Type 2 Diabetes Flashcards
what is Type 2 diabetes?
combination of insulin resistance and reduced insulin production
pathophysiology of t2d?
more and more insulin is required to insensitive cells and pancreas is fatigued and insulin output decreases
risk factors for t2d?
older age
ethnicity (black african, or caribbean and south asian)
FH
obesity
sedentary lifestyle
high carb diet
presenting features of diabetes?
tiredness, polyuria, polydipsia, unintentional weight loss, opportunistic infection, slow wound healing, glucose in urine.
acanthosis nigricans- insuin resistance
prediabetes level?
42-47 mmol/mol
what level diagnoses HbA1c?
48 mmol/mol, typically repeated after 1 month
Treatment targets for t2d?
48, but if on more than 1 antidiabetic drug then 53
measured every 3-6 months
medical management for t2d?
1st line- metformin
plus sglt2 inhibitors if cardiovascular disease/HF/ Qrisk greater than 10%
2nd line- add sulofnylurea, pioglitazone, DPP4 inhibitor, SGLT2 inhibitor
3rd line- triple therapy- metformin/ 2 secondline
insulin therapy
if triple therapy fails and BMI is above 35kg/m3?
option to switch one of drugs to GLP1 mimetic (liraglutide
side effect of sglt2 inhibitor?
diabetic ketoacidosis
how does metformin work?
increases insulin sensitivity and decreases glucose production (biguanide)
side effects of metformin?
gastrointestinal symptoms, lactic acidosis ( secondary to AKI)
patients with GI side effects can try to modified release instead of standard release
how do SGLT2 inhibitors work?
drug works on sodium glucose co-transporter 2 protein in proximal tubules causing more glucose to be excreted. lowers blood glucose, reduced bp, weight loss and improves heart failure. canc ause hypoglycaemia when used with insulin and sulfonylureas.
side effects of SGLT2 inhibitors?
genital and UTI
weight loss
DKA
lower limb amputation (canagliflozin)
fournier’s gangrene (infection of genitals and perineum)
pioglitazone?
thiazolidinedione, increases insulin sensitivity and reduces production of glucose in liver.
side effects of SGLT2 inhibitors?
weight gain, HF, bone fracture riskincreases, bladder cancer risk increases
sulfonylureas action?
gliclazide, stimulate insulin release from pancreas.
side effects of sulfonylureas?
weight gain
hypoglycaemia
how do incretins work?
hormone that reduced glucagon production, increase insulin secretion, slowing absorption by GI tract
what is the main incretin?
glucagon like peptide 1
What are incretins inhibited by?
dipeptidyl peptidase 4 DPP4
DPP 4 inhibitors side effects?
sitagliptin, alogliptin
headache, low risk of acute pancreatitis
GLP1 mimetic exenatide/liraglutide side effects?
reduced appetite, wight loss and Gi symptoms
rapid acting insulins NovoRapid works?
after 10 minutes and last 4 hours
short acting insulins Actrapid works?
30 minutes and last 8 hours
intermediate acting insulins (humulin I) works?
1 hour and lasts 16 hours
long acting insulins (levemir/lantus) works?
1 hour and lasts 24 hours or longer
combination insulins include?
rapid acting and intermediate acting
Humalog 25 (25:75)
Humalog 50 (50:50)
Novomix 30 (30:70)
complications of type 2 diabetes?
infections
diabetic retinopathy
peipheral neuopathy
autonomic neuropathy
chronic kidney disease
diabetic foot
gastroparesis
hyperosmolar hyperglycaemic state
what to use to manage HTN in TD2?
ACEi
and in CKD when albumin:creatnine ratio is above 3mg/mmol
when are SLGT2i started in CKD?
when albumin: creatinine ratio is. above 30mg/mmol
what to use in erectile dysfunction?
phosphodiesterase 5 inhibitors sildenafil or tadalafil
what can be used for fgastroparesis?
prokinetic drugs: domperidone/ metoclopramide
used in caution due to cardiac side effects
options for neuropathic pain?
amitryptyline -tricyclic antidepressant
duloxetine-SNRI antidepresant
gabapentin
pregabalin anticonvulsant
Hyperosmolar hyperglycemic state?
T2D fatal complication, hyperosmolarity, hyperglycaemia and absence of ketones
presents with polyuria, polydipsia, weight loss, dehydration tachycardia hypotension and confusion
treatment with iv fluids and careful monitoring
how to diagnose t2d?
if symptomatic: fasting glucose more than 7
random glucose =>11.1
if not symptomatic then above proven on 2 different occasions
other conditions can cause elevated HbA1c?
haemolytic anaemia
haemoglobinopathies
untreated iron deficiency anaemia
suspected gestational diabetes
children
HIV
CKD
medication that cause hyperglycaemia corticosteroids
what is impaired fasting glucose?
greater than or equal to 6.1mmol/l but less than 7
impaired glucose tolerance?
fasting glucose less than 7 then oral glucose tolerance test levels between 7 .8 and 11.1
