T2DM Flashcards
What?
Impaired sensitivity to circulating insulin
What is this associated with?
Obesity and sedentary lifestyle.
Risk factors?
Age (>40, pr 25 for South Asian) Family history Overweight or obese Asian. African- Caribbean or black African Sedentary lifestyle High carbohydrate diet
Pathophysiology?
Insulin resistance
-> More insulin required to produce response from cells (to take up & use glucose) -> pancreas beta cells become fatigued and damaged -> produce less insulin -> chronic hyperglycaemia
Symptoms?
Often asymptomatic Polyuria Thirst and polydipsia Blurred vision Genital thrush Fatigue Unintentional weight loss
Why polyuria?
Blood glucose very high so spills over into urine
Exceeds renal threshold for glucose reabsorption.
Glucose in urine causes osmotic diuresus and causes polyuria.
Why blurred vision?
Blood sugar high
Lens shrinks
Vision blurry
Restores as glucose comes down
Why genital thrush?
Sugar in urine
Symptoms/ signs of complications?
Loss of vision/ retinal bleed or retinal changes
Diagnosis?
Fasting glucose ≥ 7.0mmol/l
Random glucose test ≥ 11.1mmol/l
OGTT 2 hour result >11mmol/ l
What does HbA1c tell you?
A measure of the average blood glucose levels in the last 6-12 weeks
HbA1c in diabetes?
> 6.5%(48mmol) in diabetes.
Normal range for HbA1c?
5.7%-6.4%
Management?
Patient education lifestyle advice Metformin SGLT2 inhibitors GLP-1 receptor agonists Sulphonylureas Thiazolidinediones (TZD) DDP4 inhibitors Insulin
Metformin?
1st line oral treatment
Weight neutral
SGLT2 inhibitors?
Add on therapy to metformin
CV and renal benefits
Inc risk of thrush, DKA,
E.g. empagliflozin and canafliflozin
GLP- 1 receptor agonists?
CVD benefit Weight loss Some renal benefit SE = N&V E.g. liraglutide
Sulphonylureas?
Insulin secretagogues
Gliclazide and glimepride
First line oral agents If intolerant to metformin
Add on 2nd line therapy or triple oral therapy
Assoc hypoglycaemia and weight gain
No CV benefit
TZD?
Inc whole body insulin sensitivity Pioglitazone Dual or triple therapy Not in Heart failure Weight gain Fracture risk
DDP4 inhibitors?
Insulin secretagogues (only when insulin needed)
Weight neutral
E.g. sitagliptin
Dual or triple therapy
Insulin?
When oral agents no longer effective -> injectable
Weight gain
Hypoglycaemia
Continue oral metformin
