Type 2 Diabetes Flashcards
What is the pathophysiology of T2DM?
Central adiposity causes increased exposure and so reduced sensitivity to insulin
Over time the beta cells become fatigued and damaged so are unable to secrete the high levels of insulin required
What are the risk factors?
Old age
Ethnicity
FH
Obesity
Sedentary lifestyle
High carbohydrate diet
What blood test is used to screen for T2DM?
HbA1c
What is the presentation?
Fatigue
Polydipsia
Polyuria
Unintentional weight loss
Slow healing
Glucose in urine dipstick
What is the diagnosis of T2DM?
HbA1c>48mmol/L
Random glucose>11mmol/L
Fasting glycose>7mmol/L
Oral glucose tolerance test (OGTT) >11mmol/L
What is OGTT?
Performed before breakfast
Take a baseline fasting plasma glucose
Patient drinks a 75g glucose drink
Measure plasma glucose 2 hours later
What is pre-diabetes?
Patient is at risk of progressing to diabetes
Diagnosed with HbA1c (42-47mmol/L)
What is the treatment target for HbA1c?
48mmol/mol for new T2DM
What is the management of T2DM?
Dietary modification
Exercise and weight loss
Stop smoking
Monitor complications
What is the medical management of T2DM?
- Metformin
- Sulfonylurea, Pioglitazone, DPP-4 inhibitor or SGLT-2 inhibitor
- Triple therapy (metformin + 2 of second line agents)
or
metformin + insulin
What is metformin?
Biguanide
Increases insulin sensitivity and decreases liver production of glucose
No effect on body weight
What are the side effects of metformin?
Diarrhoea and abdominal pain
Lactic acidosis
What are sulfonylureas?
Most common is gliclazide
Stimulate insulin release from the B cells
Benefit when needing rapid improvement in BG control
What are the side effects of sulfonylureas?
Weight gain
Hypoglycaemia
Increased risk of CVD in monotherapy
Hypersensitivity reactions
What is pioglitazone?
A thiazolidinedione
Increases insulin sensitivity and decreases liver production of glucose
What are the side effects of pioglitazone?
Weight gain
Fluid retention
Anaemia
Heart failure
Increases risk of bladder cancer
What are incretins?
Hormones produced by the GI tract that act to reduce BG:
- Increase insulin secretions
- Inhibit glucagon production
- Slow absorption by GI tract
What are the 2 groups of incretins?
DPP-4 inhibitors
GLP-1 mimetics
What is the action of DPP-4 inhibitors?
DPP-4 is an enzyme that inhibits incretins
GLP-1 is the main incretin
DPP4 inhibitors therefore increase GLP-1 activity
E.g. sitagliptin
What are the side effects of DPP-4 inhibitors?
GI tract upset
Pancreatitis
What is the action of GLP-1 mimetics?
Mimic the action of the incretin hormone GLP-1 (glucagon like peptide-1)
E.g. exenatide
What are the side effects of GLP-1 mimetics?
GI tract upset
Weight loss
Dizziness
What are SGLT-2 inhibitors?
Empagliflozin, canagliflozin
Block the SLGT-2 protein that is responsible for reabsorbing glucose in the proximal tubules of the kidneys
Cause glucose to be excreted in the urine
When are SGLT-2 inhibitors used?
1st or 2nd line (after metformin if tolerated) in patients at high CV risk
Greatly reduce risk of cardiovascular events such as MI, stroke and death
What are the side effects of SGLT-2 inhibitors?
Glucosuria
UTIs
Osmotic symptoms
Weight loss
Risk of DKA (rare)
Risk of digital amputation
What are the groups of insulin?
Rapid acting e.g. novorapid
Short acting e.g. actrapid
Intermediate acting e.g. insulatard
Long acting e.g. lantus
Combination insulins (rapid + intermediate) e.g. humalog 25
