T2DM Flashcards
what is the criteria for diagnosis of T2DM?
if symptomatic:
fasting glucose greater than or equal to 7.0 mmol/l
random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test)
hba1c >48
if asymptomatic:
- as above, but on 2 separate occasions
what are HBA1C levels for normal glycemic control, prediabetes and diabetes?
normal: BM <6. HBA1C <41
prediabetes: BM 6.1-6.9. hba1c 43-47
diabetes mellitus BM>7. hba1c >48
in which conditions can HBA1C not be used for diagnosis?
haemoglobinopathies haemolytic anaemia untreated iron deficiency anaemia suspected gestational diabetes children HIV chronic kidney disease
people taking medication that may cause hyperglycaemia (for example corticosteroids)
what is the impaired glucose tolerance test and what does it suggest?
People with IFG should then be offered an oral glucose tolerance test to rule out a diagnosis of diabetes.
A result below 11.1 mmol/l but above 7.8 mmol/l indicates that the person doesn’t have diabetes but does have IGT
what is the target HBA1C for someone diagnosed with diabetes and controlling it with lifestyle measured only or lifestyle and metformin?
- 48mmol/mol
what is the target HBA1C for someone with diabetes taking an oral hypoglycaemic like sylfonylureas?
- 53mmol/mol
think about making a change if HBA1C increases to 58
what is the mechanism of action for metformin?
- reduces hepatic gluconeogenisis
- increases insulin sensitivity
what are the side effects of metformin?
- it is a biguinide
- nausea and vomiting
- GI disturbance
- AKI
- lactic acidosis
what is an example of a Sulfonylureas and what is the main side effect?
- gliclazide
- stimulate the release of insulin
- cause weight gain and hypoglycaemia
what type of drug is pioglitazone and what are the side effects??
reduce insulin resistance
thiazolidinedione
- weight gain
- fluid retention
- hepatotoxicity
- bladder cancer
what type of drug is sitagliptin and what is the main side effect?
DPP-4 inhibitor
risk of pancreatitis
what are examples of SGLT2 inhibitors and what is their main side effect?
dapagiflozin
causes excretion of glucose in the urine so can cause UTIs
what type of drug is liragutide?
GLP1 mimic
side effects include decreased appetite, nausea and vomiting and pancreatitis
what can you do for someone with GI side effects of metformin?
- start them on a modified release version
which conditions would lead to higher than expected Hba1c levels?
- vitamin b12/folate deficiency
- iron deficiency anaemia
- splenectomy
