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Endocrine > Type 2 diabetes lifestyle management and therapeutics > Flashcards

Type 2 diabetes lifestyle management and therapeutics Flashcards

1
Q

what are the key physiological changes in type 2 diabetes?

A

insulin resistance

Beta cell destruction

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2
Q

what does this describe?

the receptor is not responsive to the insulin molecule and therefore less glucose enters the cell. this results in a build up of glucose in the blood

A

insulin resistance

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3
Q

what causes insulin resistance?

A

increased inflammatory mediators

ectopic fact accumulation

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4
Q

name some things associated with insulin resistance?

A 
intra-abdominal obesity
inactivity
polycystic ovaries
genetics
smoking
fetal malnutrition
aging
hypertension
macrovascular disease
 and more
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5
Q

as beta cell function declines….what increased?

A

blood glucose levels increase

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6
Q

what can cause a decline in beta cell function

A

insulin resistance leading to hyperglycaemia (glucosetoxicity) and lipotoxicity (elevated FFA, TG)

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7
Q

who has a higher risk of diabetes-apples or pears?

A

apples

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8
Q

name some complications of diabetes?

A

retinopathy
neuropathy
nephropathy
erectile dysfunction

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9
Q

what is the therapy staircase for type 2 diabetes?

A

diet and exercise

oral monotherapy

oral combination

injection (inuslin) and oral therapy

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10
Q

how can diabetic improve their lifestyle?

A

weight loss
exercise
smoking cessation
improve diet

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11
Q

name the biguanide used in type 2 diabetes?

A

metformin

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12
Q

what does metaformin do?

A

improve sensitivity to insulin

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13
Q

what does of metaformin do you normally start on?

A

500mg 2x day

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14
Q

does metformin cause hypos?

A

no-not when used as a monotehrapy

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15
Q

can you lose weight when on metaformin?

A

yes-it suppresses appetite

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16
Q

can metaformin prevent macro and microvascular complications

A

yes

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17
Q

is metaformin safe in pregnancy?

A

yes

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18
Q

can metformin make your periods more regular and improve fertility?

A

yes

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19
Q

name some adverse side effects of metformin

A

lactic acidosis

liver failure

rash

anorexia, nausea, vomiting, diarrhoea, abdo pain, taste disturbance

20
Q

when do you not want to use metformin?

A

if advanced cirrhosis or liver failure
if serum creatinine >150
if eGFR

21
Q

first line treatment for type 2 diabetes

A

metformin

22
Q

what type of drugs are these?

glicazide
glipizide

A

sulphonylureas

these 2 are the most common

23
Q

does the sulphonylureas prevent macro and microvascular disease?

A

only microvascular disease

24
Q

adverse side effects of sulphonylureas?

A

hypoglycaemia
weight gain

GI upset

headache

25
Q

when should you avoid taking sulphonylureas?

A

in severe renal or liver failure

26
Q

when do sulphonylureas get used?

A

after metaformin

or in those who cant tolerate metaformin

27
Q

PPARgamma agonists

A

TZDs

28
Q

what is pioglitazone

A

TZD

29
Q

why can TZDs cause heart failure?

A

they cause fluid retention

30
Q

doe TZDs prevent macro/micro vascular diease?

A

mainly macrovascular but they do improve microalbuminuria

31
Q

what is dapaglifozin?

A

SGLT2 inhibitor

work on the incretin pathway

32
Q

what type of drugs are these?

exenatide
exendin
liarglutide
lixisenatide

A

GLP-1 agonists

33
Q

benefits of GLP-1 agonist

A

promote insulin secretion from pancreas without hypoglycaemia

suppress glucagon

decrease gastric emptying
weight loss

34
Q

adverse side effects of GLP-1 agonists

A

nausea

its injectable

pancreatitits

35
Q

what are type of drugs are these?

sitagliptin
saxagliptin
vildagliptin

A

DDP-4 inhibitors

36
Q

benefits of DDP-4 inhibitors?

A

no hypos
suppress glucagon
weight neutral

37
Q

not so good about DDP-4 inhibitors?

A

not that potent

pancreatitits

38
Q

same some SGLT2 inhibitors?

A

dapagliflozin
canagliflozin
empagliflozin

39
Q

how do SGLT2 inhibitors work?

A

decrease uptake of sugar in the kidney by making you pee it out!

40
Q

what is the downside to SGLT2 inhibitors?

A

sugar in urine means more thrush and UTIs

41
Q

when is insulin used in type 2 diabetes?

A

usually when oral agents arent working

less use of basal-bolus

more use of basal insulin

42
Q

what does alpha glucosidase do?

A

its an enzyme which breaks down starch and other big sugars to glucose

43
Q

what do alpha glucosidase innibitors do?

A

delay absorption of glucose so there is a decrease in post prandial increase in blood glucose

44
Q

what type of drug is acarbose?

A

alpha-glucosidase inhibitor

45
Q

is there a hypo risk with alpha glucosidase innibitors?

A

no

46
Q

where do SGLT2 inhibitors block the reabsorption of glucose?

A

proximal tubule

Endocrine (29 decks)

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