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Endocrinology > Type 2 Diabetes Mellitus > Flashcards

Type 2 Diabetes Mellitus Flashcards

1
Q

What is Type 2 Diabetes Mellitus?

A

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.

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2
Q

Risk factors of T2DM?

A

Older age
Black, Chinese or South Asian ethnicity
Family history
Obesity
Sedentary lifestyle
High carb diet

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3
Q

Presentation of T2DM?

A

Fatigue
Polydipsia
Polyuria
Unintentional weight loss
Opportunistic infections
Slow healing
Glucose on dipstick

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4
Q

How do we test for T2DM?

A

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

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5
Q

What is the HbA1c we use to diagnose pre-diabetes?

A

42-47mmol/mol

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6
Q

What is the fasting glucose measurement we use to diagnose pre-diabetes?

A

?7

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7
Q

What is the random blood glucose value we use to diagnose pre-diabetes?

A

> 11

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8
Q

What is the OGTT result at 2 hrs we use to diagnose pre-diabetes?

A

> 11

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9
Q

What is the HbA1c treatment target for patients on metformin as monotherapy?

A

48mmol/mol

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10
Q

What is the HbA1c treatment target for patients on treatment beyond metformin monotherapy?

A

53mmol/mol

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11
Q

What is the first line drug for T2DM?

A

Metformin

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12
Q

What type of drug is metformin?

A

Biguanide

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13
Q

What does metformin do?

A

Increases insulin sensitivity and increases glucose uptake in tissues.

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14
Q

What is meformin’s mechanism of action?

A

Activates AMP kinase

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15
Q

Why is metformin good for obese patients?

A

It reduces CVD risk

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16
Q

Side-effects of metformin?

A

GI upset
Anorexia
Lactic acidosis

17
Q

What drug do you add to metformin monotherapy for patients with CVD/ or at high risk of developing CVD?

A

SGLT2 inhibitor e.g., empagliflozin

18
Q

How do SGLT2 inhibitors work?

A

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.

19
Q

What is a helpful side-effect of SGLT2 inhibitors in obese patients?

A

They facilitate weight loss by causing the patient to pee out glucose (i.e., calories!)

20
Q

Side-effects of SGLT2 inhibitors?

A

Genital candidiasis and increase risk of UTI

21
Q

What are the drugs you can add to metformin if monotherapy is not controlling blood glucose?

A

DPP-4 inhibitor
SGLT2 inhibitor
Pioglitazone
Sulfonylurea

22
Q

How does pioglitazone work?

A

Increases insulin sensitivity and decreases insulin resistance.
Enhances peripheral glucose uptake from tissues.

23
Q

Side-effects of pioglitazone?

A

Anaemia
Congestive heart failure
Peripheral oedema
Osteoporosis (–> fractures)
Weight gain
Increases risk of bladder cancer

24
Q

How do sulfonylureas work?

A

They are insulin-secretagogues thus stimulate B-cell insulin release.
Their effect wears off as B-cell function declines.

25
Q

Side-effects of sulfonylureas?

A

Hypoglycaemia
Weight gain

26
Q

What is the safest drug to use in the elderly with T2DM (and what is its drug class)?

A

Tolbutamide
= sulfonylurea

27
Q

How do DPP-4 inhibitors work?

A

Rapidly inhibit GLP-1.
Increases insulin secretion and decreases glucagon secretions.

28
Q

Side-effects of DPP-4 inhibitors?

A

Nausea
Acute pancreatitis

29
Q

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?

A

GLP-1 mimetic

30
Q

What is a GLP-1 mimetic and how do they work?

A

They are injections that stimulate B-cells to release insulin.

31
Q

Give an example of a GLP-1 mimetic?

A

Liraglutide
Exenatide

32
Q

Side-effects of GLP-1 mimetics?

A

Headaches, muscle weakness

33
Q

Examples of rapid-acting insulins and how long they last?

A

Novorapid
Humalog
Apidra

Work within 10 mins

34
Q

Examples of short-acting insulins and how long they last?

A

Actrapid
Humulin S
Insuman Rapid

Work within 30 mins and last for 8 hrs

35
Q

Examples of intermediate-acting insulins and how long they last?

A

Insulatard
Humulin 1
Insuman Basal

Work within 1 hr and last for 16 hrs

36
Q

Examples of long-acting insulins and how long they last?

A

Lantis
Levemir
Degludec (over 40 hrs)

Work within 1 hr and last for 24 hrs

37
Q

Examples of combination insulins and what are they combinations of?

A

They are combinations of rapid and intermediate-acting insulins.

Humalog 25 (25:75)
Humalog 50 (50:50)
Novomix 30 (30:70)

Endocrinology (12 decks)

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