Type 2 Diabetes

Question 1

HbA1c and glucose levels needed to diagose type 2 diabetes?

Answer 1

HbA1c of 48

Fasting plasma glucose 7.0mml

Random plasma glucose 11.1 mmol

OGTT 2 hour result os >11

If pt is symptomatic then only abnormal HbA1c or fasting plasma glucose can be used to confirm diagnosis

If pt is asymptomatic, must repeat testing.

If HbA1c result is difficult to interpret then diagnosis on fasting plasma glucose of 7+

Question 2

What groups of people should HbA1c not be used to diagnose diabetes?

Answer 2

Ppl under 18 yrs
Prenant women (or 2mo post partnum)
Diabetes sx for <2mo
Acutely ill
On meds that cause hyperglycaemia- long term steroids
Ppl with pancreatic damage
End stage renal disease
HIV infection

Question 3

What is Oral Glucose TOlerance Test?

Answer 3

Oral Glucose Tolerance Test:

Performed in morning prior to having breakfast.
Take baseline fasting plasma glucose, then give glucose drink and measure plasma glucose 2 hours later.

Question 4

Pre diabetes diagnosis?

Answer 4

HbA1c 42-47

Impaired fasting glucose: 6.1-6.9 mmol

Impaired glucose tolerance:
plasma glucose at 2 hours is 7.8-11.1 on OGTT.

Question 5

Treatment targets for type 2 diabetes?

Answer 5

48 mmol for new type 2 diabetes

53 mmol for diabetes beyond metformin alone

Question 6

First line type 2 diabetes pharmacological management?

Answer 6

Standard release metformin
(gradually increase dose over weeks to minimize adverse effects, consider using modified release metformin if intolerable GI side effects)

Question 7

Pharmacological management for diabetics who have established cardiovascular disease/ heart failure and/or are high risk?

Answer 7

Metformin
+
SGLT-2 inhibitor (-gliflozin)fj

Question 8

Common side effects of metformin?

Answer 8

Diarhhoea and abdo pain
Lactic acidosis

IS weight neutral and DOES NOT cause hypoglycaemia

Question 9

Common side effects of SGLT-2 inhibitors like empagliflozin?

Answer 9

Glucoseuria
Increased rate of UTIs
Weight loss
DKA (rare complication)

Question 10

Second line treatment for diabetes?

Answer 10

Consider dual therapy of metformin + one of:
DPP-4 inhibitor
Pioglitazone
Sulfonylurea

Question 11

Treatment for diabetes if metformin is contraindicated or not tolerated?

Answer 11

DPP-4 + pioglitazone

or DPP-4 + sulfonylurea

Question 12

Third line treatment for diabetes?

Answer 12

Triple therpy of metformin with DPP-4 inhibitor and sulfonylurea

Or any other 2 meds plus metformin

Question 13

When should insulin therapy be considered for type 2 diabetics?

Answer 13

When on max tolerated doses of antiviabetic drugs and syptoms persist/suboptimal blood glucose.

Recommended basal insulin therapy with isophane (NPH( insulin. Quick acting insulins may be added in with meals

Question 14

Adverse effects of insulin therapy?

Answer 14

Weight gain

Refraction disorder (altered vision on initiation of insulin tx, should stabilise once blood sugars stabilise)

Oedema

Insulin neuritis

Question 15

What drugs can enhance the glucose lowering effects of insulin?

Answer 15

Alcohol
Anabolic steroids
ACEi
BBs

Question 16

Drugs that antagonise the glucose lowering effects of insulin?

Answer 16

Corticosteroids
Diuretics
Glucagon
Levothyroxine
Oral contraceptives
Sympathomimetic drugs

Question 17

Example of pioglitazone drug and common side effects?

Answer 17

Increases insulin sensitivity and decreases glucose production in liver

Weight gain
Fluid retention
Anaemia
Heart failure

Question 18

Example of a sulfonylureas and their notable side effects?

Answer 18

Glicazide- stimulates insulin release from pancreas

Hypoglycaemia
Weight gain
Increased CVS disease when used as monotherapy

Question 19

What are incretins? Examples?

What inhibits incretins?

Answer 19

Hormones produced by GI tract which increase insulin secretions, inhibit glucaon production and slow absoprtion by the GI tract.

GLP-1. This is inhibited by DPP-4.

Question 20

Example and notable side effects of DPP-4 inhibitors?

Answer 20

Sitagliptin.

This inhibits the DPP-4 enzyme therefore increasing GLP-1 activity.

SEs:
GI tract upset
Sx of URTI
Pancreatitis

Question 21

Examples of GLP-1 mimetics and notable side effects?

Answer 21

Exanatide.

GI tract upset
Weight loss
Dizziness

Question 22

What preventative therapy should you start diabetics on to reduce their CVD risk?

Answer 22

Not already established CVD:
Atorvostain 20mg od.

IF have established CVD:
Atorvostatin 80mg od

Question 23

Contraindications to statin therapy?

Answer 23

Acute liver disease

Pregnant and breastfeeding women

Question 24

Hypertension diagnosis in diabetics? Target BP for diabetics?

Answer 24

140/90 clinic
135/85 ABPM

Targets:
<135/85 for under 80s

<145/85 for 80+