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Royal college IM > T2 diabetes > Flashcards

T2 diabetes Flashcards

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1
Q

MOA Biguanide

A

Increases peripheral sensitivity to insulin by activating AMP protein kinase

Metformin

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2
Q

MOA DPP4

A

Inhibits degradation of incretin

Incretin:

  • stimulates insulin secretion
  • inhibits glucagon release
  • delays gastric emptying

GLIPTINS

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3
Q

MOA GLP1 receptor agonist

A

Binds to GLP1 receptor to promote insulin release
suppresses elevated glucagon
Delays gastric emptying
Stimulates Beta cell regeneration and differentiation in vitro

UTIDES

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4
Q

MOA SGLT2

A

Increases urinary glucose secretion from proximal convoluted tubule

OZINS

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5
Q

MOA Sulfonureas

A

Increases insulin production by closing potassium channels, up-regulating calcium mediated release of insulin.

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6
Q

MOA Meglitonides

A

Increases Beta cell insulin release by closing Potassium channels , up-regulating calcium mediated release of insulin. They bind to a different part of the receptor to Sulfonureas.

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7
Q

drug classes that are insulin secretatogues

A

Meglitonides

Sulfoureas

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8
Q

MOA Thiazolidinediones

A

Bind to PPARgamma in adipose tissue to promote adipogenesis and fatty acid uptake.
This sensitizes the tissues to insulin

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9
Q

MOA Alpha glucosidase inhibitors

A

Slows carbohydrate digestion by inhibiting brush border alpha glucosides

Acarbose

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10
Q

Diabetic medications which increase risk of hypoglycemia

A

Meglitonides
sulfonureas
insulin

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11
Q

Diabetic medications to be held when dehydrated

A

SGLT2
Metformin
Sulfonureas

(ACEi, diuretics, ARB, NSAIDs

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12
Q

Diabetic medications to aid with weight loss

A

GLP1 receptor agonists
SGLT2
Metformin

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13
Q

Diabetic medications safe for eGFR<15

A 
Alogliptin at 6.25mg dose
Sitagliptin at 25mg dose
linagliptin
Dulaglutide
repaglinide
Pioglitazone
Rosiglitazone
Insulin
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14
Q

Diabetic medications which improve CVD

A

SGLT2
Liraglutide
Metformin (reduction in MiI in overweight)

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15
Q

Diabetic medications safe in pregnancy

A

Metformin

Insulin

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16
Q

Specific side effects for metformin

A

Lactic acidosis

B12 deficiency

17
Q

Specific side effects for Sulfonureas

A

Discolouration of teeth

18
Q

specific side effects for SGLT2

A

UTI’s

DKA with normoglycemia

19
Q

Indications for insulin in type 2 diabetes

A

poorly controlled on 3 agents
metabolic decompensation
Symptomatic hyperglycaemia
A1c over 10% and already on oral therapy

20
Q

monitoring/ targets for insulin effectiveness

A

targeting fasting blood glucose 4-7

21
Q

how to initiate insulin in type 2 diabetes

A

0.1-0.2u/Kg or
5 units for elderly
or 10 units for basic bitches

22
Q

Factors which increase A1c

A 
iron deficiency
B12 deficiency
decreased erythropoeisis
Alcoholism
chronic renal failure
Decreased erythrocyte pH
Increased erythrocyte lifespan (e.g. lifespan)
23
Q

Factors which alter ACCURACY of A1c

A

Blood transfusion
Anemia
Red blood cell pathology e.g. sickle cell
blood donation frequent
end stage renal disease
medications (HIV medications, EPO, Vitamin C&E, ASA, opiods)

24
Q

factors which decrease A1c

A 
EPO use
Iron supplements
B12 supplements
Reticuloytosis
Chronic liver disease
Ingestion of aspirin
Ingestion of vitamin C
Ingestion of vitamin E
Hemoglobinopathies
increased erythrocyte pH
Decreased erythrocyte lifespan
25
Q

screening indications for Type 2 diabetes as per Diabetes Canada

A

age 40 and over every 3 years

patients who are high risk (greater than 33% chance of developing DM over 10 years) (CANRISK)

26
Q

Diagnostic criteria for T2D/M

A

Asymptomatic Hyperglycemia with A1c >6.5 on 2 occasions,
FG >7 on 2 occasions or
A1c >6.5 + FG >7

27
Q

RF for type 2 diabetes

A

Age ≥40 years
First-degree relative with type 2 diabetes
Member of high-risk population (African, Arab, Asian, Hispanic, Indigenous, South Asian, social class)
History of prediabetes (lGT, lFG or A1C 6.0%–6.4%) or GDM
History of delivery of a macrosomic infant (over 9lbs)
Presence of end organ damage associated with diabetes
Presence of vascular risk factors:
HDL-C <1.0 mmol/L in males, <1.3 mmol/L in females∗
>TG ≥1.7 mmol/L∗
Hypertension∗
Overweight/ abdominal obesity
Smoking
Presence of associated diseases (pancreatitis, PCOS, Acanthosis nigricans, gout, NAFLD,
Psychiatric disorders, HlV infection, OSA, Certain drugs, CF, etc.)

28
Q

Diseases Associated with Type 2 diabetes

A 
History of pancreatitis
Polycystic ovary syndrome∗
Acanthosis nigricans∗
Hyperuricemia/gout
Non-alcoholic steatohepatitis
Psychiatric disorders (bipolar disorder, depression, schizophrenia†
HlV infection‡
Obstructive sleep apnea§
Cystic fibrosis

Royal college IM (18 decks)

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