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DPD > T2DM > Flashcards

T2DM Flashcards

1
Q

How do you work out the osmolality?

A

Cations + anions + glucose + urea

However there’s too much anions so you just double the cations (sodium and potassium) then add glucose and urea

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2
Q

Normal osmolality

A

Na + K x 2 = 288
+ 4 + 4 for glucose and urea

296mil osmoles per kg

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3
Q

Why don’t they get acidosis?

A

They have enough insulin to suppress ketoacidosis

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4
Q

Why do over half the patients in the UK not know they have diabetes?

A

They think the polydipsia/polyuria is due to UTI/prostate trouble

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5
Q

What are the three microvascular complications?

A

Retinopathy
Nephropathy
Neuropathy

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6
Q

Features of macrovascular complications

A

Ischemic heart disease
Cerebrovascular disease
Peripheral gangrene

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7
Q

What are the features of background retinopathy?

A

Hard exudates
Microaneurysms
Blot haemorrhages

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8
Q

Why does the patient see fine despite background retinopathy?

A

Because the macula is preserved

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9
Q

Treatment for background retinopathy?

A

Improve BLOOD GLUCOSE CONTROL

not blood pressure (this is for nephropathy)

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10
Q

What are hard exudates?

A

cholesterol deposits

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11
Q

What is the difference between cotton wool spots and hard exudates?

A

Cotton wool spots actually look soft around the edge

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12
Q

What is the next stage of eye disease after background?

A

Pre-proliferative

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13
Q

What are the features of pre-proliferative

A

Cotton wool spots (the hard edges become round and soft)

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14
Q

Features of proliferative eye disease

A

Neovascularisation

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15
Q

What are cotton wool spots?

A

The products of ischaemia

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16
Q

Treatment of pre-proliferative

A

Pan retinal photocoagulation (around the periphery)

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17
Q

How long does it take to see the effect of proper diabetes control? What study published this data and when?

A

15 years

UKPDS, 1998

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18
Q

What happened 10 years after this study, in 2008? What is the name of the key effect?

A

The legacy effect - the benefits of having tight control for 20 years extends for nearly 10 years even after the cessation of randomised control!

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19
Q

DCCT

A

Type 1 diabetes

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20
Q

What did the Accord research show?

A

This study was done on older people with more than 6% HbA1c with vascular disease

They had

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21
Q

What happens if you suddenly tighten up control in older people with poor control?

A

It increases their chances of hypos and therefore daeath

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22
Q

What happens if you suddenly tighten up control in older people with poor control?

A

It increases their chances of hypos and therefore death

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23
Q

Name a sulphonylurea

A

Gliclazide

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24
Q

Name insulin sensitisers

A

Pioglitazones

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25
Q

Which drug was banned after the Accord study?

A

Rosiglitazone

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26
Q

What do you add after insulin sensitisers?

A

Add insulin

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27
Q

What do you add after insulin?

A

Incretins e.g. GLP-1

28
Q

What prevents breakdown of GLP-1?

A

DPP4 inhibitors

29
Q

What is the problem with using natural soluble insulin sc?

A

It forms a hexamer under the skin (A and B chain form parallel links) and releases c-peptide

Took a while to work so had to be injected 30 mins before meals

30
Q

What did pharmaceutical companies do to reduce the time taken for the insulin to work?

A

Lispro - rapidly acting as they switched the lysine and proline

Aspart - lysine removed? (proline and aspartate)

31
Q

Give an example of long acting insulin

A

Glargine

Arginine added to B chain

32
Q

What is the point of giving background long acting insulin?

A

less risk of hypoglycemia

33
Q

What is detemir?

A

Long chain insulin
14 carbon fatty acid chain attached to b29

delayed onset 7hr
can be used as part of bolus

34
Q

What is the advantage of insulin over other diabetic drugs?

A

Metformin
Sulphonylurea - skin reactions?
Thiazolidinediones - hepatic, osteoporosis (rare)

35
Q

What are the disadvantages of insulin?

A

Can’t work if you drive a HGV as hypoglycemia is common

Weight gain (as it makes you more hungry)

36
Q

What is GLP1?

A

Secreted from gut, stimulates pancreas to make insulin

37
Q

What is another advantage of GLP1?

A

Reduces gastric emptying (feel more full)

38
Q

What ending do DPP4 inhibitors have?

A

Gliptins (DPP4 inhibitors)

39
Q

Give examples of GLP1 analogues

A

Exanatide

Liraglutide (Saxenda)

40
Q

How do SGLT2 inhibitors work?

A

Block reabsorption of glucose so increases glucosuria

41
Q

Main SE of SGLT2 inhibitors?

A

UTI

Thrush

42
Q

Example of an SGLT2 inbhibitor?

A

Empagliflozin

43
Q

Which study showed how beneficial SGLT2 inhibitors were?

A

EMPA-REG Outcome study

44
Q

What is the effect of SGLT2 inhibitors on the kidneys

A

GFR is acutely changed, but then remains stable, and it maintains renal function

Thus renoprotective

45
Q

The risk of death increases if someone has

A

CKD plus diabetes

46
Q

What histological features are seen on kidney biopsy?

A

Mesangial expansion
BM thickening
Glomerulosclerosis

47
Q

What are the features of kidney disease

A

Increased proteinuria
Increased
BP
Deranged kidney fucntion

48
Q

Normal range for proteins in urine?

A

<30mg/24hrs

49
Q

Microalbuminuria range

A

30-300mg/34hr

50
Q

What is nephrotic syndrome?

A

More than 3g/24hrs

51
Q

What are the four interventions for kidney contrl

A

Tight diabetic control
BP control
Inhibit RAS with ACEi/ARB
Start smoking

52
Q

When do you start treatment on

A

Once someone has micro albuminuria

53
Q

Give an example of an ARB

A

Irbesartan

54
Q

What is the effect of ACEi on creatinine within days of starting it?

A

The creatinine gets worse, but it gets better so keep going with it

55
Q

ACEi should not be used in?

A

SHOULD NOT BE USED IN RENAL ARTERY STENOSIS

56
Q

ACEi causes hyper or hypokalemia?

A

hyperkalemia

57
Q

???

A

Less albuminuria

Less GFR

58
Q

SE of metformin

A

Diarrhoea

Tummy ache

59
Q

When do you try a second oral agent after metformin?

A

If the non-insulin monotherapy does not achieve the target HbA1C after 3 months

60
Q

What is the second line for diabetes after metformin?

A

GLP-1 receptor agonist (e.g. liraglutide) or basal insulin

61
Q

A network meta analysis shows that which drugs should you give if someone has atherosclerosis/vascular disease, AND diabetes?

A

Empagliflozin

Liraglutide

62
Q

What are the glutides?

A

GLP-1 agonists (incretins, increase

63
Q

SE of SGLT-2 inhibitors

A

Increased risk of genital skin reactions

64
Q

If you need to minimise hypoglycaemia, what do you do?

A

DDP4?

65
Q

Gliclazide should be given when

A

If the pt is overweight?

DPD (38 decks)

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