Type 2 Diabetes

Question 1

What are the symptoms of type 2 diabetes

Answer 1

• Often picked up incidentally
• Polydipsia
• Polyuria

Question 2

Explain the diagnosis of type 2 diabetes

Answer 2

• Fasting glucose greater than or equal to 7 mmol/l
• Random glucose greater than or equal to 11.1 mmol/l
• HbA1c greater than/equal to 48mmol/mol
• If symptomatic then demonstrate once, if asymptomatic then demonstrate twice

Question 3

What can you not use HbA1c for a diagnosis of diabetes?

Answer 3

• Haemoglobinopathies,
• Haemolytic anaemias,
• Untreated iron def anaemia,
• Suspected gestational diabetes
• Children
• HIV
• CKD

Question 4

What results indicate prediabetes?

Answer 4

HbA1c between 42-47 mmol/mol
Fasting glucose of 6.1-6.9

Question 5

What is the treatment overview for type 2 diabetes?

Answer 5

1st line- Lifestyle changes
2nd line - Metformin (+ empagliflozin if CV risks)
3rd line - Add 2nd drug (sulphonylurea, piogliflozin, DDP-4 inhibitor, SGLT2 inhibitor)
4th line - Metfrmin and two other drugs or metformin and injectable

Question 6

Describe features of metformin

Answer 6

• MOA = Increases insulin sensititivity and reduced hepatic gluconeogenesis
• Side effects include GI uoset, metabolic acidosis and lactic acidosis
• DO NOT GIVE IF eGFR < 30

First line

Question 7

Describe features of sulphonylureas

Answer 7

• MOA = Stimulates pancreatic beta cells to secrete insulin (squeeze)
• Side effects = hypoglycaemia, weight gain and hyponatraemia
• Gliclazide

Squeezes extra insulin out regardless of blood sugar which causes risk of hypoglycaemia

Question 8

Describe features of pioglitazone

Answer 8

• MOA = Activates PPAR gamma receptors in adipocytes to promote fatty acid uptake.
• Side effects include weight gain, increased risk of fractures and fluid retention
• Do not give heart failure or osteoporosis.

Question 9

Describe features of DPP-4 inhibitors

Answer 9

• Increases incretin levels which inhibits glucagon secretions.
• Well tollerated but increases risk of pancreatitis
• Sitagliptin

Question 10

Describe features of SGLT2 inhibitors

Answer 10

• Inhibitrs reabsorption of glucose in the kidney
• Side effects include UTIs
• Typically causes weight loss

Question 11

Describe features of GLP-1 agonists

Answer 11

• Incretin mimetic which inhibits glugacon secretion
• Side effects include nausea, vomiting and pancreatits
• Weight loss
• Exenatide