Type 2 Diabetes Flashcards
Type 2 Presentation
-Fatigue
-Polyuria
-Polydipsia
-Polyphagia
-Weight loss (usually when hyperglycaemia is more severe [e.g., >16.6 mmol/L, >300 mg/dL])
-Blurred vision
-Paraesthesias
-Skin infections (bacterial or candida)
-Urinary tract infections
-Acanthosis nigricans
Strong risk factors indicating screening
-Older age
-Overweight/obesity
-Certain ethnic groups (including black, South Asian, or Hispanic ancestry)
-Family history of type 2 diabetes
-History of gestational diabetes
-Presence of non-diabetic hyperglycaemia
-Polycystic ovary syndrome
-Hypertension
-Dyslipidaemia
-Known cardiovascular disease
Diagnosis criteria
-Fasting (8hr) plasma glucose ≥7.0 mmol/L (≥126 mg/dL)
-Plasma glucose ≥11.1 mmol/L (≥200 mg/dL) 2 hours after 75 g oral glucose
-Glycosylated haemoglobin (HbA1c) ≥48 mmol/mol (≥6.5%)= reflects degree of hyperglycaemia over preceding 3 months)
-In a symptomatic patient, random plasma glucose of ≥11.1 mmol/L (≥200 mg/dL)= used for rapid assessment of glucose status if symptoms present
When to check urine ketones
-Symptomatic of hyperglycaemia (polyuria, polydipsia, weakness)
-Volume depletion (dry mucous membranes, poor skin turgor, tachycardia, hypotension, and, in severe cases, shock)
When is DKA more likely to occur in T2DM?
-In the presence of an underlying infection or other stressors
-Following cardiovascular events, malignancy, antipsychotic medication, and concomitant treatment with sodium-glucose co-transporter-2 (SGLT2) inhibitors
Definition of Type 2 Diabetes
Insulin resistance and a relative insulin deficiency result in persistent hyperglycaemia
=Caused by relative deficiency of insulin due to excess of adipose tissue
What is insulin resistance increased by?
-Obesity
-Stress
-Illness
-Steroids
-Pregnancy
T2DM Drugs
-Metformin
-Sulphonylureas
-Pioglitazone
-DPP4 inhibitors (sitagliptin)
-GLP1 analogues
SGLT2 inhibitors
-Insulin
Describe Metformin
-Remains 1st line
-Reduces insulin resistance, reduces hepatic glucose production
-Highly effective
-Weight loss
-GI side –effects limit use
-Must be stopped when eGFR <30
=Risk of lactic acidosis
Describe sulphonylureas
-Promotes insulin secretion regardless of blood glucose level
=Weight gain and hypo risk
-Highly effective (useful if very hyperglycaemic or with steroid induced diabetes)
-Reducing/holding in hepatic and renal failure
=Increased hypo risk from impaired metabolism/ clearance so glucose monitoring
=Always check a BM in a confused patient
=Hold if NBM
Describe Pioglitazone
-High efficacy, enhances actions of endogenous insulin
-Weight gain
-Rarely hypoglycaemia
-Fluid retention
=Increased risk of congestive cardiac failure
-Increased risk of bladder cancer and fractures
-Stop if fluid overloaded or fracture
-Has long duration of action so no rebound increase in glucose
Describe DPP4 inhibitors
-Moderate efficacy (increase insulin and decrease glucagon relative to plasma glucose)
-No risk of hypoglycaemia
-Safe in renal impairment
=Sitagliptin can be used down to eGFR <30
-Potential risk of pancreatitis
-Reduce dose in AKI
-Stop in pancreatitis
Describe GLP1 analogues
-Highly effective (increases insulin and decreases glucagon relative to blood glucose)
-Weight loss
-No hypoglycaemia risk
-Injected – but potentially only weekly
-GI side effects limit use
=nausea
-CV benefits seen
-Risk of pancreatitis/ gall stone disease
-Check if weekly dosing
-Stop in suspected pancreatitis
-Hold if very dehydrated
Describe SGLT2 inhibitors
-Intermediate efficacy (acts at kidney to prevent glucose resorption)
-Weight loss
-Initiated if eGFR >60
-Stopped if eGFR <45
-GU side effects limit use
-Risk of dehydration (polyuria) and DKA (hold in dehydration or fasting, AKI, eGFR<45)
Types of insulin
-Basal long-acting (Lantus)
-Prandial rapid-acting (Novorapid)
-Basal intermediate acting (insulatard)
-Prandial short-acting (actrapid)
-Premixed human (Humulin M3)
