Type 2 diabetes Flashcards
Confirmation of hyperglycemia - criteria
> = 7 mmol/L venous fasting glucose
= 11.1 mmol/L venous random glucose
=11.1 mmol/L 2 hr post 75 g OGTT
6.5% HbA1c
3 microvascular complications of Typ2 DM
retinopathy
neuropathy
nephropathy
2 macrovascular disease complications of Type 2 DM
- MI
- stroke
7 year incidence of MI in people with diabetes and no prior MI is the same as
No DM with prior MI
In Type 2 Diabetic what should HBA1c be
between 6 and 7
What should fasting cap glucose be in a type 2 diabetic
between 4 and 7
What should 2 hr postprandial cap glucose be in a type 2 diabetic
between 5 and 8 if HBA1c is above target, between 5 and 10 otherwise
HBA1c levels were determined based on
risk for retinopathy
Metformin is
an insulin sensitizer -
reduces glucose output from liver
increases glucose uptake in tissues
Metformin, glitazone, exercise and weight loss are acting to reduce
insulin resistance in fat and muscle
Insulin, sulfonylurea, meglitanide and incretins
on pancreas improve ability to secrete insulin
alpha-glucosidase inhibitors, and pancreatic lipase
block carbohydrate absorption in the gut
most potent insulin sensitizer is
Thiazolidinedione - Glitazone -
Incretins : glucagon like peptide 1
act by increasing insulin secretion
decrease apetite
decrease glucose production
Newest class to treat Type 2DM
- SGLT2 inhibitors prevent glucose resorption in prox tubule of kidney
how do you screen for chronic kidney disease in diabetes
Urine albumin: creatinine ratio < 2
In type 1 and type 2 diabetes when to screen for diabetic retinopathy
1- 5 yrs after diagnosis >15 yrs of age, annual
2- at diagosis, q1-2 years
2 agents that cause weight loss
GLP1 agonist
SGLT2 inhibitor
impaired fasting glucose
6.1-6.9
impaired glucose tolerance
2hrpost 75g OGT, 7.8-11
% risk reduction by lifestyle in incidence of diabetes vs metformin
58% vs 31%
If someone has IFG or IGT then
implement moderate weight loss, and regular activity
3 main mechanisms of Type 2 diabetes
1) insulin resistance
2) excess glucose output by the liver
3) relative insulin deficiency
what is hemoglobin A1C
3 month reflection of average blood sugar
those who are at risk for hypoglycemia can have what level of A1C
a slightly higher level >7, consider 7.1-8.5
metformin cannot be used in
patients with renal failure, it can lead to lactic acidosis
drug that can cause hypoglycemia and weight gain
sulfonylureas
How do TZD’s act?
increase glucose uptake in liver, adipose and muscle, take 4 weeks to work
TZD’s not used because
cause cardiac disease, edema
when is GLP1 released
in response to glucose in GI tract
Function of incretins
increases insulin secretion - no hypoglycemia
- no weight gain
- reduces gastric emptying, reduces apetite
why is GLP1 not given generally?
lasts seconds needs to be given IV
what is the incretin therapy given now?
GLP1 analogue
and
DPP4 inhibitors
3 drugs that increase insulin sensitivity
metformin
TZDs
GLP1 analogues
Blood pressure for Typ2 dM
<130/80
Target LDL for Type 2 DM
<2.0
What do you screen for CKD?
Microalbuminuria before overt nephropathy
