T2DM Flashcards

1
Q

T2DM progression on pancreas

A

Starts as insulin resistance in the muscle and liver and progresses to secretory deficit

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2
Q

diabetes complications

A
  • Retinopathy (leading cause)
  • Cardiovascular disease (2-3x)
  • 10 fold ERSD increase
  • every 30sec amputation
  • trans generational effects
  • erectile dysfunction
  • depression and anxiety
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3
Q

diabetes mortality ratios

A

Heart disease and stroke = 0.6
Cancer = 0.15
All other = 0.25
Shortens life span by 6 years

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4
Q

Does diabetes diagnosis decrease mortality?

A

NO
even people with impaired glucose tolerance have twice the mortality rate

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5
Q

Core ominous octect

A

Decreased insulin production
decreased glucose uptake

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6
Q

Additional ominous octect

A
  • Increased glucagon
  • decreased incretin effect
  • increased lipolysis
  • increased glucose reabsorption
  • nerotransmitter dysfunction
  • increased hepatic glucose production
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7
Q

extra ominous octect

A

inflammation
vascular insulin resistance

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8
Q

Life style impact

A

can reduce progression by 58% and increase insulin resistance but hard to keep up

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9
Q

Alpha-glucosidase inhibitors

A

Acarbose, 25% RR but 90% of people can’t tolerate GI A/E

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10
Q

Pioglitazone

A

72% RR but heart failure change (still used some places)

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11
Q

Rosiglitazone

A

62% RR but massive cardiac side effects

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12
Q

sulfonylureas

A

Work too well and cause hypoglycaemia
still use glicazide MR

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13
Q

thiazolidinediones TZD

A

cause heart attacks and heart failure

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14
Q

ACE inhibitors

A

Ramipril has no effect on T2DM progression

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15
Q

Metformin

A

31% RR decrease with manageable side effects

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16
Q

Treatment of <1.5% over target

A

start metformin and lifestyle

17
Q

Treatment of >1.5 over target

A

Two agents, Metformin + SGLT2 is preferable

18
Q

Treatment initiation with metabolic decompensation

A

(Very high glucose, ketosis, weight loss, polyuria, polydipsia, volume depletion), start insulin and +/- metformin till regulated then drop to metformin or metformin +

19
Q

Ideal diabetes drug dose

A

Best at middle dose, high doses don’t increase glycemic control and only serve adverse effects

20
Q

Metformin dosing

A

Start slow as GI side effects are common in the first two weeks 250mg BID, 250mg TID, 500mg BID, 500mg TID

21
Q

metformin evidence

A

only about 600 people tested, and only controls sugars, provides no complication risk benefit

22
Q
A