Type 2 diabetes Flashcards
What is type 2 diabetes?
A condition in which a combination of insulin resistance and reduced insulin production cause persistently high blood sugar levels
What does a high carbohydrate diet combined with insulin resistance and reduced pancreatic function lead to?
Chronic hyperglycaemia
Give some non-modifiable risk factors of type 2 diabetes?
Older age
Family history
Ethnicity - Black African / Caribbean / South Asian
Give some modifiable risk factors of type 2 diabetes?
Obesity
Sedentary lifestyle
High carbohydrate diet - sugar
What is acanthosis nigricans?
Thickening and darkening of the skin giving a ‘velvety’ appearance often at the neck, axilla and groin
What is acanthosis nigricans associated with in type 2 diabetes?
Insulin resistance
What HbA1c range indicates
pre-diabetes?
42-47 mmol/mol
What HbA1c indicates type 2 diabetes?
48 mmol/mol or above
Give some non-medical management options for type 2 diabetes?
Patient education
High fibre + low carb diet
Exercise
Weight loss
What is the HbA1c target for new type 2 diabetes patients?
48 mmol/mol
What is the HbA1c target for patients requiring more than one antidiabetic medication?
53 mmol/mol
How often should HbA1c be measured in patients with type 2 diabetes inititally?
Every 3 to 6 months
What is the first line treatment of type 2 diabetes?
Metformin
What antidiabetic should be given additionally to metformin in a patient with cardiovascular disease or heart failure?
SGLT-2 inhibitor
What is the second line treatment of type 2 diabetes?
Add a sulfonylurea, pioglitazone, DPP-4 inhibitor or SGLT-2 inhibitor
What are the two third-line treatments for type 2 diabetes?
Triple therapy - metformin and two second-line drugs
Insulin therapy
What can be done if triple therapy fails in type 2 diabetes?
Switching one of the drugs to a GLP-1 mimetic
How does metformin work?
Increases insulin sensitivity
Decreases glucose production
What are the notable side effects of metformin?
Gastrointestinal upset - aches, nausea + diarrhoea
How do SGLT-2 inhibitors work?
It blocks the reabsorption of glucose from urine into blood causing more glucose to be excreted in the urine
What are the notable side effects of SGLT-2 inhibitors?
Glycosuria - glucose in urine
Genital infections / UTIs
Weight loss
Diabetic ketoacidosis
Fournier’s gangrene - rare
What does pioglitazone (a thiazolidinedione) do?
Increases insulin sensitivity
Decreases liver production of glucose
What are the notable side effects of pioglitazone?
Weight gain
Heart failure
Increased fracture risk
What do sulfonylureas do?
Stimulate insulin release from the pancreas
What are the notable side effects of sulfonylureas?
Weight gain
Hypoglycaemia
What do DPP-4 inhibitors do?
Block the action of DPP-4 which allows increased incretin activity
What are the notable side effects of DPP-4 inhibitors?
Headaches
Low risk of acute pancreatitis
What do GLP-1 mimetics do?
Mimic the action of GLP-1 to increase insulin secretion and inhibit glucagon production
What are the notable side effects of GLP-1 mimetics?
Reduced appetite
Weight loss
Gastrointestinal symptoms
What are the main complications of type 2 diabetes?
Infections - thrush, infected ulcers
Diabetic retinopathy
Peripheral neuropathy
Autonomic neuropathy
Chronic kidney disease
What drugs are used to manage hypertension in patients with type 2 diabetes?
ACE inhibitors
Name 3 drugs that can be used for neuropathic pain?
Amitriptyline
Gabapentin
Pregabalin
What does HHS stand for?
Hyperosmolar hyperglycaemic state
What is hyperosmolar hyperglycaemic state?
A rare but potentially fatal complication of type 2 diabetes
It is characterised by hyperosmolality, hyperglycaemia and an absence of ketones
What is the clinical presentation of hyperosmolar hyperglycaemic state?
Polyuria, polydipsia
Weight loss
Dehydration
Tachycardia
Hypotension
Confusion
How is hyperosmolar hyperglycaemic state managed?
Medical emergency managed with IV fluids and careful monitoring
