T2DM Flashcards
What happens in T2DM
Insulin resistance
•insulin sensitivity tissues/organs fail to respond to insulin
• this occurs due to impaired insulin signalling
Beta cell dysfunction/death
What is the cause:mechanism behind beta cell death/dysfunction
•lipotoxicity
•inflammation
•ER stress
•amylis deposits out side beta cell, affecting function
• beta cell exhaustion
According to WHO, what is the fasting and 2h post prandial in T2DM
Fasting: >7mmol
2hr post prandial: >11.1mml
What methods are used in diagnosing T2DM
• fasting glucose test
• OGTT
• random glucose test
• HbA1c test
Insulin resistance risk factors?
• obesity
• low birth weight
• gastrointestinal diabetes
• low economic status ~ ethnicity in west
• HTN
• Meds: corticosteroids
Describe step 1 of management
Give insulin for hyperglycaemia
Describe step 2 of management
Assess:
• HbA1c
• CVD risk
• renal function
Describe step 3 of management, for those not at high risk of CVD
• give metformin (or metformin MR)
• if metformin is CI, then give:
- DPP4 inhibitors (gliptins) OR
- sulponylurea OR
- pioglitazone
Describe step 3 of management, for those at risk of CVD, including: HF, atherosclerosic, CVD and QRisk >10%
• give metformin (or metformin MR)
• once metformin is tolerated, the five SGLT2 inhibitor
if metformin is CI, give SGLT2 inhibitor alone
Which drugs increase insulin sensitivity
• metformin
• pioglitazone
Which drugs increase insulin secretion
• sulfonylurea
• DPP4 inhibitors
• GLP-1 agonist
Which drugs decreases glucose reabsorption
SGLT2 inhibitors
Which 2 drugs can are in injection form
insulin and GLP-1 agonist (this can also be tablet)
Which drug delays carbs absorption?
Acarbose
Which class of drugs are involved in the incretin affect?
• DPP4 inhibitors
• GLP-1 agonist
Which drugs increase weight?
• Sulfonylurea
• pioglitazone (TZDs)
• insulin
Which drugs reduced weight
• GLP-1 agonist
• SGLT2 inhibitors
Which drug have the highest hypo risk
Insulin
Which class of drug reduces cardiac events?
SGLT2 inhibitors
Which drug that increases insulin secretion requires glucose too?
This drug also increases intercellular ca
(Glucose-dependent)
GLP-1 agonist
Which peptide hormones are a part of the incretin effect?
GLP-1 and GIP
What is the incretin affect?
The incretin hormones release from the intestinal cells in response to food intake (fat mainly)
They boost insulin release and reduce glucagon release
Helps in weight reduction
GLP-1 and GIP can be inactived by…
DPP4
If triple therapy (performing and 2 other drugs) is CI or not affective. What would you switch one of the drugs to and in which sort of patients
GLP-1 mimic, in those with:
• BMI over 35
• BMI lower than 35
- where insulin would have big implications OR weight loss would be benifical to other obesity relatives conditions
