Type 2 DM Flashcards
What is the pathophysiology of T2DM?
↓insulin secretion ± ↑insulin resistance
What are the RF?
- FHx
- Increasing age
- Obesity + inactivity
- Ethnicity - Asian, African and Black
- Poor diet - low fibre, high glycemic index
- Drugs - statins, CS
- PCOS
- Hx of gestational diabetes
How do children and young people with T2DM tend to present?
- Persistent hyperglycaemia (RPG >11mmol/L)
- Characteristic features e.g. thirst, polyuria, blurred vision WL, recurrent inf not usually as severe can be absent)
- RF for T2DM
- Evidence of insulin resistance
How do adults w T2DM tend to present?
- Persistent hyperglycaemia - HbA1c >48mmol/mol or RPG >11
- Characteristic features usually less severe or absent
- RFs for T2DM
- Evidence of insulin resistance
When should HbA1c not be used to diagnose DM?
- <18yrs
- Pregnant women or women 2 months postpartum
- Sx of DM for less than 2m
- Those taking meds that may cause hyperglycaemia
- End stage CKD
What dietary advice do you give in the management of T2DM?
Encourage high fibre, low GI sources of carbs
Include low fat dairy products + oily fish
Less sat fats + trans fats
Discourage use of foods marketed specifically at ppl w DM
Target weight loss to 5-10% f overweight
What is the HbA1c target with lifestyle management?
48
How often should HbA1c be checked
3-6monthly then 6 monthly one stable
What is the target HbA1c if levels aren’t adequately controlled by a single drug and rises to 58mmol/mol or more
53
What is the first line drug treatment for T2DM not controlled with lifestyle factors? how would u give it?
Metformin - gradually increase the dose over several weeks to minimise the risk of GI effects
What is the second line treatment?
Dual therapy: metformin plus either of the following:
- DPP-4i
- Pioglitazone
- SU
- SGLT-21
What is the third line treatment?
Triple therapy:
- Triple therapy:
- Met + SU+ DPP4i
- Met + SU + pioglitazone
- Met + SU/pioglitazone + SGLT-2i - Insulin based therapy
What type of drug is metformin?
biguanide
What are the SE of metformin?
Nausea Diarrhoea Abdo pain Anorexia NOT HYPOGLYCAEMIA
When is metformin contraindicated?
Acute metabolic acidosis (lactic + DKA)
Avoid if eGFR <30 due to risk of lactic acidosis
What are SE of SU?
Hypoglycaemia
Weight gain
What are CIs of SU?
Hepatic impairment - metabolised by the liver
Severe renal impairment
not a CI but if overweight as promotes weight gain
Give an example of an SU
gliclazide
What SU should be used in the elderly?
oral tolbutamide
how does metformin work?
increases insulin sensitivity and helps weight
How does SU work?
increases insulin secretion
When are SUs only effective?
when some residual pancreatic beta cell activity is present
