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2a Endocrinology > T2 DM > Flashcards

T2 DM Flashcards

1
Q

Type 2 diabetes is a condition where a combination of insulin ____ and reduced insulin ____ cause persistently high blood sugar levels.

A

resistance, production

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2
Q

Repeated exposure to ___ and ____ makes the cells in the body resistant to the effects of insulin

A

glucose
insulin

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3
Q

More and more insulin is required to…

A

stimulate body cells to take up and use glucose

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4
Q

Overtime, the ____ becomes fatigued and damaged by producing so much insulin and the insulin output is reduced

A

pancreas

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5
Q

A high carbohydrate diet combined with insulin resistance and reduced ____ f______ leads to chronic high blood glucose levels known as…

A

pancreas function

hyperglycaemia

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6
Q

What kinds of complication can chronic hyperglycaemia lead to?

A

Microvascular
Macrovascular
Infectious

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7
Q

What are non-modifiable risk factors for T2 DM?

A

Older
Black African, Caribbean or South Asia
Family history

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8
Q

What are some modifiable risk factors for T2 DM?

A

Obesity
Sedentary lifestyle
High carb diet (particularly sugar)
Smoking

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9
Q

What are presenting features of T2 DM?

A

Tiredness
Polyuria
Polydipsia
Unintentional weight loss
Opportunistic infections
Slow wound healing
Glucose in urine

T2DM is a risk factor itself for hypertension, silent MI, nephrotic syndrome, CKD…

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10
Q

What is acanthosis nigricans?

A

Thickening and darkening of the skin, giving a velvety appearance, often at the neck, axilla and groin.
Associated with insulin resistance.

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11
Q

An HbA1c of what range indicates pre-diabetes?

A

42 - 47 mmol/mol

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12
Q

How do you diagnose T2 DM?

A

An HbA1c of 48 mmol/mol or above

Repeat after 1 month to confirm diagnosis

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13
Q

How do you manage T2 DM according to NICE?

A

Structured education program
Low-glycaemic-index and high-fibre diet
Exercise
Weight loss if overweight
Antidiabetic drugs
Monitoring and managing complications

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14
Q

What are the HbA1c treatment target for new T2DM patients?

A

48 mmol/mol

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15
Q

What are the HbA1c treatment target for T2DM patients requiring more than 1 antidiabetic med?

A

53 mmol/ mol

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16
Q

What is the first line medication for T2DM?

A

Metformin
If has CVD or HF, then add SGLT-2 inhibitor like dapagliflozin.
Consider it for patients with a QRISK score above 10%

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17
Q

What is second line medication for T2DM?

A

If HbA1c is 58+, add one of the below:
Sulfonylurea
Pioglitazone
DPP-4 inhibitor
SLGT-2 inhibitor

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18
Q

What are third line medication options for T2DM?

A

Triple therapy = metformin with 2 second line drugs

and last resort = giving insulin

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19
Q

How does metformin work?

A

Increases insulin sensitivity and decreases glucose production by the liver.

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20
Q

True or false: metformin is a biguanide

A

True

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21
Q

True or false: metformin causes weight gain

A

False, may cause weight loss.

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22
Q

What are side effects of metformin?

A

GI:
pain, nausea, diarrhoea
Lactic acidosis secondary to having AKI and taking metformin

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23
Q

What is the suffix for SGLT-2 inhibitors?

A

-gliflozin

eg. empagliflozin, canagliflozin, dapagliflozin

24
Q

Where are SGLT2 proteins found?

A

Sodium-glucose co-transporter 2 protein is found in the proximal tubes of the kidneys.

25
Q

How do SGLT2 proteins work?

A

Reabsorb glucose from the urine back into the blood.

26
Q

How do SGLT-2 inhibitors work?

A

Block the SGLT2 proteins from reabsorbing glucose back so more is excreted in the urine, lowering HbA1c and reducing blood pressure. Also leads to weight loss and improves HF.

Risk of hypoglycaemia when used with insulin or sulfonylureas.

27
Q

What are side effects of SGLT-2 inhibitors

A

Glycosuria
Increased urine output
UTIs
Weight loss
DKA
Fournier’s gangrene (rare but severe infection of genitals or perineum)

28
Q

Name a thiazolidinedione and how it works

A

Pioglitazone
Increases insulin sensitivity and decreases liver production of glucose

29
Q

What are some side effects of pioglitazone?

A

Weight gain
Heart failure
Increased risk of bone fractures
Small increase in risk of bladder cancer

30
Q

Name a sulfonylurea and how it works

A

Gliclazide
Stimulate insulin release from pancreas

31
Q

What are side effects of gliclazide

A

Weight gain
Hypoglycaemia

32
Q

What group of hormones are produced in response to large meals to reduce blood sugar?

A

Incretins

33
Q

How do incretins work?

A

Increase insulin secretion
Inhibit glucagon production
Slow absorption in GI tract

34
Q

What is the main incretin, and what is it inhibited by?

A

Glucagon-like peptide-1 (GLP-1)

Inhibited by enzyme dipeptidyl peptidase-4 (DPP-4)

35
Q

What do DPP-4 inhibitors do?

A

Block the action of DPP-4 , allowing increased incretin activity

36
Q

What are some common DPP-4 inhibitors?

A

sitagliptin
alogliptin

Do not cuase hypoglycaemia

37
Q

What are side effects of DPP-4 inhibitors?

A

Headaches
Low risk of acute pancreatitis

38
Q

What are examples of GLP-1 mimetics?

A

exenatide
liraglutide
(SC injections)

39
Q

What are side effects of GLP-1 mimetics?

A

Reduced appetite
Weight loss
GI symptoms: discomfort, nausea and diarrhoea

40
Q

How long does it take rapid-acting insulin to start working and last?

A

eg NovoRapid
Takes 10 minutes
Lasts 4 hours

41
Q

How long does it take short-acting insulin to start working and last?

A

eg Actrapid
Takes 30 minutes
Lasts 8 hours

42
Q

How long does it take intermediate-acting insulin to start working and last?

A

eg Humulin I
Takes 1 hour
Lasts 16 hours

43
Q

How long does it take long-acting insulin to start working and last?

A

eg Levemir and Lantus
Takes 1 hour
Lasts about 24 hours

44
Q

Combination insulins contain a _____ and ______ insulin

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

A

rapid-acting and intermediate-acting

45
Q

What are key complications of T2 DM?

A

Infections
Diabetic retinopathy
Peripheral neuropathy
Autonomic neuropathy
CKD
Diabetic foot
Gastroparesis
Hyperosmolar hyperglycemic state

46
Q

What is 1st line treatment of hypertension in T2 DM patients?

A

ACE inhibitors

47
Q

What med is given to T2DM patients with CKD when the albumin-to-creatinine ratio is above 3 mg/mmol

A

ACE inhibitor

48
Q

When would you give a SGLT-2 inhibitor along with the ACE inhibitor to a T2DM patient with CKD?

A

When the albumin-to-creatinine ratio is above 30 mg/mmol

49
Q

What are the 4 treatment options for neuropathic pain with T2DM?

A

Amitriptyline (tricyclic antidepressant)
Duloxetine (an SNRI antidepressant)
Gabapentin (anticonvulsant)
Pregabalin (anticonvulsant)

50
Q

What is a rare but potentially fatal complication of T2DM?

A

hyperosmolar hyperglycemic state (HHS)

51
Q

What characterises HHS?

A

hyperosmolality - water loss leads to very concentrated blood with high sugar levels but absence of ketones.

Polyuria, polydipsia, weight loss, dehydration, tachycardia, hypotension and confusion

52
Q

How do you treat HHS?

A

IV fluids and careful monitoring

53
Q

What is IGT?

A

Impaired Glucose Tolerance

Seen in prediabetics.

Sees normal FPG of less than 6 mmol/l
but 2 hours after taking set amount of glucose in Oral Glucose Tolerance Test (OGTT), the glucose levels are now 7.8-11 mmol/l

54
Q

What is IFG?

A

Impaired Fasting Glucose

Seen in prediabetics.

FPG is between 6.1-6.9 mmol/l (greater than normal)
and
2 hours post OGTT, less than 7.8 mmol/l

55
Q

What are OGTT levels in normal, pre-diabetic and diabetic patient?

A

Normal = less than 7.8 mmol/l
Prediabetic = 7.8-11 mmol/l
Diabetic = more than 11 mmol/l

56
Q

What are FPG (fasting plasma glucose) levels in normal, pre-diabetic and diabetic patients

A

Normal = up to 6 mmol/l
Prediabetic = 6.1-6.9
Diabetic = 7+

2a Endocrinology (26 decks)

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