T2DM Flashcards
name the 2 things that contribute to insulin resistance in T2DM
genetic predisposition and obesity lifestyle factors
insulin resistance -> compensatory ____-cell ____________ -> _____ beta-cell failure -> ____ beta-cell failure
insulin resistance -> compensatory BETA-cell HYPERPLASIA -> EARLY beta-cell failure -> LATE beta-cell failure
compensatory beta-cell hyperplasia = ?
early beta-cell failure = ?
late beta-cell failure = ?
compensatory beta-cell hyperplasia = NORMOGLYCEMIA
early beta-cell failure = IMPAIRED GLUCOSE TOLERANCE
late beta-cell failure = DIABETES
the ominous octet - increased or decreased?
neurotransmitter dysfunction
incretin effect
glucagon secretion
hepatic glucose production
insulin secretion
lipolysis
glucose reabsorption
glucose reuptake
INCREASED neurotransmitter dysfunction
DECREASEDincretin effect
INCREASED glucagon secretion
INCREASED hepatic glucose production
DECREASED insulin secretion
INCREASED lipolysis
INCREASED glucose reabsorption
DECREASED glucose reuptake
ALL RESULT IN HYPERGLYCEMIA
beta cell dysfunction leads to what?
hyperglycaemia
chronic hyperglycaemia leads to what?
microvascular disease
what reduces the incidence and progression of microvascular complication of diabetes?
intensive glucose control
CVD risk is best treated through use of what 2 drugs?
statins and anti-hypertensives
54 year old male
P/W thirst/ polyuria and balanitis
No significant PMH
FHx T2DM
BMI 38
BP 146/98
RBG 16 mmol/l
Urinalysis: glucose +++, Protein +
diagnosis?
T2DM
what drugs causes:
decreased gluconeogenesis and increased peripheral glucose uptake
metformin
what drugs causes:
decreased HbA1c
neural weight
no hypoglycaemia
decreased Ca and CHD risk
metformin
metformin adverse effects?
GI and lactic acidosis
reduced HbA1c results in reduced risk of what 4 things?
retinopathy
nephropathy
neuropathy
CHD
what is the SIGN 116 glycemic targets?
48-53 mmol/l
what is the stage 1 drug used in T2DM?
metformin
2 drug combination:
metformin + ? (5)
metformin + …
sulfonylurea thiazolidinedione DPP-4 inhibitors GLP-1 receptor agonist insulin
what drug causes:
blocked beta cell Katp channel and increased 1st and 2nd phase insulin secretions
sulphonylurea
does sulphonylurea cause weight gain?
yes
name a sulphonylurea
gliclazide
what is the estimated beneficial dose of gliclazide?
80-120mg
what T2DM drug has a low incidence of hypoglycaemia?
gliptins
name a SGLT-2 inhibitor
empagliflozin
dapagliflozin
name a thiazolidinedione
glitazone
what drug is a PPARgamma activator and causes increased peripheral glucose uptake?
glitazone
does glitazone cause weight gain?
yes
state the adverse side affect of glitazone
increased fracture risk
what drug combination should someone with a history of CVD get?
metformin + SGLT2 inhibitor
what drug is goof for T2DM and NAFLD?
pioglitazone
BMI >30 (>28 asian) + insulin sensitive = drug?
MF/SGLT2/DPP4I/PIO
BMI <30 (<28 asian) + insulin sensitive = drug?
SUs - low dose and do not step up
