetesmyway
Why is it in someones interest to have treatment for diabetes?
relief of primary symptoms
prevention of complications - how else can this be addressed?
preservation of quality of life - balance good effects against side effects
damage minimilisation - avoidace of emergencies
study this flow diagram showing type 2 diabetes
what are symptoms of uncontrolled type 2 diabetes?
frequent urination
increased thirst
blurry vision
feeling drowsy or sleepy
increased hunger - Body cells deprived of glucose even though blood glucose is high so find them selves very hungry
slow or improper healing of cuts and bruises
tingling, pain, or numbness in hands and feet
Prevention of complications - What else needs considered?
mood
smoking
dietary change
statins
blood pressure
physical activity/sedentary behaviour
Legacy Effect of Earlier Glucose Control?
Legacy effect – if managed well earlier on then better down the line
What happens as the percentage of HbA1c increases?
What is the 5 step framework for choosing a glucose lowering drug?
- Set a target HbA1c
- “Take 5” Are there other risk factors that should be treated first?
- Are the current treatments optimised. Max dose? Tolerated? Taken?
- What are the glucose lowering options?
- Remove any that are contraindicated
- Of the remaining what are the pros and cons
- Select the preferred choice.
- Agree a review date and the target HbA1c with the patient
Consider relaxing the target HbA1c level on a case‑by‑case basis - what are some example cases?
People who are older or frail
For adults with type 2 diabetes:
- With reduced life expectancy
- high risk of the consequences of hypoglycaemia- those at increased risk of falling, impaired awareness of hypoglycaemia, and people who drive or operate machinery as part of their job
- intensive management not appropriate- multiple comorbidities
When tpye 2 diabetics have tried hard with lifestyle then the first drug you try is what?
metformin
How does metformin help type 2 diabetes?
Works by improving insulin action
Defect it targets is insulin resistance
works by acting on liver and muscle
what are all the helping affects of metformin?
Biguanide (refers to a group of oral type 2 diabetes drugs that work by preventing the production of glucose in the liver, improving the body’s sensitivity towards insulin and reducing the amount of sugar absorbed by the intestines)
Improves insulin sensitivity:
- Affects glucose production, decrease fatty acid synthesis
- Improves receptor function
- Inhibits gluconeogenic pathways
Half life 6 hours.
How do Sulphonylureas improve type 2 diabetes and where do they act on?
increase insulin release
What is the mechanism of action of sulphonylureas?
Binds to sulfonylurea receptors (SUR-1) on functioning pancreatic 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
How do Thiazolidinediones work?
improve insulin action
improve insulin sensitivity
How does Pioglitazone (Thiazolidinediones) work?
selectively stimulates the nuclear receptor peroxisome proliferator-activated receptor gamma (PPAR-gamma) and to a lesser extent PPAR - alpha
modulates the transcription of the insulin-sensitive genes involved in the control of glucose and lipid metabolism in the muscle, adipose tissue, and the liver.
reduces insulin resistance in the liver and peripheral tissues;
increases the expense of insulin-dependent glucose;
decreases withdrawal of glucose from the liver;
reduces quantity of glucose, insulin and glycated haemoglobin in the bloodstream
A
Metformin
B
SUs
C
Glitazone
