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.
2
Q
What is T2DM associated with?
A
- Obesity
- Metabolic syndrome
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
4
Q
What is the pathophysiology of T2DM?
A
- Peripheral Insulin resistance
- Reduced Insulin secretion
5
Q
What receptor allows entry of glucose into cells?
A
- GLUT4
6
Q
What are the clinical features of T2DM?
A
- lethargy
- polyuria
- polydipsia
- recurrent infections
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
8
Q
How would you braodly Mx T2DM?
A
- Lifestyle advice
- Antidiabetic drugs
- Insulin use in T2DM
- Treatment targets
- Monitoring for complications
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
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
11
Q
A
12
Q
When will Metformin be contraindicated?
A
- CKD
- Risk of lactic acidosis
- poorly tolerated
13
Q
What is the function of Metformin?
A
- inhibit hepatic gluconeogenesis
- increase peripheral insulin sensitivity
- enhance peripheral uptake of glucose
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
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
