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Type 2 Diabetes and drugs Flashcards

1
Q

who is most likely to present with type 2 diabetes

A

middle aged/elderly

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2
Q

What is the most common cause of type 2

A

obesity

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3
Q

What kind of onset does type 2 have

A

insidious

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4
Q

How do ketones present in type 2

A

minimal or absent in urine

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5
Q

Do people with type 2 usually present with microvascular disease

A

yes

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6
Q

Do people with type 2 have beta cells

A

yes but later on in their disease they begin to die

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7
Q

Why does diabetes occur in people with type 2 if they still have beta cells

A

because their body is no longer responding to insulin (insulin resistance)

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8
Q

Why do beta cells die off later in the disease of type 2

A

due to exhaustion, limited glucokinase activity and decreased ATP production

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9
Q

what are the main symptoms of type 2

A 
polydipsia 
polyuria 
thrush
infections
weakness/fatigue 
*neuropathy 
*retinopathy
*nephropathy

*if advanced

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10
Q

With which conditions can type 2 occur in

A 
metabolic syndrome 
insulin resistance 
gestational diabetes 
acromegaly 
Cushing's syndrome
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11
Q

What is metabolic syndrome

A 
glucose/impaired glucose tolerance/diabetes/ insulin tolerance 
plus 2 of - 
-diabetes 
-hypertension 
-high tri-glycerides
-low HDL
-central obesity 
-microalbuminaemia
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12
Q

Most people with type 2 have insulin resistance and all patients with insulin resistance have type 2. true/false

A

false - most people with type 2 have IR but not all patients with IR have type 2

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13
Q

Gestational diabetes occurs in

A

pregnancy

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14
Q

Which trimester does gestational diabetes usually occur

A

3rd

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15
Q

In acromegaly, how many patients have type 2 diabetes

A

1/3rd

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16
Q

How does type 2 occur in acromegaly

A

IR due to the increased growth hormone

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17
Q

How is acromegaly tested for

A

glucose tolerance test

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18
Q

How does Cushing’s cause type 2

A

increased cortisol can inhibit uptake of glucose by cells –> hyperglycaemia and IR

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19
Q

What percentage of people with Cushing’s have type 2

A

10-20%

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20
Q

what is the investigations for type 2

A

fasting blood glucose
oral glucose tolerance test
ketones

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21
Q

An individual with a 1st degree relative with T2DM has what risk of getting it themselves

A

10-15%

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22
Q

What is the risk of a twin getting type 2 if the first has it in monozygotic twins

A

90%

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23
Q

What is the first line treatment for type 2

A

diet and exercise (lifestyle changes)

smoking cessation

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24
Q

when will a patient move on to pharmacological treatment for type 2

A

if HbA1c doesn’t go down or glucose still uncontrolled even after lifestyle changes

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25
What are the 2 first line medications for type 2
metformin | Dapagliflozin
26
what group of drugs does metformin belong to
biguanides
27
When is metformin best used
in overweight people as it suppresses appetite
28
what route is metformin used
oral
29
What is metformins mechanism of action
unknown
30
What are the side effects of metformin
``` lactic acidosis N&V (GI upset most common) diarrhoea renal failure metallic taste in mouth ```
31
What group of drug is dapagliflozin from
SGLT2 inhibitors
32
What is the mechanism of action of dapagliflozin
blocks the reabsorption of glucose in the proximal tubule of the kidney nephron causing glycosuria
33
what is glycosuria
peeing out glucose
34
Does dapagliflozin cause weight loss or gain
loss
35
What are the side effects from dapagliflozin
genital and UTIs (more common in women) = due to glycosuria
36
What are the contraindications for dapagliflozin
patients with an eGFR <60 (kidney disease) | watch out for loop diuretics
37
what are the contraindications for metformin
``` renal failure alcoholism cirrhosis chronic lung disease cardiac failure any current serious illness mitochondrial myopathy ```
38
What is used as 2nd line therapy with metformin
Sulphonylureas Pioglitazone Gliptins
39
Tolbutamide, Chlorpropramide, Glibenclamide and Gliclazide are all from which group of drugs
sulphonylureas
40
Can sulphonylureas work without beta cells
no
41
What is the mechanism of action of sulphonylureas
works on the SUR1 to BLOCK IT and allow K channels to close causing depolarisation and insulin release
42
What are the side effects of sulphonylureas
hypoglycaemia weight GAIN has an addictive effect when combined with metformin
43
Pioglitazone is part of which drug group
TZDs
44
What is the mechanism of action of pioglitazone
It binds to the receptors within the cell nucleus and affects the gene expression causing decreased insulin resistance
45
what are the side effects of pioglitazone
``` stomach pain haematuria/painful urination weight gain SOB muscle and back pain ```
46
What are the contraindications for pioglitazone
``` heart failure or Hx of heart failure Hepatic impairment DKA Current/Hx of bladder cancer un-investigated visible haematuria ```
47
what drug group are sitagliptin and vildagliptin apart of
DDP-4 inhibitors
48
What is the mechanism of action of DDP-4 inhibitors
DDP-4 usually inhibits the action of GLP-1, by inhibiting DDP-4 it allows decreased gastric emptying, increased insulin secretion and decreased glucagon secretion and increased insulin sensitivity in peripheral tissues
49
What are the side effects of gliptins
``` N&V diarrhoea abdominal pain flu-like symptoms heart failure ```
50
What are the contraindications of gliptins
pancreatitis (acute/chronic) | Kidney impairment
51
Another name for incretin analogues is
GLP-1 analogues
52
What drug group are exenatide and liraglutide a part of
GLP-1 analogues
53
What is the mechanism of action of GLP-1 analogues
``` mimic GLP-1 cause increased insulin secretion increased insulin sensitivity in peripheral tissues decreased glucagon secretion decreased gastric emptying ```
54
What are the side effects of Incretins
N&V | diarrhoea
55
When is insulin used in type 2
as a last option treatment
56
How many patients will need insulin eventually in type 2
1/3rd
57
What is the max dose for insulin
there is no max dose - take as much is needed to control hyperglycaemia
58
What is the route of administration of insulin
subcutaneous injection
59
What are the side effects of insulin
``` hypoglycaemia hyperglycaemia (through compensation of a hypo - known as somogyi effect) local reaction at injection site loss of fatty tissue at injection site insulin resistance ```
60
If a patient has renal failure, what must you do to insulin
decrease the dose as it is excreted by the kidney

Diabetes (5 decks)

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