Type 2 Diabetes Flashcards
What percentage of diabetics are T2?
90%
Pathophysiology of T2DM
- Insulin resistance in the cells (mechanism not fully understood)
- Thought that GLUT transporters do not bind to cell membrane so glucose cannot be taken up into cells
- As glucose in blood remains high, further insulin is secreted by beta cells in pancreas (b cell hyperplasia)
- Beta cells also increase secretion of amylin (builds up and aggregates beta cells)
- Beta cells become exhausted and become dysfunctional and undergo hypertrophy & hypoplasia and die off
- As beta cells are lost, insulin decreases and glucose rises in blood
- Patients develop symptoms (polyphagia, glycosuria, polyuria, polydipsia)
- Still SOME circulating insulin
- DKA not likely because of this
Why doesn’t DKA commonly occur in T2?
Because there is still a small amount of circulating insulin
What is a Hyperosmolar Hyperglycaemic State (HHS) and why does it occur?
- Emergency presentation more common in T2DM
- Causes increased plasma osmolarity due to extreme dehydration and concentration of the blood
- Serious situation as dehydration can cause mental status changes
Risk factors for developing T2DM
- Obesity
- Lack of exercise
- HTN
- Family history of diabetes (parent or sibling)
- Race or ethnicity (unclear but Black, Hispanic, American Indian & Asian American at higher risk)
- Age (especially over 45)
What are the 3 P’s of diabetes symptoms
Polyphagia
Polydipsia
Polyurea
In pre-diabetes, the goal is to bring HbA1c levels below ..?
5.7%
Brief explanation of treatment of T2DM
Lifestyle changes (healthy eating, weight loss, exercise) Antidiabetic medication- metformin If metformin does not keep HbA1c below 7% = 2nd and 3rd antidiabetic medication added (dependent on patient factors) If antidiabetic medication does not work alone, + insulin
How do sulfonylureas (glimepiride/glipizide etc) work, what are the main side effects & who are they contraindicated in?
- Increase the amount of insulin the pancreas normally releases
- Can cause weight gain and biggest risk of hypoglycaemia
- Contraindicated in those with CKD
How do thiazolinedoiones (Pioglitazone) work and what are the side effects and contraindications?
- Help reduce insulin resistance so the insulin in body is more effective
- Reduced hepatic gluconeogenesis
- Can cause weight gain
- Contraindicated in those with severe heart disease or suspected HF as it causes fluid retention and increases CVD risk and lipid abnormalities
How do SGLT-2 inhibitors (dapagliflozin) work, what are the side effects and benefits and who are they contraindicated in?
- Reduces the amount of glucose absorbed by your kidneys and your blood by blocking SGLT2 receptor in kidney and increases glycosuria which decreases blood glucose
- Helps with weight loss
- Beneficial effect on BP and CV health in those with artherosclerosis
- Hypoglycaemia risk
- Contraindicated in those with CKD
How do GLP-1 (liraglutide, dulaglutide + exenatide) work, what are the benefits and side effects and who is it contraindicated in?
- GLP1 is a hormone secreted by the GI tract after meals that decrease glucagon levels and increase insulin production
- Causes feeling of satiety and reduces appetite
- Helps promote weight loss
- Nausea or vomiting is likely
- Contraindicated in severe CKD
- Good for patients with artherosclerosis or CVD and diabetic neuropathy
How do DPP-4 inhibitors (glipins) work, what are the benefits and side effects and is it contraindicated in any patients?
- DPP-4 degrades GLP-1 so using an inhibitor increases the amount of GLP-1
- Stimulates the pancreas to secrete more insulin
- Small risk of hypoglycaemia
- Can be used in those with CKD
What are the side effects of antidiabetic drugs? (4)
- Hypos
- Weight loss or gain
- Bloating and diarrhoea
- Feeling sick
What value indicates a high random glucose test?
Venous plasma concentration >11.1mmol/L
