Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 2 - Endocrine > Management of type 2 DM > Flashcards

Management of type 2 DM Flashcards

1
Q

What a diabetic should expect from care from their MDT (11)

A 
BG monitoring
BP monitoring
Cholesterol monitoring
Eye screening
Foot screening
Kidney function monitoring
Weight monitoring
Smoking cessation support
Individual care plan
Education course about diabetes
Emotional + psychological support
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Drug types used to increase insulin release in type 2 (4)

A

Sulphonylureas - oral
Metiglinides - oral
Incretin mimetics aka GLP-1 analogues - injectable
DPPIV inhibitors - oral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Drug type used to increase excretion of glucose in type 2 (1)

A

SGLT2 inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Drug types used to improve insulin action (so increase glucose uptake) in type 2 (2)

+ non-pharmacological way of improving insulin action

A

Biguanides, e.g. metformin
Thiazolidinediones (or glitazones)

Weight reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Target HbA1c level for both type 1 and 2

A

<48mmol/mol (6.5%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Target HbA1c for both type 1 and 2 is usually 48mmol/mol but for type 2’s prescribed on a single drug associated with hypoglycaemia (such as a sulphonylurea), or two or more antidiabetic drugs in combination should aim for what target

A

53 mmol/mol (7.0%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

1st line treatment of type 2 DM/ initial treatment of type 2
+ what other option if contra-indicated/ not tolerated

A

Metformin

If contra-indicated
-sulfonylureas (Glimepiride, Gliclazide, Glipizide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When should drug treatment be intensified, alongside reinforcement of advice regarding diet, lifestyle, and adherence to drug treatment in type 2 diabetics

A

If HbA1c concentrations are poorly controlled despite treatment with a single drug (usually considered to be a rise of HbA1c to 58 mmol/mol (7.5%) or higher)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

If 1st line treatment doesn’t control HbA1C adequately, what are the 2nd line options (i.e. what is added to 1st line treatment) (any of 4)

A

Metformin
+

sulfonylurea
or
thiazolidinedione (or glitazone)
or
dipeptidylpeptidase-4 (DPP-IV) inhibitor
or
sodium glucose co-transporter 2 (SGLT-2) inhibitor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

If 2nd line treatment doesn’t control HbA1C adequately, what are the 3rd line options (i.e what is added to the 1st and 2nd line treatment) (any of 3 oral options or 2 injectable options)

A

Metformin
+
2nd line (usually sulfonylurea)
+

thiazolidinedione (or glitazone)
or
dipeptidylpeptidase-4 (DPP-IV) inhibitor
or
sodium glucose co-transporter 2 (SGLT-2) inhibitor

or
insulin
GLP-1 agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Name some sulfonylureas

A

Glimepride

Gliclazide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name a thiazolidineodione

A

Pioglitazone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name a dipeptidylpeptidase-4 (DPP-IV) inhibitor (‘gliptins’)

A

Sitagliptin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name a sodium glucose co-transporter 2 (SGLT-2) inhibitor (‘gliflozins’)

A

empaglifiozin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Mechanisms of action of metformin (3)

A

Reduces amount of glucose produced by liver
-inhibits gluconeogenesis

Improves insulin sensitivity of muscle tissue to increase glucose uptake

Improves glucose transport

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Advantages of metformin (5)

A

Doesn’t cause weight gain

Cheap

Well tolerated

Doesn’t stimulate insulin secretion so doesn’t trigger hypoglycaemia alone

Reduces risk of microvascular complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Common side effects of metformin (5)

A 
Nausea
Vomiting
Diarrhoea
Abdo pain
Decreased appetite
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Rare side effect of metformin

A

Lactic acidosis

-due to it inhibiting lactic acid uptake by liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Mechanism of action of sulphonylureas

A

Bind to sulfonylurea receptors on functioning beta cells in pancreas to stimulate increased insulin release

  • binding closes ATP sensitive potassium channels linked to the receptor
  • so decreased potassium entering cell, leads to depolarisation of cell membrane
  • voltage dependent Ca2+ channels open resulting in influx of Ca2+ and subsequent Ca2+ dependent exocytosis of insulin vesicles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Side effects of sulphonylureas (5)

A 
Weight gain
Abdominal pain; 
diarrhoea; 
hypoglycaemia; 
nausea
21
Q

Contra-indications of sulphonylureas (2)

A

Pregnancy

Breast feeding

22
Q

Mechanism of action of thiazolidinediones (glitazones)

A

Reduces insulin resistance (improves insulin sensitivity) in liver and peripheral tissue, allowing the insulin that the body produces to work more effectively

23
Q

Contraindications of thiazolidinediones (glitazones) (5)

A 
Heart failure
Bladder cancer
Hepatic impairment
Pregnancy
Breastfeeding
24
Q

Side effects of pioglitazone (a thiazolidinedione) (5)

A 
Bone fracture - esp women
increased risk of infection;
numbness; 
visual impairment; 
weight gain
25
Q

What are incretins

A

Hormones that stimulate a decrease in blood glucose levels

Incretins are released after eating and increase the secretion of insulin

26
Q

What is the incretin effect + what happens to this type 2 diabetics

A

defined as the increased stimulation of insulin secretion elicited by oral as compared with intravenous administration of glucose under similar plasma glucose levels.

type 2 diabetics lose this incretin effect

27
Q

Mechanism of action of DPP-IV inhibitors (gliptins)

A

DPP-IV is an enzyme that rapidly degrades incretins (natural hormones that stimulate insulin release)

so inhibitors of this delay breakdown of incretins therefore increasing the time it is active, thus increasing insulin secretion

28
Q

Advantages of DPP-IV inhibitors (3)

A

No risk of hypos
Doesn’t cause weight gain/loss
Can be used in renal impairment; dose just needs to be adjusted

29
Q

Need to be cautious with use of sulphonylureas if have (2)

A

renal impairment - reduce dose

hepatic impairment - reduce dose

30
Q

Contraindications of DPP-IV inhibitors

A

Pregnancy

Breast feeding

31
Q

Common side effect of DPP-IV inhibitors (sitagliptin)

+ uncommon side effect

A

Headache

Pancreatitis

32
Q

Name some incretin mimetics (GLP-1 (glucagon like peptide-1) analogues)

A

Lixisenatide

Exenatide

33
Q

Mechanism of action of incretin mimetics (GLP-1 analogues) (3)

A

Binds to, and activates, the GLP-1 (glucagon-like peptide-1) receptor to increase insulin secretion, suppresses glucagon secretion, and slows gastric emptying

Act like incretin and stimulate release of insulin

Injectable analogues are resistant enzyme degradation so longer half life

34
Q

Injectable incretin mimetics (GLP-1 analogues) only indicated if BMI greater than

A

30-35

35
Q

Advantages of incretin mimetics (GLP-1 analogues) (2)

A

Weight loss

No risk of hypos

36
Q

Side effects of incretin mimetics (GLP-1 analogues) (5)

A 
Nausea
Vomiting
Appetite loss --> weight loss
diarrhoea
headache
risk of pancreatitis
37
Q

Contraindications of incretin mimetics (GLP-1 analogues)

A

Pregnancy

Breastfeeding

38
Q

Which drug class used to treat type 2 DM has a completely different mechanism of action than all other agents

A

SGLT2 inhibitors

39
Q

Majority of glucose is reabsorbed back into blood by what and where in the kidney

A

via SGLT2 transporter in proximal tubule of kidneys

40
Q

Mechanism of action of SGLT2-inhibitors (‘gliflozins’)

A

Selectively inhibit SGLT2 transporter in the proximal tubule of the kidney so preventing glucose reabsorption therefore excreting more glucose in urine

41
Q

Advantages of SGLT2 inhibitors (3)

A

Lowers HbA1C - good glycaemic control
Weight loss
No risk of hypos if used alone
Lowers systolic BP

42
Q

Side effects of SGLT2 inhibitors (5)

A

UTI
Fungal infections
Balanoposthitis - inflamed foreskin of penis
Postural hypotension
risk of hypos if used alongside insulin or sulphonylurea

43
Q

Contraindications of SGLT2 inhibitors (4)

A

Pregnancy
Breastfeeding
Renal impairment, eGFR <60
Hepatic impairment

44
Q

Insulin is indicated in type 2 DM when…

A

if they have osmotic symptoms and poor glycaemic control still despite being on other agents

45
Q

When insulin is used in type 2 DM, it’s supplementary (i.e. used alongside oral agents, never on its own), what type of insulin is usually used in type 2

A

Isophane insulin - intermediate acting

-once daily

46
Q

Contraindication of metformin

A

if eGFR <30

47
Q

Side effects of insulin

A

Hypos

Weight gain

48
Q

If HbA1c levels are not adequately controlled by a single drug and rise to 58 mmol/mol (7.5%) or higher, what should be done

A

reinforce advice about diet, lifestyle and adherence to drug treatment

intensify treatment

49
Q

What factors should be managed first before choosing a glucose lowering drug (5)

A 
Smoking
BP
Cholesterol
Diet
Exercise

Year 2 - Endocrine (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions