Type 2 Diabetes Mellitus Flashcards
What is Type 2 Diabetes Mellitus?
Repeated exposure to glucose and insulin can lead to insulin resistance as B-cells of the pancreas become damaged. This can lead to chronic hyperglycaemia and microvascular, macrovascular and infectious complications.
Risk factors of T2DM?
Older age
Black, Chinese or South Asian ethnicity
Family history
Obesity
Sedentary lifestyle
High carb diet
Presentation of T2DM?
Fatigue
Polydipsia
Polyuria
Unintentional weight loss
Opportunistic infections
Slow healing
Glucose on dipstick
How do we test for T2DM?
Oral glucose tolerance test (OGTT):
1. Fasting plasma glucose taken
2. 75g glucose drink given
3. Plasma glucose measured 2 hours later to see response of insulin
What is the HbA1c we use to diagnose pre-diabetes?
42-47mmol/mol
What is the fasting glucose measurement we use to diagnose pre-diabetes?
?7
What is the random blood glucose value we use to diagnose pre-diabetes?
> 11
What is the OGTT result at 2 hrs we use to diagnose pre-diabetes?
> 11
What is the HbA1c treatment target for patients on metformin as monotherapy?
48mmol/mol
What is the HbA1c treatment target for patients on treatment beyond metformin monotherapy?
53mmol/mol
What is the first line drug for T2DM?
Metformin
What type of drug is metformin?
Biguanide
What does metformin do?
Increases insulin sensitivity and increases glucose uptake in tissues.
What is meformin’s mechanism of action?
Activates AMP kinase
Why is metformin good for obese patients?
It reduces CVD risk
Side-effects of metformin?
GI upset
Anorexia
Lactic acidosis
What drug do you add to metformin monotherapy for patients with CVD/ or at high risk of developing CVD?
SGLT2 inhibitor e.g., empagliflozin
How do SGLT2 inhibitors work?
They increase the excretion of glucose in the urine via inhibition of SGLT2 co-transporters in the renal tubules. This lowers blood glucose and facilitates weight loss.
What is a helpful side-effect of SGLT2 inhibitors in obese patients?
They facilitate weight loss by causing the patient to pee out glucose (i.e., calories!)
Side-effects of SGLT2 inhibitors?
Genital candidiasis and increase risk of UTI
What are the drugs you can add to metformin if monotherapy is not controlling blood glucose?
DPP-4 inhibitor
SGLT2 inhibitor
Pioglitazone
Sulfonylurea
How does pioglitazone work?
Increases insulin sensitivity and decreases insulin resistance.
Enhances peripheral glucose uptake from tissues.
Side-effects of pioglitazone?
Anaemia
Congestive heart failure
Peripheral oedema
Osteoporosis (–> fractures)
Weight gain
Increases risk of bladder cancer
How do sulfonylureas work?
They are insulin-secretagogues thus stimulate B-cell insulin release.
Their effect wears off as B-cell function declines.
Side-effects of sulfonylureas?
Hypoglycaemia
Weight gain
What is the safest drug to use in the elderly with T2DM (and what is its drug class)?
Tolbutamide
= sulfonylurea
How do DPP-4 inhibitors work?
Rapidly inhibit GLP-1.
Increases insulin secretion and decreases glucagon secretions.
Side-effects of DPP-4 inhibitors?
Nausea
Acute pancreatitis
If triple therapy is not working, what drug should you swap into a patients treatment regime if they have a BMI >35 or insulin is not appropriate?
GLP-1 mimetic
What is a GLP-1 mimetic and how do they work?
They are injections that stimulate B-cells to release insulin.
Give an example of a GLP-1 mimetic?
Liraglutide
Exenatide
Side-effects of GLP-1 mimetics?
Headaches, muscle weakness
Examples of rapid-acting insulins and how long they last?
Novorapid
Humalog
Apidra
Work within 10 mins
Examples of short-acting insulins and how long they last?
Actrapid
Humulin S
Insuman Rapid
Work within 30 mins and last for 8 hrs
Examples of intermediate-acting insulins and how long they last?
Insulatard
Humulin 1
Insuman Basal
Work within 1 hr and last for 16 hrs
Examples of long-acting insulins and how long they last?
Lantis
Levemir
Degludec (over 40 hrs)
Work within 1 hr and last for 24 hrs
Examples of combination insulins and what are they combinations of?
They are combinations of rapid and intermediate-acting insulins.
Humalog 25 (25:75)
Humalog 50 (50:50)
Novomix 30 (30:70)
