Management of Type 2 diabetes Flashcards
Type 2 diabetes presentation
asymptomatic
with complications
non-specific = tiredness, persistent skin infection
weight changes
nocturia
blurred vision
macrovascular disease - MI, stroke
microvascular disease - blurred/loss of vision, neuropathy
at pregnancy
Non-pharmacological management of Type 2 diabetes
weight loss
lifestyle changes - diet
stop smoking
alcohol in moderation
physical activity - 150 mins/week
List some oral medications that can be used to treat Type 2 diabetes
biguanides
sulphonylureas
meglitinides
alpha glucosidase inhibitors
thiazolidinediones
DPP4 inhibitors
SGLT2 inhibitors
List 2 injectable medications that can be used to treat Type 2 diabetes
insulin
GLP1 analogue
How does biguanides (metformin) work to treat Type 2 diabetes?
increase glucose utilisation, anaerobic glycolysis and lactate production in gut
in liver - increases insulin signalling, decrease glucagon activity, reduces gluconeogenesis and glycogenolysis
Describe metformin
reduces fasting blood glucose
weight neutral, low risk of hypoglycaemia
Metformin side effects
abdominal symptoms - nausea, diarrhoea
lactic acidosis in presence of renal failure
How do sulphonylureas help treat Type 2 diabetes?
block ATP sensitive potassium channels on the beta cell plasma membrane, through SUR 1
results in exocytosis of stored insulin
reduction in fasting blood glucose
Sulphonylureas side effects
hypoglycaemia
weight gain
Name some sulphonylureas
Glibenclamide
Gliclazide
Glipizide
Glimepiride
Name some meglitinides
natiglinide
repaglinide
How do metaglinides help treat Type 2 diabetes?
non-sulphonylurea insulin secretalogue, need residual beta cell function
binds to benzamido site of SUR1 on beta cells
relatively rapid onset and short duration of action
Meglitinides side effects
hypoglycaemia
weight gain
Name an alpha glucosidase inhibitor
acarbose
How do alpha glucosidase inhibitors help treat Type 2 diabetes?
prevents cleaving of complex carbohydrates into monosaccharides
prevents glucose absorption in the intestine
glucose leaves with stool
Side effects of alpha glucosidase inhibitors
flatulence
diarrhoea
hypoglycaemia uncommon
How do thiazolidinediones help treat Type 2 diabetes?
agonists of peroxisome proliferator activated receptor gamma, a receptor expressed in adipose tissue, muscle, liver, beta cells, vascular endothelium
promotes adipogenesis, insulin sensitivity, tissue glucose uptake, reduces inflammation
reduced hepatic gluconeogenesis, reduces circulating levels of free fatty acids
Name a thiazolidinedione
pioglitazone
Thiazolidinediones side effects
low risk of hypoglycaemia
oedema
weight gain
increased fracture risk
contraindicated in heart failure, uninvestigated macroscopic haematuria and bladder cancer
How do DDP4 inhibitors help treat Type 2 diabetes?
inhibits DDP4 which degrade GLP1 and GIP
causes elevation of circulating levels of incretin hormones - GLP1 and GIP
resulting in enhancement of nutrient induced insulin responses during feeding
Name some DDP4 inhibitors
sitagliptin
saxagliptin
linagliptin
alogliptin
What are patients being treated with DDP4 inhibitors at risk of?
pancreatitis
SGLT2 inhibitors MOA
competitive inhibition of SGLT2 results in elimination of 60-90g glucose/day
shown improvement in renal and cardiovascular outcomes
insulin independent
reduces BP and weight
Adverse effects of SGLT2 inhibitors
low risk of hypoglycaemia
increased risk of genital and urinary tract infections
hypovolaemia
dizziness
euglycaemix and hyperglycaemic DKA
