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Endocrinology > Type 2 Diabetes > Flashcards

Type 2 Diabetes Flashcards

1
Q

What is T2DM?

A
  • group of metabolic disorders that result from an inability to produce and/or reduced sensitivity to insulin.
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2
Q

What is T2DM associated with?

A
  • Obesity
  • Metabolic syndrome
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3
Q

What are the RF for T2DM?

A
  • Genetic
  • Obesity
  • Inactive
  • Poor dietary habit (low fibre, high glycemic index diet)
  • Low birth weight
  • Medications
  • Polycystic ovarian syndrome
  • History of GDM
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4
Q

What is the pathophysiology of T2DM?

A
  1. Peripheral Insulin resistance
  2. Reduced Insulin secretion
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5
Q

What receptor allows entry of glucose into cells?

A
  • GLUT4
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6
Q

What are the clinical features of T2DM?

A
  • lethargy
  • polyuria
  • polydipsia
  • recurrent infections
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7
Q

What Ix would you ordeer for T2DM?

A

Bedside

  • fasting glucose: 7mmol/L or more
  • random glucose: 11 or more

Bloods

  • HbA1c >48mmol/L
  • Oral glucose Tolerance Test (OGTT)
    • >11mmol/L suggest diabetes
    • >7.8 suggest impaired glucose tolerance
    • *OGTT reserved for gestational diabetes
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8
Q

How would you braodly Mx T2DM?

A
  • Lifestyle advice
  • Antidiabetic drugs
  • Insulin use in T2DM
  • Treatment targets
  • Monitoring for complications
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9
Q

What lifestyle advices would you give to T2DM pt?

A
  • High fibre, low-index carbohydrate, low fat
  • Daily exercise of 150mins moderate intensity over a week
  • reduce alcohol consumption and stop smoking
  • Target HbA1c <48mmol/L
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10
Q

What is the pharmacological mx for T2DM?

*remember stepwise approach

A
  • Step 1
    • Standard release Metformin
    • Aim HbA1c <48
    • Consider modified release if GI adverse effects
  • Step 2
    • Consider dual antidiabetic therapy if HbA1c rises > 58 mmol/L
    • Sulfonylurea (SU) - Glicazide
    • Dipeptidyl peptidase-4 inhibitor (DPP-4i)
    • Pioglitazone
    • Sodium–glucose cotransporter 2 inhibitor (SGLT-2i)
    • Aim for HbA1c < 53 mmol/mol​
  • Step 3
    • Consider triple antidiabetic therapy or an insulin-based regimen if HbA1c > 58 mmol/mol
    • Metformin, Glicazide and SU
    • consider insulin regimen
  • Step 4
    • Metformin + SU + GLP-1 mimetics + anything else
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11
Q
A
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12
Q

When will Metformin be contraindicated?

A
  • CKD
  • Risk of lactic acidosis
  • poorly tolerated
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13
Q

What is the function of Metformin?

A
  • inhibit hepatic gluconeogenesis
  • increase peripheral insulin sensitivity
  • enhance peripheral uptake of glucose
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14
Q

What will the stepwise approach be like if Metformin is contraindicated?

A
  • Alternative step 1
    • DPP-4i or pioglitazone or SU
    • Aim for HbA1c < 48 mmol/mol or < 53 mmol/mol if treatment with a SU
  • Alternative step 2
    • If HbA1c rises > 58 mmol/mol consider a combination of:
    • SU and pioglitazone
    • SU and DPP-4i or
    • Pioglitazone and DPP-4i
  • Alternative step 3
    • Consider an insulin-based regimen if HbA1c > 58 mmol/mol
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15
Q

What are the different types of insulin regimen?

A
  • Once or twice daily intermediate-acting insulin (NPH)
  • Intermediate-acting insulin along-side a short-acting insulin
  • Once daily long-acting insulin therapy (glargine, determir)
  • Basal-bolus regimes
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16
Q

Describe the sick day rules for T2DM Mx

A
  1. Check blood glucose every 2 to 4 hours.
  2. Drink at least 3L in a day
  3. If unable to eat, drink or vomit, replace meals with sugary fluids or ice cream
  4. Never stop insulin
  5. May need to stop hypoglycaemic agents
  6. Restart hypoglycaemic agents (1-2days after normal eating & drinking)
17
Q

How often should T2DM pt get their HbA1c checked?

A
  • every 3-6months
18
Q

What are the cx of T2DM?

A
  • Microvascular cx
    • retinopathy
    • neuropathy
    • nephropathy
    • diabetic foot
  • Macrovascular
    • atherosclerosis
19
Q

What are the acute cx of T2DM?

20
Q

What diseases on foot are associated with diabetic foot?

A
  • Diabetic ulcers
  • cellulitis
  • osteomyelitis
  • skin necrosis
  • charcot’s joint
21
Q

What is the diagnostic criteria for diabtees?

A
  • Diabetic sx (polyuria, polydipsia, unexplained weight loss for T1) +
  • random blood glucose 11mmol/L or more
  • fasting blood glucose 7mmol/L or more
  • OGTT 11.1mmol/L or more
  • HbA1c 6.5% (48mmol/L) and above

*if pt has no sx, use two test

22
Q

When is HbA1c not appropriate for diagnosis of diabetes?

A
  • All children and young people
  • pt suspeted of T1D
  • pt with diabetic sx for lexx than 2 months
  • pt at high risk but are acutely ill
  • pt on steroids, antipsychotics
  • pt c acute pancreatic damage
  • preganncy
    *

Endocrinology (17 decks)

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