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Endocrine > Type 2 Diabetes Mellitus > Flashcards

Type 2 Diabetes Mellitus Flashcards

1
Q

What is T2DM?

A

Relative insulin reduction and insulin insensitivity.

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2
Q

What can cause T2DM?

A

Genetics- very strongly linked
Obesity
Insulin insensitivity

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3
Q

What is the blood chemistry of T2DM?

A

Hyperinsulinemia

Hyperglycemia

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4
Q

What causes hyperinsulinemia in T2DM?

A

Increased body mass requiring more insulin

Insulin insensitivity requiring more insulin for normal function

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5
Q

How does the insulin profile change as the disease progresses?

A

Drops as beta cells wear out.

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6
Q

What does beta cell failure lead to?

A 
Decreased insulin secretion and effect
Decreased muscular glucose uptake
Increased lipolysis
Increased gluconeogenesis
Increased glucagon secretion
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7
Q

How does T2DM usually present?

A 
Often obese
Slow onset
Microvascular disease
Unexplained weight loss
Fatigue
Recurrent infection
Blurred vision
Foot damage
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8
Q

How do you diagnose T2DM?

A

Fasting blood glucose
OGTT
Random blood glucose + symptoms

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9
Q

What additional factor can be used to support T2DM diagnosis?

A

HbA1c

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10
Q

What are the ranges for fasting blood glucose?

A

<6mmol/l normal
6.1-6.9mmol/l prediabetes
>7mmol/l diabetes

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11
Q

What are the ranges for OGTT?

A

<7.7mmol/l normal
7.8-11 mmol/l prediabetic
>11.1 mmol/l diabetic

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12
Q

What must a random blood glucose be for diabetes to be diagnosed?

A

> 11.1 mmol/l

Plus symptomatic

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13
Q

What are the ranges for HbA1c?

A

<41 normal
42-47 prediabetic
>48 diabetic

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14
Q

Who should be tested regularly for T2DM?

A 
BMI >25 w/1+ of:
1st degree relative affected
Black, Latino, Asian, Pacific islander
CVD
Hypertension
HDL < 35mg/dl
Polycystic ovary disease
Physical inactivity
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15
Q

What are the treatment options for diabetes?

A

Weight loss
BP control
Drugs
Insulin

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16
Q

What is the best treatment for diabetes?

A

Weight loss and exercise

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17
Q

What BP control drug is claimed to be the best for diabetic control?

A

ACEI

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18
Q

What are the 4 mechanism by which drugs can control diabetes?

A

Increase insulin secretion
Increase insulin sensitivity
Slow glucose absorption
Enhance renal glucose excretion

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19
Q

What classes of drugs increase insulin secretion?

A

Sulfonylureas
Incretin mimics
Glinides
Gliptins

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20
Q

How do sulfonylureas work?

A

Bind to SUR1 causing Kir6 closure

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21
Q

Give some example of sulfonylureas

A

Tolbutamide
Glibenclamide
Gliclazide
Glipizide

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22
Q

What are three benefits of sulfonylureas?

A

Reduce microvascular complications
Well tolerated
Oral

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23
Q

What are three negatives of sulfonylureas?

A

Can cause hypo
Weight gain- ~2kg
Urine retention

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24
Q

How do incretin mimics work?

A

Mimic GLP-1

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25
Q

Give some examples of incretin mimics

A

Exenatide

Liraglutide

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26
Q

What are five benefits of incretin mimics?

A 
Increase insulin secretion
Suppress glucagon secretion
Slow gastric emptying
Decrease appetite
Modest weight loss
27
Q

What are three of the negatives of incretin mimics?

A

Nausea
Pancreatitis
Subcut injection

28
Q

How do glinides work?

A

Similar to SUs but augmented by glycemia

29
Q

What do glinides end in?

A

-glinide

30
Q

Give three benefits of glinides?

A

Oral
Rapid onset (1h to max, 4 to offset)
Less likely to cause hypo

31
Q

When should you not use glinides?

A

Severe hepatic impairment
Pregnant
Breast feeding

32
Q

How do gliptins work?

A

Inhibit DDP-4 enzyme which breaks down incretins

33
Q

What do gliptins end in?

A

-gliptin

34
Q

Give four benefits of gliptins?

A

Oral
Once daily
Weight neutral
No hypo

35
Q

Give a negative of gliptins?

A

Nausea

36
Q

How can gliptins be used?

A

In monotherapy

With Su or metformin

37
Q

What classes of drug can increase insulin sensitivity?

A

Biguanides

Glitazones (TZD)

38
Q

What is the only biguanide in use?

A

Metformin

39
Q

What is metformin?

A

Biguanide

40
Q

How does metformin work?

A

Reduced hepatic gluconeogenesis
Increases skeletal muscle glucose uptake (similar to exercise)
Reduces carb absorption
Increases FA oxidation

41
Q

Give five benefits of metformin

A 
Oral
Reduces microvascular complications
No hypo
Weight loss
Good in combo
42
Q

Give two negatives of metformin

A

GI upsets

Lactic acidosis

43
Q

Who should you not give metformin to?

A

Alcoholics

Severe hepatic or renal dysfunction

44
Q

What must you have to be given metformin?

A

Normal hepatic and renal function

45
Q

How do glitazones work?

A

Increase insulin sensitivity by genetically increasing signalling.

46
Q

What is the only glitazone licenced in the UK?

A

Pioglitazone

47
Q

When is pioglitazone used?

A

In combo with metformin or SUs

48
Q

Give three positives of pioglitazone

A

FA taken up into adipocytes- healthier
Increased glucose uptake
No hypo

49
Q

Give four negatives of pioglitazone?

A

Weight gain
Fluid retention
Hepatotoxicity
Increased bone fractures

50
Q

What is the only drug class that inhibits glucose absorption?

A

Glucosidase inhibitors

51
Q

Name a glucosidase inhibitor?

A

Acarbose

52
Q

How do glucosidase inhibitors work?

A

Inhibit alpha glucosidase which breaks down monosaccharides thus preventing absorption

53
Q

Give a benefit of glucosidase inhibitors

A

No hypo

54
Q

Give two negatives of glucosidase inhibitors

A

Not very effective

GI upsets- Diarrhoea and flatulence etc

55
Q

When should glucosidase inhibitors be used?

A

Only in those with poor lifestyle and drug control.

56
Q

What is the only class of drug this increases renal excretion of glucose?

A

SGLT2 inhibitors

57
Q

How do SGLT2 inhibitors work?

A

Inhibit the SGLT2 channel in the proximal nephron resulting in less glucose reuptake

58
Q

What do SGLT2 inhibitors end in?

A

-liflozin

59
Q

Give three positives of SGLT2 inhibitors

A

Lowers blood glucose
Low risk of hypo
Calorie loss

60
Q

Give a negative of SGLT2 inhibitors?

A

Dehydration

61
Q

What drugs are first line T2DM treatment?

A

Metformin

SUs in those who cannot tolerate metformin

62
Q

What drugs are second line T2DM treatment?

A

SUs
TZD/glitazones- If hypoglycemia is a concern
Gliptins- If weight gain is a concern

63
Q

What drugs are third line T2DM treatment?

A

TZD/glitazones
Gliptins- If weight gain is a concern
Insulin- For rising HbA1c
Incretin analogues- Only if BMI >30

Endocrine (23 decks)

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