T2 diabetes Flashcards
MOA Biguanide
Increases peripheral sensitivity to insulin by activating AMP protein kinase
Metformin
MOA DPP4
Inhibits degradation of incretin
Incretin:
- stimulates insulin secretion
- inhibits glucagon release
- delays gastric emptying
GLIPTINS
MOA GLP1 receptor agonist
Binds to GLP1 receptor to promote insulin release
suppresses elevated glucagon
Delays gastric emptying
Stimulates Beta cell regeneration and differentiation in vitro
UTIDES
MOA SGLT2
Increases urinary glucose secretion from proximal convoluted tubule
OZINS
MOA Sulfonureas
Increases insulin production by closing potassium channels, up-regulating calcium mediated release of insulin.
MOA Meglitonides
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.
drug classes that are insulin secretatogues
Meglitonides
Sulfoureas
MOA Thiazolidinediones
Bind to PPARgamma in adipose tissue to promote adipogenesis and fatty acid uptake.
This sensitizes the tissues to insulin
MOA Alpha glucosidase inhibitors
Slows carbohydrate digestion by inhibiting brush border alpha glucosides
Acarbose
Diabetic medications which increase risk of hypoglycemia
Meglitonides
sulfonureas
insulin
Diabetic medications to be held when dehydrated
SGLT2
Metformin
Sulfonureas
(ACEi, diuretics, ARB, NSAIDs
Diabetic medications to aid with weight loss
GLP1 receptor agonists
SGLT2
Metformin
Diabetic medications safe for eGFR<15
Alogliptin at 6.25mg dose Sitagliptin at 25mg dose linagliptin Dulaglutide repaglinide Pioglitazone Rosiglitazone Insulin
Diabetic medications which improve CVD
SGLT2
Liraglutide
Metformin (reduction in MiI in overweight)
Diabetic medications safe in pregnancy
Metformin
Insulin
Specific side effects for metformin
Lactic acidosis
B12 deficiency
Specific side effects for Sulfonureas
Discolouration of teeth
specific side effects for SGLT2
UTI’s
DKA with normoglycemia
Indications for insulin in type 2 diabetes
poorly controlled on 3 agents
metabolic decompensation
Symptomatic hyperglycaemia
A1c over 10% and already on oral therapy
monitoring/ targets for insulin effectiveness
targeting fasting blood glucose 4-7
how to initiate insulin in type 2 diabetes
0.1-0.2u/Kg or
5 units for elderly
or 10 units for basic bitches
Factors which increase A1c
iron deficiency B12 deficiency decreased erythropoeisis Alcoholism chronic renal failure Decreased erythrocyte pH Increased erythrocyte lifespan (e.g. lifespan)
Factors which alter ACCURACY of A1c
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)
factors which decrease A1c
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
screening indications for Type 2 diabetes as per Diabetes Canada
age 40 and over every 3 years
patients who are high risk (greater than 33% chance of developing DM over 10 years) (CANRISK)
Diagnostic criteria for T2D/M
Asymptomatic Hyperglycemia with A1c >6.5 on 2 occasions,
FG >7 on 2 occasions or
A1c >6.5 + FG >7
RF for type 2 diabetes
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.)
Diseases Associated with Type 2 diabetes
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
