T2DM Flashcards
what is GLP-1
- Secreted by L cells of the intestine in response to nutrients
- Rapidly metabolized by DPP-4
- Decreases serum glucose
–Pancreas
—Stimulates insulin secretion
—Inhibits glucagon secretion
—Increases beta cell mass
–GI tract
—Slows gastric emptying, leading to lower post-prandial glucose excursion
–CNS
—Decreases appetite through central actions on the hypothalamus
*GLP-1 analogues available as injected agents
*DPP-4 inhibitors decrease metabolism of endogenous GLP-1
Prevention of T2DM
- Breastfeeding
- Lifestyle
- Improve sleep quality and quantity
- Decrease sedentary behaviours
- Increase both light and vigorous physical activity
- Reducing sugar-sweetened beverage consumption
- Limit screen time
- In children with obesity, family-based healthy behaviour interventions
Target A1c T2DM
7%
Health lifestyle for T2DM
- 60 minutes daily of moderate-to-vigorous physical activity
limiting recreational screen time to < 2 hours per day - Limiting sedentary (motorized) transport, extended sitting and time spent indoors throughout the day
When to start insulin in T2DM
DKA
A1C ≥9.0%
symptoms of severe hyperglycemia
Once-a-day basal insulin
Complications and comorbidities of T2DM
Neuropathy
Retinopathy
Nephopathy
Dyslipidemia
Hypertension
NAFLD
PCOS
OSA
Depression
Binge eating
Dx T2DM
- FPG ≥ 7.0 mmoL/L
- OGTT 2-hour plasma glucose ≥11.1 mmoL/L
- Symptoms of diabetes and a random plasma glucose ≥11.1 mmol/L
○ Sx: polyuria, polydipsia, nocturia and unexplained weight loss - HbA1c ≥ 6.5%
HbA1C alone shouldn’t be used for screening
S/E of Metformin
- GI: nausea, diarrhea, abdo pain
- Lactic acidosis - rare, may be in context of AKI
Neuropathy screening in T2DM
- when and frequency
- screening test
yearly starting at dx
questions and exam
symptoms, vibration, touch, ankle reflex
retinopathy screening in T2DM
- when and frequency
- screening test
yearly starting at dx
7-standard field- stereoscopic-colour funds photography w interpretation by a trained reader
Nephropathy screening in T2DM
- when and frequency
- screening test
yearly starting at dx
first AM ACR (or random)
Dyslipidemia screening in T2DM
- when and frequency
- screening test
yearly starting at dx
fasting TC, HDL-C, TG, calculated LDL-C
hypertension screening in T2DM
- when and frequency
- screening test
at dx and every dm-related encounter
BP measurement with appropriate sized cuff
NAFLD screening in T2DM
- when and frequency
- screening test
yearly starting at dx
ALT and/or fatty liver on ultrasound
PCOS screening in T2DM
- when and frequency
- screening test
yearly clinical screening starting at dx for pubertal females
clinical assessment on hx and p/e for oligo/amenorrhea, acne, hirsutism
CVD prevention in T2DM
smoking cessation
activity
when to start statin in T2DM
In children with familial dyslipidemia + a positive FHx of early CV events:
start if the LDL-C level remains >4.1 mmol/L after a 3- to 6-month trial of dietary intervention
Who should be screened for T2DM?
- ≥3 risk factors in nonpubertal children beginning at 8 years of age or ≥2 risk factors in pubertal children. Risk factors include:
1) Obesity (BMI ≥95th percentile for age and gender)
2) Member of a high-risk ethnic group (e.g. African, Arab, Asian, Hispanic, Indigenous or South Asian descent)
3) First-degree relative with type 2 diabetes and/or exposure to hyperglycemia in utero
-4) Signs or symptoms of insulin resistance (including acanthosis nigricans, hypertension, dyslipidemia, NAFLD [ALT >3X upper limit of normal or fatty liver on ultrasound]) - PCOS
- IFG and/or IGT
- Use of atypical antipsychotic medications
how to screen T2DM
an A1C and a FPG or random plasma glucose
not A1C alone
What are high risk ethnic groups for T2DM
Asian
Arab
African
Hispanic
Indigenous
South Asian descent
physical activity rec
≥60 minutes of moderate-to-vigorous physical activity daily,
what is OGTT
abnormal?
1.75 g/kg (max 75 g) anhydrous glucose dissolved in water
check BG at baseline and 2h later
abnormal = ≥11.1 mmoL/L
Metformin
Class:
Mech of Action
Lowers A1C by:
Weight:
SE:
Class: biguanide
Mech of Action:
- Enhance insulin sensitivity in liver and peripheral tissues by activation of AMP-activated protein kinase
- Inhibits hepatic glucose production
Lowers A1C by: 1%
Weight: Neutral
SE: GI symptoms (Nausea, diarrhea)
Lactic acidosis
Where is GLP1 secreted
What does it do
What degrades it
secreted by L-cells in the small intestine in response to food
increases insulin secretion proportionate to BG concentrations
suppresses glucagon
prolongs gastric emptying
promotes satiety.
rapidly degraded by DPP- IV
