Type 2 Diabetes Flashcards
Which type of diabetes has an insidious onset?
T2
List common symptoms / presentations of T2DM
Tired, lethargic
Polyuria and polydipsia
Drink lucozade / coke bcos of thirst
List signs of T2DM
High glucose
High sodium
Dehydrated
Recall the osmolality equation
2 (Na + K) + glucose + urea = osmolality
List complications of T2DM
Microvascular - retinopathy, nephropathy, neuropathy
Macrovascular = IHD, CVA, gangrene
List features of background diabetic retinopathy
Hard exudates (cholesterol)
Microaneurysms
Blot haemorrhages
What is the treatment of background diabetic retinopathy
Better BGC control
What do cotton wool spots indicate?
Ischaemia
What is the treatment for proliferative and pre proliferative diabetic retinopathy? What is the logic?
Pan retinal photocoagulation
To kill off peripheral cells in order to spare central vision
Name the famous UK diabetes study
UKPDS - UK prospective diabetes study
What did UKPDS show?
Tight BGC control from the moment of diagnosis will have ‘LEGACY EFFECTS’ throughout life, even if the control is then slackened
What did the Accord study show?
Sudden tight control of BGC in people who had already suffered cardiac events lead to more sudden death
List the management for T2DM
- diet and exercise
- metformin
- gliclazide
- Insulin sensitiser
- Insulin
- Incretins
- Gliptins
What type of drug is metformin?
Biguianide
What type of drug is gliclazide?
Sulphonureas
What are gliptins and what do they do?
Dipeptidyl peptidase 4 inhibitors, which prevent your own GLP1 breakdown
Describe the different types of insulin analogues
Long acting - zinc suspension
Slow acting - actrapid (soluble)
Delayed insulin subcut
List 2 advantages of insulin
HbA1c control
No side effects as its a natural product
List side effects of metformin and sulphonureas
Metformin = diarrhoea Sulphonureas = skin reactions
List disadvantages of insulin
Can’t drive HGVs
Hypoglycaemia is common if control is good
Weight gain
List effects of GLP1 analogues
Increase insulin secretion
Slows stomach down so you eat less
What are the effects of SGLT2 inhibitors?
SGLT2 is the transporter that reabsorbs glucose from tubules in nephron –> blocking it makes you pee out glucose IN HEART FAILURE PTs ONLY
List positives of SGLT2 inhibitors
Prevents death in 6 months (!!!) HbA1c drops BP drops (its a diuretic) lose weight and waist circumference shrinks prevents heart failure and renal disease
