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Endocrine SOH > Type 2 diabetes > Flashcards

Type 2 diabetes Flashcards

1
Q

Definition

A

Insufficient insulin to maintain glucose homeostasis

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2
Q

Are beta cells present?

A

Yes

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3
Q

Can the patient make their own insulin?

A

Yes

  • because beta cells are present
  • but the insulin doesn’t work well
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4
Q

Who gets it?

A

Middle aged / elderly population

Obese

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5
Q

Link between T2DM and obesity

A

Obese people are resistant to the actions of insulin
Pancreas tries to produce more beta cells to overcome the resistance but the pancreas can’t keep up
Patient becomes hyperglycaemic

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6
Q

Pathogenesis

A

Insulin levels are sufficiently high over a prolonged period of time
Fibrosis of islets
Beta cells present but they loose ability to sense changes in glucose level
Increased lipolysis
Increased glucose reabsorption

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7
Q

What happens if a person with T2DM looses weight?

A

Restores physiological glucose to normal levels
Beta cells start functioning properly again
Increased insulin secretion

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8
Q

Risk factors

A

Obesity
Age
FH
Hx heart conditions

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9
Q

Clinical features

A 
Gradual onset 
Overweight 
Thirst (polydypsia)
Frequent urination (Polyuria)
Tiredness
Thrush
Blurred vision
Infections
Balantitis (inflammation of the glands of the penis)
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10
Q

Discriminatory tests

A

GAD / anti-islet antibodies
Ketones
C-peptide

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11
Q

Investigations

A 
Fasting blood glucose 
Glucose tolerance test
Random fingerprick glucose test 
HbA1c 
Urinalysis 
Auto-antibodies -ve
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12
Q

Management - initial

A

Try monitor by lifestyle factors (weight loss) for at least one month before starting any medication

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13
Q

Management - first line drug therapy

A

Metformin

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14
Q

Management - second line drug therapy

A

Sulphonylurea
OR
Meglitinides

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15
Q

Management - third line drug therapy

A

Thiazolidenedione or DPPIV inhibitor
OR ADD
Injectible insulin or GLP-1 agonist

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16
Q

Metformin - what class of drug is it?

A

Biguanide

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17
Q

Metformin - administration route

A

Oral

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18
Q

Metformin - dosage

A

Start on low dose and gradually increase

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19
Q

Metformin - mechanism of action

A 
Increases glucose uptake into skeletal muscle 
Reduces hepatic gluconeogenesis 
Increases fatty acid oxidation 
Reduces carb absorption 
Works by being toxic to cells
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20
Q

Metformin - benefits

A

Reduces HbA1c levels
Weight loss (as it does not promote insulin release)
Decreases risk of CV events
Safe in pregnancy

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21
Q

Metformin - side effects

A 
GI disturbances 
Lactic acidosis (don't give in pts with renal impairment)
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22
Q

Metformin - who doesn’t get it

A

Patients with renal impairment

Skinny patients

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23
Q

Sulphonylureas - examples

A

Tolbutamide (short acting)

Glibenclamide and Glicazide (long acting)

24
Q

Sulphonylureas - administration route

A

Oral

25
Q

Sulphonylureas - mechanism of action

A

Stimulates insulin secretion
Binds to and blocks K+ATP channel
This depolarises functioning beta cells and stimulates insulin release

26
Q

Sulphonylureas - caution

A

If blood glucose levels drop to normal levels and there is not as much need for insulin, sulphonylureas will continue to produce insulin. This could lead to a hypo which is very dangerous

27
Q

Sulphonylureas - benefits

A

Reduces HbA1c levels

Improves microvascular complications of diabetes

28
Q

Sulphonylureas - side effects

A

Weight gain (as it promotes insulin secretion)
Hypoglycaemia (due to continuous insulin release)
Not safe in pregnancy
Hepatic failure
Renal failure

29
Q

Meglitinides - examples

A

Repaglinide, Nateglinide

30
Q

Meglitinides - mechanism of action

A

Similar to sulphonylureas…
Bind to K+ATP channels and block them
This ultimately triggers insulin release

31
Q

Thiazolidinediones (glitazones) - examples

A

pioglitazone

32
Q

Thiazolidinediones (guitarrones) - administration route

A

Oral

33
Q

Thiazolidinediones (glitazones) - mechanism of action

A

Activates PPAR-gamma

This promotes pre-adipocyte differentiation into mature adipocyte

34
Q

Thiazolidinediones (glitazones) - benefits

A

Reduces HbA1c levels

Promotes fatty acid uptake and storage in adipocytes

35
Q

Thiazolidinediones (glitazones) - side effects

A

Weight gain
Fluid retention (contra-indicated in HF)
Fractures
Avoid in pregnancy

36
Q

GLP-1 receptor agonists - examples

A

Exenatide

37
Q

GLP-1 receptor agonists - administration route

A

IV (before first and last meal of the day)

38
Q

GLP-1 receptor agonists - mechanism of action

A

mimics the action of GLP-1 (a peptide hormone released in response to a meal which provides early stimulus to insulin secretion).
Acts on the incretin pathway
Lowers blood glucose levels after a meal by
- slowing gastric emptying
- increasing insulin release

39
Q

GLP-1 receptor agonists - benefits

A

Weight loss
Decreased gastric emptying
Reduces hepatic fat accumulation
Prevents hypoglycaemia - when blood glucose levels are low, the drug responds accordingly by decreasing the secretion of insulin

40
Q

GLP-1 receptor agonists - side effects

A

Nausea

41
Q

DPP-IV inhibitors - examples

A

Gliptins

42
Q

DPP-IV inhibitors - administration route

A

Oral

43
Q

DPP-IV inhibitors - mechanism of action

A

Normally DPP-IV breaks down GIP and GLP-1, leading to increased glucose levels.
By inhibiting DPP-IV, blood glucose levels are lowered as GIP and GLP-1 levels are prolonged and free to continue the release of insulin

44
Q

DPP-IV inhibitors - benefits

A

Prevents hypoglycaemia

45
Q

DPP IV inhibitors - side effects

A

Nausea

Avoid in pregnancy

46
Q

SGLT2 inhibitors - examples

A

Canaglifozin

47
Q

SGLT2 inhibitors - administration route

A

Oral

48
Q

SGLT2 inhibitors - mechanism of action

A

Decreases glucose uptake

Causes you to pee out the glucose instead

49
Q

SGLT2 inhibitors - benefits

A

Weight loss

Decreased cardiovascular risk

50
Q

SGLT2 inhibitors - side effects

A

Thrush

Increased UTI’s

51
Q

Alpha-glucodiase inhibitor - examples

A

Acarbose

52
Q

Alpha-glucodiase inhibitor - mechanism of action

A

alpha glucosidase b/d complex carbs to smaller, absorbable units.
Inhibitors delay the absorption of glucose

53
Q

Insulin - use

A

Last treatment option in T2DM

For patients who fail on non-insulin therapies

54
Q

Insulin - side effects (driving)

A

Can only regain HGV drivers license if stable diabetes control for at least 3 months on insulin

55
Q

Annual review

A

Check feet
Check eyes - retinopathy
Check urine
Measure BP, weight, bloods

Endocrine SOH (25 decks)

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