Type 2 diabetets Flashcards
what is type 2 diabetes?
when there is a relative insulin insufficiency. So, insulin is secreted but not enough to overcome the insulin resistance
how do we diagnose type 2 diabetes?
- Hyperosmolar Hyperglycaemia State (HHS)
- HbA1c
- Fasting glucose
what education courses are available for type 2 diabetes?
DESMOND and XPERT courses
what are the 3 treatment targets of type 2 diabetes?
- Lipids
- Blood Pressure
• Blood Glucose
when HbA1c is less than 9%, what therapy is used?
consider monotherapy
when HbA1c is greater than or equal to 9%, what therapy is used?
consider dual therapy
when HbA1c is greater than or equal to 10% and blood glucose is greater than or equal to 300mg/dL what therapy is used?
Combined injectable therapy
what is included in monotherapy?
Lifestyle management and metformin
what is included in dual therapy?
Lifestyle management, metformin and an additional agent
what is included in triple therapy?
Lifestyle management, metformin and 2 additional agents
what is included in combination with injectable therapy?
- Basal insulin + 1 rapid acting insulin injection before largest meal
- Basal insulin + GLP-1 inhibitor
- Premixed insulin twice daily before breakfast and evening meal
give an example of a biguanide?
metformin
give an example of a Thiazolidinediones?
pioglitazone
give an example of an alpha-glucosidase inhibitor?
acarbose
what do DPP4 inhibitors end in?
‘liptin’ e.g. sitagliptin
what do SGLT2 inhibitors end in?
“liflozin” e.g. dapagliflozin
what do GLP1 agonists end in?
“tide” e.g. lixisenatide
what do sulphonylureas end it?
“ide” e.g. gliclazide
give examples of meglitinides?
Nateglinide, repaglinide
what are side effects of metformin?
GI symptoms e.g. diarrhoea and nausea and vomiting
what is the expected HbA1c drop for metformin?
1-2%
what is the expected HbA1c drop for Thiazolidinediones?
0.5-1.4%
what are side effects of Thiazolidinediones?
- weight gain
- oedema
- anaemia
- GI disturbances,
- headache,
- dizziness
- visual disturbance.
what are side effects of sulfonylureas?
- hypoglycaemia
- GI disturbance
- weight gain
- rashes
- liver function derangement
what is the expected HbA1c drop for sulfonylureas?
1-2%
what are side effects of Meglitinides?
gastrointestinal, hypoglycaemia.
what are side effects of DPP4 Inhibitors?
- GI disturbance
- headache
- nasopharyngitis
- rash
what is the expected HbA1c drop for DPP4 inhibitors?
0.8%
what is the expected HbA1c drop for SGLT2?
1-1.5%
what are side effects of SGLT2?
- Dyslipidaemia
- UTI
- thrush
- raised
- haematocrit
- nausea
- constipation
Others of note: euglycaemic ketoacidosis, lower limb amputation and bone fractures
what are side effects of GLP1?
- GI disturbances (N+V, indigestion, reflux etc.)
- Hypoglycaemia if used
with sulphonylureas.
what is the expected HbA1c drop for GLP1?
0.5-1%
