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*Diabetes & Endocrinology > Management of Type 2 > Flashcards

Management of Type 2 Flashcards

1
Q

What should a patient expect from their care?

A
  • BG levels
  • BP
  • Blood lipids
  • Eyes screened
  • Feet checked
  • Kidney function
  • Weight
  • Smoking cessation support
  • Individual care plan
  • Education course
  • Emotional + psychological support
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2
Q

What sort of questions should be asked in a type 2 consultation?

A
  • How has life/health/diabetes been? (open Q)
  • What improvements patient feels they could make
  • Establish challenging times for glycaemic control ahead e.g. hols, weddings
  • Review BG levels
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3
Q

What are the 4 main 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

What are the 3 pancreatic defects found in type 2 and what are their effects?

A

BETA CELL DYSFUNCTION
DIMINISHED INCRETIN EFFECT
= decreased insulin production

EXCESS GLUCAGON
= decreased insulin action

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5
Q

What is the defect found in the periphery in type 2 and what is its effect?

A

INSULIN RESISTANCE

= insulin resistance

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6
Q

Name 4 meds which increase insulin release

A

Sulphonylureas
Metiglinides
Incretin Mimetics
DPPIV inhibitors

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7
Q

What med increases excretion of glucose?

A

SCLT2 inhibitors

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8
Q

Name 3 meds/methods which improve insulin action

A

Biguanides
Thiazolidiones
Weight reductions

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9
Q

Give 7 signs of type 2 DM

A

Thirst
Blurry vision
Drowsiness/sleepiness
Increased hunger
Frequent urination
Slow/improper healing of cuts and bruises
Tingling, pain or numbness in hands + feet

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10
Q

Other than meds, what else needs considered in type 2 to prevent complications?

A 
Smoking
Mood
Statins
Blood pressure 
Physical activity
Diet
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11
Q

Step 1 of framework for choosing glucose lowering drug

A

Set a target HbA1c

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12
Q

Step 2 of framework for choosing glucose lowering drug

A

‘Take 5’ - are there other risk factors to be treated first

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13
Q

Step 3 of framework for choosing glucose lowering drug

A

Are the current treatments optimised; max dose, tolerated, taken?

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14
Q

Step 4 of framework for choosing glucose lowering drug

A

What are the glucose lowering options?

  • remove any contraindicated
  • of remaining what r pros n cons
  • select preferred choice
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15
Q

Step 5 of framework for choosing glucose lowering drug

A

Agree a review date and target HbA1c with patient

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16
Q

In who should the target HbA1c level be relaxed?

A

People who r older/frail
Adults with reduced life expectancy
Adults at high risk of the consequences of hypo (falling, impaired awareness of it, those who drive/operate machinery)
People in whom intensive management is not appropriate - multiple comorbidities

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17
Q

What is the usual first line oral treatment for type 2?

A

Metformin

18
Q

What is the first line is there are osmotic/weight loss symptoms?

A

Sulfonylurea

19
Q

What is added as the usual 2nd line oral treatment for type 2?

A

Sulfonylurea

20
Q

What other 3 meds can be 2nd line if contraindications to Sulfonylurea (for all - if hypos a concern)?

A

Thiazolidinedione(if no CCF)
DPP-IV inhibitor (if weight gain a concern)
SGLT-2 inhibitor (if weight gain a concern)

21
Q

Then review 2nd line meds, if not reaching target then move to 3rd line and add/substitute - give the 3 oral 3rd line agents?

A

Thiazolidinedione
DPP-IV inhibitor
SGLT-2 inhibitor

22
Q

Give the 2 injectable 3rd line meds, and the indications for each?

A

GLP-1 agonist (if BMI>30kg/m2; if desire to lose wt; usually <10 yrs from diagnosis)

Insulin (if osmotic symptoms/rising HbA1c)

23
Q

Continue medication if either…

A

glycaemic target acheived or HbA1c falls >5mmol/mol in 3-6 months

24
Q

Give the 3 common names for Sulfonylureas

A

GLIMEPIRIDE
GLICLAZIDE
GLIPIZIDE
(the ‘gli…ides’)

25
Q

Give the common name for Thiazolidinedione

A

PIOGLITAZONE

26
Q

Give the common name for DPP-IV inhibitor

A

SITAGLIPTIN

27
Q

Give the common name for SGLT-2 inhibitor

A

EMPAGLIFLOZIN

28
Q

Give the common name for GLP-agonist

A

LIXISENATIDE

29
Q

What type of drug is metformin?

A

A biguanide

30
Q

What is the action of metformin?

A

Improves insulin sensitivity

31
Q

How does metformin improve insulin sensitivity?

A

Affects glucose production, decreases FA synthesis
Improves receptor function
Inhibits gluconeogenic pathways

32
Q

What are some advantages of metformin?

A 
Improves CVS outcomes + mortality in obese T2 DM
Cheap
Efficaceous 
Well tolerated 
No weight gain 
Used in pregnancy 
HbA1c by 12-17% reduction
33
Q

What are 3 possible disadvantages of metformin?

A

Risk of lactic acidosis (by inhibiting lactic acid uptake by liver)
GI side effects 20-30%
Risk vitamin B12 malabsorption

34
Q

How do sulfonylureas work?

A

By increasing insulin release

35
Q

What is the mechanism by which sulfonylureas increase insulin release?

A 
Binds to its receptor 
Closes of ATP sensitive potassium channels 
Decrease potassiun 
Depolarisation 
Influx of calcium 
Insulin is exocytosed
36
Q

What are some advantages of sulphonylureas?

A 
Used with metformin
Rapid improvement in control/symptoms
Rapid titration 
Cheap
Genereally well tolerated
37
Q

What are some disadvantages of sulphonylureas?

A 
Risk of hypo
Weight gain 
Caution in renal/hepatic disease
CI in pregnancy and breastfeeding 
SE include hypersensitivity/photosensitivity reactions; blood disorders
38
Q

What is the action of thiazoliinedione?

really only pioglitazone

A

Improve insulin action/reduces insulin resistance by sensitising liver and muscle to increase glucose uptake

39
Q

Give some advantages of thiazoliinedione

A

Good for people if insulin resistance significant
HbA1c by 0.6-1.3%
Cheap
CVS safety established in pioglitazone

40
Q

Give some disadvantages of thiazoliinedione

A

Increase risk of bladder cancer
Fluid retention - CCF
Weight gain
Fractures in females (small risk)

*Diabetes & Endocrinology (24 decks)

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