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Diabetes > Type 2 Diabetes and drugs > Flashcards

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
Q

What are the 2 first line medications for type 2

A

metformin

Dapagliflozin

26
Q

what group of drugs does metformin belong to

A

biguanides

27
Q

When is metformin best used

A

in overweight people as it suppresses appetite

28
Q

what route is metformin used

A

oral

29
Q

What is metformins mechanism of action

A

unknown

30
Q

What are the side effects of metformin

A 
lactic acidosis 
N&V (GI upset most common) 
diarrhoea 
renal failure 
metallic taste in mouth
31
Q

What group of drug is dapagliflozin from

A

SGLT2 inhibitors

32
Q

What is the mechanism of action of dapagliflozin

A

blocks the reabsorption of glucose in the proximal tubule of the kidney nephron causing glycosuria

33
Q

what is glycosuria

A

peeing out glucose

34
Q

Does dapagliflozin cause weight loss or gain

A

loss

35
Q

What are the side effects from dapagliflozin

A

genital and UTIs (more common in women) = due to glycosuria

36
Q

What are the contraindications for dapagliflozin

A

patients with an eGFR <60 (kidney disease)

watch out for loop diuretics

37
Q

what are the contraindications for metformin

A 
renal failure
alcoholism
cirrhosis
chronic lung disease
cardiac failure
any current serious illness
mitochondrial myopathy
38
Q

What is used as 2nd line therapy with metformin

A

Sulphonylureas
Pioglitazone
Gliptins

39
Q

Tolbutamide, Chlorpropramide, Glibenclamide and Gliclazide are all from which group of drugs

A

sulphonylureas

40
Q

Can sulphonylureas work without beta cells

A

no

41
Q

What is the mechanism of action of sulphonylureas

A

works on the SUR1 to BLOCK IT and allow K channels to close causing depolarisation and insulin release

42
Q

What are the side effects of sulphonylureas

A

hypoglycaemia
weight GAIN
has an addictive effect when combined with metformin

43
Q

Pioglitazone is part of which drug group

A

TZDs

44
Q

What is the mechanism of action of pioglitazone

A

It binds to the receptors within the cell nucleus and affects the gene expression causing decreased insulin resistance

45
Q

what are the side effects of pioglitazone

A 
stomach pain
haematuria/painful urination
weight gain
SOB
muscle and back pain
46
Q

What are the contraindications for pioglitazone

A 
heart failure or Hx of heart failure 
Hepatic impairment 
DKA
Current/Hx of bladder cancer
un-investigated visible haematuria
47
Q

what drug group are sitagliptin and vildagliptin apart of

A

DDP-4 inhibitors

48
Q

What is the mechanism of action of DDP-4 inhibitors

A

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
Q

What are the side effects of gliptins

A 
N&amp;V
diarrhoea
abdominal pain
flu-like symptoms
heart failure
50
Q

What are the contraindications of gliptins

A

pancreatitis (acute/chronic)

Kidney impairment

51
Q

Another name for incretin analogues is

A

GLP-1 analogues

52
Q

What drug group are exenatide and liraglutide a part of

A

GLP-1 analogues

53
Q

What is the mechanism of action of GLP-1 analogues

A 
mimic GLP-1 
cause increased insulin secretion 
increased insulin sensitivity in peripheral tissues
decreased glucagon secretion 
decreased gastric emptying
54
Q

What are the side effects of Incretins

A

N&V

diarrhoea

55
Q

When is insulin used in type 2

A

as a last option treatment

56
Q

How many patients will need insulin eventually in type 2

A

1/3rd

57
Q

What is the max dose for insulin

A

there is no max dose - take as much is needed to control hyperglycaemia

58
Q

What is the route of administration of insulin

A

subcutaneous injection

59
Q

What are the side effects of insulin

A 
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
Q

If a patient has renal failure, what must you do to insulin

A

decrease the dose as it is excreted by the kidney

Diabetes (5 decks)

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