Type 2 Diabetes Flashcards
What is the pathophysiology?
Insulin resistance in cells causes increased insulin production and secretion from the beta cells
Beta cells become hypertrophied
Continues until Beta cells can no longer maintain this level of production and die causing decreased insulin production
Leads to increased glucose concentration in blood which causes water to leave cells due to the osmotic imbalance
Results in cells becoming dehydrated leading to symptoms
What are the symptoms?
Polyuria Polydipsia Polyphagia Weight loss Fatigue Increased infections Impaired healing Glucosuria Older people present with complications
What are the risk factors?
Increasing age Obesity High carbohydrate diet Sedentary lifestyle HTN Family history Ethnicity
How is T2DM diagnosed?
HbA1c >48mmol/L
Fasting blood glucose >7mmol/L
OGTT or random blood glucose >11.1mmol/L
If asymptomatic will need 2 separate readings to confirm diagnosis
What is pre-diabetes?
Where glucose levels are raised but do not meet the threshold to diagnose diabetes, these patients are able to prevent diabetes from onsetting
HbA1c 42-47mmol/L
Fasting blood glucose 6.1-6.9mmol/L
Random blood glucose/OGTT 7.8-11.0mmol/L
What is the management of T2DM?
First line is lifestyle advice
- increase exercise
- reduce sugar intake
- increase fibre intake
- stop smoking
- control other risk factors e.g. CVD
Medication- if lifestyle factors do not suffice
1) Metformin
2) Metformin PLUS DPP4 inhibitor/ SGLT2 inhibitor/ glitazone/sulphonylurea
3) Triple therapy with Metformin plus 2 above
- can do Metformin plus sulphonylurea plus GLP-1 mimetic if BMI >35 or insulin not appropriate
4) Metformin plus insulin
When should diabetic medication be increased?
Target HbA1c on metformin alone= 48mmol/L
If HbA1c >58mmol/L then add another drug
New target when on two drugs 53mmol/L
What is the mode of action of metformin and its side effects?
Increases insulin sensitivity and decreases liver production of glucose Weight neutral SE -abdo pain -diarrhoea -lactic acidosis
What is the mode of action of glitazones and the side effects?
E.g. pioglitazone
Increases insulin sensitivity and decreases liver production of glucose
SE
- weight gain
- fluid retention- CI in HF
- fractures
- Liver dysfunction
- Extended use associated with bladder cancer
What is the mode of action of sulphonylureas and the side effects?
E.g. glicazide
Increases insulin secretion from the pancreas
SE
- weight gain
- hypoglycaemic episodes
- SIADH
- Liver dysfunction
What is the mode of action of DPP4 inhibitors and the side effects?
E.g.Sitagliptin
Stops the action of DPP4 which inhibits incretin
Incretin promotes insulin secretion and stops glucagon production
SE
- URTI
- GI upset
- pancreatitis
What is the mode of action of GLP-1 mimetics and the side effects?
E.g. exenatide
Mimics the effect of GLP-1 a form of incretin
SE
- Weight loss
- GI upset
- dizziness
What is the mode of action of SGLT2 inhibitors and its side effects?
Anything with ending glifozin
Stops resorption of glucose in PCT causing glucose to be excreted in urine
SE
- glucosuria
- increased risk of urinary and genital infections
- weight loss
- DKA
- increased risk of amputation
