Type 2 Diabetes Flashcards
What is the primary mechanism behind Type 2 Diabetes?
Insulin resistance due to repeated exposure to glucose and insulin
Insulin resistance leads to increased insulin requirements for glucose uptake.
What happens to the pancreas in Type 2 Diabetes?
Pancreas becomes fatigued and damaged, leading to reduced insulin output
This results from the increased demand for insulin due to resistance.
List the non-modifiable risk factors for Type 2 Diabetes.
- Older age
- Ethnicity (black African/Caribbean, South Asian)
- Family history
92% of T2DM cases present between ages 26-39.
What are the modifiable risk factors for Type 2 Diabetes?
- Obesity
- Sedentary lifestyle
- High carbohydrate/sugar diet
Lifestyle changes can significantly impact these factors.
What are some common symptoms of Type 2 Diabetes?
- Tiredness
- Polyuria and polydipsia
- Unintentional weight loss
- Opportunistic infections
- Slow wound healing
- Glucose in urine
Microvascular: vision blurred, ulcers
Macrovascular: Angina, tingling
Symptoms can vary in severity among individuals.
What is Acanthosis Nigricans?
Thickening and darkening of the skin, typically around the neck, axilla, and groin, associated with insulin resistance
Appears velvety in texture.
What is the HbA1c range indicating pre-diabetes?
42-47 mmol/mol
Pre-diabetes is reversible with lifestyle changes.
What HbA1c level confirms a diagnosis of Type 2 Diabetes?
HbA1c of 48 mmol/mol or greater, or HbA1c > 6.5%
A repeat test is required for confirmation unless complications are present.
What are the criteria for diagnosing Type 2 Diabetes?
- Fasting blood glucose > 7 mmol/L
- Random glucose > 11 mmol/L on 2 separate occasions
- HbA1c of 48 mmol/mol or greater
Diagnosis requires confirming tests.
What is the first-line medication for Type 2 Diabetes?
Biguanide (Metformin)
Used primarily for its efficacy in improving insulin sensitivity.
What is recommended for patients with cardiovascular disease or heart failure?
SGLT-2 inhibitor as monotherapy
This is recommended for patients with a QRISK score of 10% or more.
What constitutes dual therapy in Type 2 Diabetes management?
Adding a sulfonylurea, pioglitazone, DPP-4 inhibitor, or SGLT-2 inhibitor to Metformin
Dual therapy is used when monotherapy is insufficient.
What is included in triple therapy for Type 2 Diabetes?
- Metformin + 2 second-line drugs
- Insulin therapy
Triple therapy is utilized when dual therapy fails.
What are some key complications of Type 2 Diabetes?
- Infections
- Diabetic retinopathy
- Peripheral neuropathy
- Autonomic neuropathy
- Chronic kidney disease
- Diabetic foot
- Gastroparesis
- Hyperosmolar hyperglycaemic state
These complications can significantly impact quality of life.
Fill in the blank: Patients with Type 2 Diabetes and hypertension should be treated with _______.
ACE inhibitors
This is part of managing co-morbid conditions.
What are the features of hyperosmolar hyperglycaemic state?
- Hyperosmolality
- Hyperglycaemia
- Absence of ketones
It is a potentially fatal complication of diabetes.
What symptoms are associated with hyperosmolar hyperglycaemic state?
- Polyuria
- Polydipsia
- Weight loss
- Dehydration
- Tachycardia
- Hypotension
- Confusion
These symptoms indicate severe hyperglycaemia.
What is the emergency management for hyperosmolar hyperglycaemic state?
IV fluids and monitoring
Immediate treatment is crucial to prevent complications.
What is the class of Metformin?
Biguanide
Metformin is classified as a biguanide, which is a type of medication used to treat type 2 diabetes.
What is the primary action of Metformin?
Increases insulin sensitivity and decreases hepatic gluconeogenesis
Metformin helps the body use insulin more effectively and reduces glucose production in the liver.
What are the pros of using Metformin?
- Weight loss
- Unlikely to cause hypos
Metformin is beneficial for weight management and has a low risk of causing hypoglycemia.
What are common side effects of Metformin?
- Gastro (pain, nausea, diarrhoea)
- Lactic acidosis (AKI)
Gastrointestinal issues are common, and lactic acidosis is a serious but rare side effect.
What should be tried for those experiencing side effects from Metformin?
Modified-release metformin
Modified-release formulations may help reduce gastrointestinal side effects.
What is the class of SGLT-2 inhibitors?
‘-gliflozin’
SGLT-2 inhibitors include medications ending in ‘-gliflozin’.
Name two examples of SGLT-2 inhibitors.
- Empagliflozin
- Canagliflozin
These medications are used to manage blood glucose levels in diabetes.
What is the mechanism of action of SGLT-2 inhibitors?
Block SGLT 2 transporter in the proximal tubule of the kidney
This action prevents glucose reabsorption, leading to glucose excretion in urine.
What are the benefits of SGLT-2 inhibitors?
- Lowers HbA1c
- Reduced BP
- Weight loss
- Improves HF
- Reduces CVD
SGLT-2 inhibitors provide multiple cardiovascular and metabolic benefits.
What are the side effects of SGLT-2 inhibitors?
- Hypoglycaemia
- Glycosuria
- Increased urine frequency
- UTI
- Genital infection
- Weight loss
- DKA
- Lower-limb amputation
- Gangrene
These side effects can vary in severity and impact patient management.
What class of medication is a DPP-4 inhibitor?
Dipeptidyl peptidase 4 inhibitor
DPP-4 inhibitors are a class of drugs used to lower blood sugar in type 2 diabetes.
What is a pro of DPP-4 inhibitors?
Reduce postprandial and fasting hyperglycaemias
They help control blood glucose levels after meals and throughout the day.
What are the cons of DPP-4 inhibitors?
- Risk of hypos
- Headaches
- Mask pain
- GI disturbances
Patients may experience a range of side effects that can affect their quality of life.
What class of medication is Pioglitazone?
Thiazolidinedione
Pioglitazone is used to improve insulin sensitivity.
What is the action of Pioglitazone?
Increases insulin sensitivity and decreases liver production of glucose
This action helps in managing blood sugar levels effectively.
What are the side effects of Pioglitazone?
- Weight gain
- Heart failure
- Risk of bone fracture
- Bladder cancer risk
These side effects necessitate careful patient selection and monitoring.
What is the action of Sulfonylureas?
Stimulate insulin release from pancreas
They help to increase insulin levels in the body to lower blood sugar.
What is an example of a Sulfonylurea?
Gliclazide
Gliclazide is a commonly used sulfonylurea in diabetes management.
What are the side effects of Sulfonylureas?
- Weight gain
- Risk of hypos
Similar to other diabetes medications, sulfonylureas carry a risk of hypoglycemia.
What are GLP-1 agonists?
GLP-1 Agonists
* (-tides and -glutides)
* Stimulate insukin secretion, reduce glucagon concentration
* Daly gastric emptying which delays apprtitie hormones and causes weight loss
- Side effects: Weight loss and decrease appetitie, GI distrubances, headaches/diziness
