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Endocrine > Type 2 Diabetes > Flashcards

Type 2 Diabetes Flashcards

1
Q

What are the risk factors for T2DM?

A

Non modifiable:

  • older age
  • ethnicity (black, chinese, south asian)
  • family history

Modifiable:

  • obesity
  • sedentary lifestyle
  • high refined carb diet
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2
Q

How can a patient be screened for T2DM?

A

Check HbA1c

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3
Q

Which symptoms might be present in T2DM?

A 
Fatigue
Polydipsia + polyuria
Unintentional weight loss
Opportunistic infections
Slow healing
Glucose in urine (on dipstick)
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4
Q

How is T2DM diagnosed?

A

If symptomatic, any of:

  • fasting glucose > 7
  • random glucose or OGTT >/= 11.1
  • HbA1c > 48 (6.5%)

If asymptomatic:
- repeat test on a separate occasion to confirm

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5
Q

What is pre-diabetes and how is it diagnosed?

A 
Indication that the patient is heading towards diabetes - require good education + lifestyle advice to prevent progression
Diagnosed with either:
- HbA1c
- impaired fasting glucose
- impaired glucose tolerance
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6
Q

Which HbA1c results would indicate pre-diabetes?

A

42-47

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7
Q

How is impaired fasting glucose defined?

A

Fasting glucose 6.1 - 6.9

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8
Q

How is impaired glucose tolerance defined?

A

Plasma glucose at 2 hours on OGTT –> 7.8 - 11.1

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9
Q

Which dietary modifications are recommended for T2DM?

A

Vegetables + oily fish

Low glycemic index, high fibre diet

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10
Q

Which other risk factors should be modified in the management of T2DM?

A 
Exercise + weight loss
Stop smoking
Optimise treatment for other illnesses:
- hypertension
- hyperlipidaemia
- CVD
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11
Q

What should the target HbA1c be for T2DM?

A

48 for new type 2 diabetics

53 for those who have moved beyond metformin alone

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12
Q

What is HbA1c?

A

Measure of glycated haemoglobin (glucose attached to Hb)

–> reflects average glucose level over the last 3 months

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13
Q

What is the first line medical management for T2DM?

A

Metformin

- initially 500mg once daily as tolerated

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14
Q

What is the second line medical treatment for T2DM?

A

If HbA1c remains > 48, add either:
- sulfonylurea (usually first unless risk of hypo undesirable)
- pioglitazone
- DPP-4 inhibitor
- SGLT2 inhibitor
(based on individual factors + drug tolerance)

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15
Q

What is the third line medical treatment for T2DM?

A

Triple therapy with metaformin + 2 of second line drugs
OR
Metformin + insulin

(if HbA1c remains > 58 despite two drugs)

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16
Q

Which drugs are preferred for patients with cardiovascular disease?

A

SGLT2 inhibitors + GLP-1 inhibitors

17
Q

What type of drug is metformin and how does it work?

A

Biguanide

- increases insulin sensitivity + decreases liver production of glucose

18
Q

What are the side effects of metformin? What are the contraindications?

A

Diarrhoea + abdominal pain (dose dependent, reducing the dose often helps)
LACTIC ACIDOSIS

Doesn’t cause hypoglycaemia, weight neutral

CI:

  • significant renal impairment
  • those at risk of tissue hypoxia e.g. dehydration, sepsis, acute heart/liver/resp impairment
  • iodine containing contrast (stop day before)
19
Q

What kind of drug is pioglitazone and how does it work?

A

Thiazolidinedione

- increases insulin sensitivity + decreases liver production of glucose

20
Q

What are the side effects of pioglitazone?

A 
Weight gain
Fluid retention (oedema, ascites)
Anaemia
Heart failure
Bladder cancer (extended use)
Raised LFTs
Fractures

Doesn’t cause hypoglycaemia

21
Q

How do sulfonylureas work? Give an example

A

Stimulate insulin release from the pancreas

  • gliclazide
  • glibenclamide
22
Q

What are the side effects of sulfonylureas?

A

Weight gain
HYPOGLYCAEMIA
Increased risk of CVD + MI when used as monotherapy
SIADH

23
Q

How do DPP-4 inhibitors work? Give an example

A

Inhibit the DPP-4 enzyme –> increase in GLP-1 activity

  • sitagliptin
24
Q

What are the side effects of DPP-4 inhibitors?

A

GI upset
Symptoms of URTI
Pancreatitis

25
Q

Give an example of a GLP-1 mimetic. When are they used?

A

Exenatide - given as a SC injection twice daily or once weekly in MR form

Sometimes used in combination with metformin + sulfonylurea in overweight patients

26
Q

What are the side effects of GLP-1 mimetic?

A

GI upset
Weight loss
Dizziness

Low risk of hypoglycaemia

27
Q

How do SGLT-2 inhibitors work? Give some examples

A

Block the reabsorption of glucose in the proximal tubules of the kidney –> excretion of glucose in the urine

End with ‘gliflozin’

  • empagliflozin
  • dapagliflozin
  • canagliflozin
28
Q

What are the side effects of SGLT-2 inhibitors?

A

Glucosuria
Increased risk of UTIs
Weight loss
DKA (rare - notably with only moderately raised glucose)
Increased likelihood of lower limb amputation

29
Q

What are the positive effects of SGLT-2 inhibitors?

A

Reduce the risk of CVD and hospitalisation with HF

30
Q

How is control of diabetes monitored in T2DM?

A

HbA1c every 3-6 months initially, then every 6 months once stable
No need for finger prick glucose unless on insulin/suspected hypos

31
Q

Which oral hypoglycaemics are okay for use in pregnancy?

A

Metformin

Glibenclamide

32
Q

When must patients with diabetes inform the DVLA?

A

All drivers on insulin

HGV drivers on insulin OR oral hypoglycaemics (even if not known to cause hypos)

33
Q

Can patients on insulin drive a HGV?

A

It is possible but very strict criteria regarding hypoglycaemia must be met

34
Q

What are the features of hyperosmolar hyperglycaemic state (HHS)?

A

Old patients, first presentation of T2DM
May be precipitated by illness, dehydration
Onset over several days:
- weakness, leg cramps, visual impairment
- severe hypovolaemia
- signs of infection
- confusion, lethargy, neuro signs, seizures, rarely coma

35
Q

What is the diagnostic criteria for HHS?

A
  1. glucose > 30
  2. serum osmolality > 320
  3. no significant ketosis
36
Q

How is HHS managed?

A

IV fluids - slower rate than DKA
Insulin after 1 hour - half the rate of DKA (very sensitive to insulin)
Monitor fluid balance, U&Es, glucose
DVT prophylaxis

37
Q

What are the complications of HSS?

A

Cerebral oedema
PE
Ischaemia: MI, stroke
Much higher mortality than DKA (due to older patients with comorbidities)

38
Q

What are the secondary causes of diabetes?

A

SHIT PANCREAS:

  • Steroids/Cushing’s
  • Haemochromatosis
  • Inflammation (pancreatitis)
  • Thyrotoxicosis
  • Phaemochromocytoma
  • Antipsychotics
  • Neoplasia
  • CF
  • anti- REtrovirals
  • Acromegaly
  • Surgical removal

Endocrine (16 decks)

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