Type 2 diabetes Flashcards
pathophysiology
repeated exposure to glucose and insulin makes cells resistant to insulin effects
body requires more insulin
pancreas fatigued and produces less
non-modifiable risk factors
age
ethnicity
FH
modifiable risk factors
obesity
sedentary lifestyles
high CHO
presentation
fatigue polydipsia and polyuria unintentional weight loss infections slow healing glucose in urine
OGTT
morning prior to breakfast
baseline fasting plasma glucose
give 75g glucose
measure plasma glucose 2 hours later
pre-diabetes diagnosis
HbA1c 42-47mmol/l or impaired OGTT
fasting glucose 6.1-6.9
glucose tolerance 7.8-11.1
diabetes diagnosis
HbA1c >48mmol/l
random glucose >11mmol/l
fasting glucose >7mmol/l
OGTT 2 hour >11mmol/l
management
education diet/lifestyle stop smoking optimise bp monitor for complications
when to start treatment?
48mmol/l for new type 2
53mmol/l metformin
medical management
metformin 500mg
sulfonylurea, pioglitazone, SGLT-2 inhibitor or DDP-4 inhibitor
insulin
metformin
biguanide increase insulin sensitivity
decrease liver producing glucose
does metformin cause weight gain?
no
side effects of metformin
lactic acidosis
GI - diarrhoea and abdo pain
pioglitazone
TZD
works similar to metformin
pioglitazone side effects
weight gain fluid retention bladder cancer heart failure anaemia
most common sulfonylurea
gliclazide
how do sulfonylureas work?
stimulate insulin release from pancreas
sulfonylurea side effects
weight gain
hypoglycaemia
CVD and MI
What are incretins?
hormones produced by GI tract in response to large meals to increase insulin, inhibit glucagon and slow absorption
main incretin
GLP-1
what enzyme inhibits incretins?
DDP-4
example of DDP-4 inhibitor
sitaglipin
DDP-4 side effects
GI tract upset
URTI
pancreatitis
side effects of GLP-1 mimetics
GI tract upset
weight loss
dizziness
How do SGLT-2 inhibitors work?
SGLT-2 reabsorb glucose in proximal tubules
blocking this cause glucose to be excreted in urine
side effects of SGLT-2 inhibitors
glucoseruia DKA lower limb amputation UTI weight loss
examples of rapid acting insulin and how long they work
work after 10 mins and last around 4 hours
novorapid, humalog and apidra
short-acting insulin examples and how long they work
take 30 mins, last 8 hours
actrapid, humulin S
Long acting isulins
levemir
last 24 hours