Type 2 Diabetes Flashcards
main 2 pathological processes in T2D?
insulin resistance
relative insulin deficiency
what BGL is diagnostic of T2DM?
> 11.1
what dose of metformin should you give intiially then what should you move on to?
500mg bd THEN
1g bd
what change do beta cells go under before dying off?
hyperplasia
what effect does hyperglycaemia have on incretins?
decreased effect
what effect does hyperglycaemia have on neurotransmitters?
lose function
is glucose reabsorbed more or less in hyperglycaemia?
more
is glucose uptake increased or decreased in hyperglycaemia?
decreased
is lipolysis increased or decreased in hyperglycaemia?
increased
how can you tell via test if beta cells are no longer working?
if there is no C peptide
what is the systemic effect of chronic hyperglycaemia?
microvascular disease
main association with macrovascular disease in diabetes?
insulin resistance
what drugs can be used as prophylaxis for CVD risk from diabetes?
statins
anti-hypertensives
what drug management should be given to a new presentation of T2DM?
metformin 500mg bd
statin
ACEI/Ca blocker
how often should you review TRDM?
6 months
non-pharmacological management plan for a new T2DM?
weight target (5-10% reduction)
exercise target
diet/lifestyle advice
what does metformin do to the body?
decreases hepatic gluconeogenesis
increases peripheral glucose uptake
metformin decreases HbA1C by how much?
0.8-2%
adverse effects of metformin?
GI problems
lactic acidosis
lowset dose of gliclazide available?
60mg
what characteristics make you less likely to meet glycaemic targets?
younger female obese on many drugs not at bp/lipid target
what should you give if the patient is getting hypo when on SUR?
change to TZD
what should you do if thr patient is gaining weight on a TZD?
DPP4 inhibitors
potential side effects of DPP4 inhibitors?
osmotic symptoms
rising HbA1C
what should you give after a DPP4 inhibitor?
insulin
last line treatment for T2D?
GLP-1 inhibitor
do SURs increase 1st, 2nd or both phases of insulin secretion?
both
maximum gliclazide dose you can give?
120mg
what do SGLT2 receptors do?
reabsorb glucose
what drug class increases peripheral glucose uptake?
TZDs
what drug class increases fracture risk?
TZDs
what drug classes are better for high BMI patients?
insulin sensitisers eg MF, SGLT-2, DPP-4i, TZDs
what shoudl you give if the patient gets NAFLD?
TZD
