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Endocrinology > T2DM > Flashcards

T2DM Flashcards

1
Q

What is the pathophysiology of T2DM?

A

Insulin resistance leading to hyperinsulinaemia then beta cell impairment resulting in decreased insulin secretion and hyperglycaemia (Impaired insulin action + Deficient insulin secretion)

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2
Q

What are symptoms of T2DM?

A
  • Polydipsia
  • Polyuria
  • Weight loss
  • Blurry vision
  • Urogenital infections
  • Fatigue
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3
Q

What are 2 macrovascular complications of T2DM?

A
  • Stroke
  • IHD
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4
Q

What are 3 microvascular complications of T2DM?

A
  • Retinopathy
  • Neuropathy
  • Nephropathy
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5
Q

What are the risk factors for T2DM?

A
  • Inactivity
  • Family history
  • Metabolic syndrome
  • PCOS
  • Poor diet
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6
Q

What is metabolic syndrome?

A

Group of conditions that collectively increase risk of heart disease, stroke & T2DM:

  • HTN
  • DM
  • Obesity
  • Dyslipidaemia
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7
Q

What investigations are used for a patient with suspected T2DM?

A
  1. FBC, U&Es, Lipid profile
  2. Urine dipstick
  3. HbA1c
  4. Fasting plasma glucose
  5. Random plasma glucose (If symptomatic)
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8
Q

What are the diagnostic criteria categorised by WHO?

A

If the patient is symptomatic:

  • Fasting glucose >= 7.0 mmol/l
  • Random glucose >= 11.1 mmol/l (or after 75g oral glucose tolerance test)
  • HbA1c >= 6.5% (48 mmol/mol)
    • ​Value of less than 6.5% does not exclude diabetes

If the patient is asymptomatic

Above criteria must be demonstrated on two separate occasions.

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9
Q

What can cause misleading HbA1c results

A

Increased red cell turnover

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10
Q

What is the HbA1c?

A

Amount of glucose covalently bonded to RBCs - Average blood glucose over last 2-3 months

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11
Q

When should HbA1c not be used?

A
  • Under 18 years old
  • Pregnancy
  • End stage kidney disease
  • HIV +ve
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12
Q

What is the target HbA1c for patient’s managed with lifestyle changes and a single drug?

A

48 mmol/L (6.5%)

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13
Q

What is the target HbA1c for patients managed with multiple drug therapy?

A

53 mmol/L (7%)

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14
Q

What is the NICE guidance of T2DM?

A
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15
Q

What is the mechanism of action of metformin?

A
  • Increases insulin sensitivity
  • Reduces hepatic gluconeogenesis
  • Reduces CVS events and limits weight gain
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16
Q

What is the mechanism of action of sulfonylureas?

A

Stimulate beta cells to release insulin

17
Q

What’s the mechanism of action of SGLT2 inhibitors (Gliflozins) ?

A

Selectively inhibits Sodium-Glucose Co-Transporter 2 in renal prox. tubule so glucose excreted in urine

18
Q

What is the action of piglitazone?

A

Increases insulin sensitivity in muscle and adipose tissue & reduces hepatic glucose output by acting on PPARs

19
Q

What is the action of DDP-4i (Gliptins) ?

A
  • Inhibits DPP-4 (enzyme that destroys incretin), increasing incretin levels, stimulating increased GLP-1 secretion from intestinal L cells
  • Action of GLP-1:
    • Increases glucose uptake
    • Increases insulin secretion
    • Decreases glucose production
20
Q

What are the contra-indications of metformin?

A

eGFR < 30

21
Q

What are the contra-indications for piaglitazones?

A
  • DKA
  • HF
  • Bladder cancer
  • Haematuria
  • Hepatic impairment
22
Q

What advice on “Sick Day Rules” would you give to patients who are commencing treatment for diabetes mellitus?

A
  • Increase frequency of blood glucose monitoring to four hourly or more frequently
  • Encourage fluid intake aiming for at least 3 litres in 24hrs
  • If unable to take struggling to eat may need sugary drinks to maintain carbohydrate intake
  • It is useful to educate patients so that they have a box of ‘sick day supplies’ that they can access if they become unwell
  • Access to a mobile phone has been shown to reduce progression of ketosis to diabetic ketoacidosis
23
Q

What are 2 common side-effects of metformin?

A
  1. Gastrointestinal side-effects
  2. Lactic acidosis
24
Q

What are 4 common side-effects of sulfonylureas?

A
  1. Hypoglycaemic episodes
  2. Increased appetite & weight gain
  3. Syndrome of inappropriate ADH secretion (SIADH)
  4. Liver dysfunction (cholestatic)
25
Q

What are 4 common side-effects of glitazones?

A
  1. Weight gain
  2. Fluid retention (Worsening HF)
  3. Liver dysfunction
  4. Fractures
26
Q

What is a common side effect of gliptins?

A

Pancreatitis

27
Q

What are typical C-Peptide levels in T2DM?

How does this compare to C-peptide levels in T1DM?

Why?

A

Normal / High in T2DM

C-peptide levels are low in T1DM

Because pancreas not creating enough insulin precursor (which is broken down into C-peptide & insulin)

28
Q

Which second intensification drug (sulfonylureas / gliptins / pioglitazone) is best to commence in a patient who is obese and why?

A

Gliptins/DPP-4 inhibitors (e.g. Sitagliptin) because they can induce weight loss.

The other two options (Sulfonylureas & Pioglitazone) can both cause weight gain.

29
Q

What is the best choice for a second intensification drug in non-obese patients?

A

Sulfonylurea (e.g. gliclazide or glibenclamide) because most effective at reducing blood glucose (with risk of sever/prolonged hypoglycaemia)

30
Q

Why are sulfonylureas not recommended for patient’s that are professional drivers?

A

Due to increased risk of severe/prolonged hypoglycaemia

31
Q

What oral-hypoglycaemic is safe to use for pregnant/breastfeeding women with T2DM?

A

Metformin

32
Q

What is the consequence of metformin causing increased risk of lactic acidosis?

A

Should be suspended when there is risk

eg. dehydration, sepsis, CT with contrast, renal failure, heart failure; particularly if the patient is frail or elderly.

33
Q

What is the target BP for a patient with T2DM and no end-organ damage?

A

< 140/90 mmHg

34
Q

What HbA1c result should make you consider adding a second intensification drug ?

A

> 58 mmol/L (7.5%)

Endocrinology (4 decks)

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