Wk 2 Diabetes

Question 1

Describe the pathophysiology, epidemiology and presenting features for diabetes

Answer 1

T1DM
Patho - beta cell destruction & insulin deficiency
Epide - childhood onset
S/S - polyuria, polydipsia, skinny

T2DM
Patho - peripheral resistance to insulin & inadequate insulin secretory response by beta cell
Epide - later onset
S/S - Kidney/nephropathy, Neuropathy, Infection, Vascular/CVD, Eyes/retinopathy, Skin/poor wound healing

Question 2

What are the signs and symptoms of monitoring diabetes?

Answer 2

DM Dx:
BGL - FBG (fasting blood glucose) > 7 mmol, RBG > 11 mmol
HbA1c (glycosylated haemoglobin) > 6.5%/48 mmol/mol
- HbA1c reflects the average BSL for over 3 months

Question 3

What is the appropriate management strategies for individual patients with diabetes?

Answer 3

Goal of treatment:

• short term: symptom relief
• long term: prevention and lifestyle change

Insulin regimen:
'basal-bolus' regimen: 
- 3*short-acting + 1*long-acting
- 3 inj before meal, 1 inj noct
- better BSL control, but regular BSL monitor (hypo)
'split-mixed' regimen:
- 2*premixed (30/70)
- 2/3 mane, 1/3 noct
- convenient, but can't skip meal (low flexibility)

NP:

• need ↑ insulin for Pt with ‘physical stress’, ie infection, trauma
• inappropriate use leads to weight gain
• lipohypertrophy: Insulin given at same spot over time may cause fat redistribution

Question 4

What are the common oral antihyperglycaemic drugs?

glycaemic control deteriorates overtime

Answer 4

Biguanides - metformin
MOA: ↓ hepatic glucose production, insulin sensitiser
Indication: ↓ insulin use in obese Pt
Benefits: assist with weight loss
AEs: N/V, stomach upset, diarrhoea, weight loss
CON:
- signs of metabolic acidosis, ie diabetic ketoacidosis
- kidney failure (renal cleared)
- reduced liver function
- CVD or HF (insufficient blood flow)

Sulfonylureas - gliclazide
MOA: stimulate pancreatic insulin secretion
Benefits: an alternative for metformin if CKD
AEs: N/V, stomach upset, hypoglycaemia
CON: T1DM (require functional beta cell), hepatorenal impairment, diabetic ketoacidosis, pregnancy&lactation

GLP-1 agonist - exenatide
MOA: mimic gut hormone (GLP-1) to ↑ insulin secretion
Benefits:
- effective in weight control (signals brain to generate full feeling)
- better liver protective effect
AEs: N/V, stomach upset, diarrhoea
CON: T1DM, diabetic ketoacidosis, renal impairment

DPP-4 inhibitor - linagliptin
MOA: inhibits DPP-4 enzyme which breaks down GLP-1 hormone
Indication: add-on to metformin, sulfonylurea, SGLT2 inhibitor
AEs: hypoglycaemia, muscle pain, constipation
CON: hypoglycaemia

SGLT2 inhibitor - empagliflozin
MOA: ↓ renal reabsorption of glucose
Indication: add-on to other antiglycaemic drugs
AEs: hypoglycaemia, UTI, polyuria, polydipsia
CON: renal impairment, elderly (↓ renal function)