T2DM Flashcards
insulin deficiency in T2DM
relative
what causes insulin deficiency in T2DM
excess adipose - not enough insulin to go around
symptoms T2DM
overweight, over 30, polydipsia, polyuria
glucose for T2DM
fasting >7 // random or glucose tolerance >11.1 // once if symptomatic, twice if asymptomatic
what is glucose tolerance testing
eat 75g glucose –> test 2 hours later
what is HbA1c
glycosated Hb over past 2-3 months
what does HbA1c give a good measure of
diabetic control over last few months
T2DM diagnosis HbA1c
> 6.5% or 48 // if asymptomatic repeat test
what are the 2 categories of prediabetes
impaired fasting glucose // impaired glucose tolerance
what is impaired fasting glucose in (IFG) pre-diabetes
fasting glucose between 6.1-7
what is impaired glucose tolerance (IGT) in pre-diaebtes
fasting glucose <7 AND glucose tolerance test between 7.8-11.1
what should patients with IGF be offered
oral glucose test // >11.1 = T2DM // 7.8-11.1 = IGT // <7.8 = IFG
what insulin resistance occurs in IFG pre-diabetes
hepatic
what insulin resistance occurs in IGT pre-diabetes
muscle
what type of pre-diabetes is more likely to result in T2DM + CVD
IGT
mx pre-diabetes
weight loss, diet, exercise // metformin if high risk
why can a low HbA1c not rule out T2DM
not as sensitive as fasting
what other factor can cause a rise in HbA1c
red cell turnover
what conditions cause low HbA1c
sickle cell anaemia // GP6D // spherocytosis // haemodialysis
what conditions cause high HbA1c
vitB + folic acid def // iron def // splenectomy
what conditions would HbA1c not be used for diabetes diagnosis (8)
haemoglobinopathies // haemolytic anaemia // iron deficiency // GDM // children // HIV // CKD // steroid users
what initial target weight loss should T2DM aim for
5-10%
what is the HbA1c target for those on lifestyle +/- metformin mx for T2DM
48mmol (6.5%)
when should a second drug be added in T2DM
if HbA1c >58mmol (7.5%)
why does metformin need to be titrated up slowly
to avoid GI upset
what type of metformin should be used if GI upset occurs
modified release
if metformin is contraindicated, what drug(s) are 1st line in T2DM
CVD risk = SGLT2i // otherwise = DDP4i, pioglitazone, SUR
in a patient with CVD, what drug should be added to metformin as 1st line treatment
SGLT2i
what dual therapy options are offered second line in T2DM
metformin + DDP4i OR pioglitazone OR SUR OR SGLT2i
what 3rd line options are available for T2DM
triple therapy OR start insulin
what drug can be used last line in T2DM mx + when is it esp indicated
GLP1 mimetic if BMI >35 // switch out a drug eg use triple therapy
T2DM BP targets
clinical <140/90 (ABPM 135/85)
1st line anti HTN in T2DM
ACEi or ARB (ARB if black)
