Type 2 Diabetes Lecture Powerpoint

Question 1

Type 2 diabetes definition

Answer 1

Chronic and progressive disease with multiple organ and hormone dysfunctions both micro and macrovascular contributing to pathophysiology and resistance to insulin

Question 2

Risk factors for type 2 diabetes (1 big one and 6 others)

Answer 2

• first degree relative with DM***
• age >45
• obesity
• sedentary lifestyle
• hypertension
• dislipidemia
• Gestational diabetes history (or large child delivery >9lbs)

Question 3

Classic lipid abnormality in dislipidemia presenting alongside diabetes type 2

Answer 3

High triglycerides and low HDL

Question 4

Only __% of type 2 diabetics have A1C, BP, LDL, and BMI goals under control

Answer 4

8%

Question 5

The ominous octet of type 2 diabetes causes

Answer 5

• Liver overproducing sugar
• B cells not making enough insulin (exhaustion after making excess in early stages of resistance)
• a cells making too much glucagon
• Skeletal muscle not taking up glucose
• GI tract and incretin effect
• Neurotransmitter dysfunction in the brain causing hunger
• Increased glucose reabsorption at the kidney
• increased lipolysis of fat cells

Question 6

Metformin acts as a insulin ___ allowing the body to utilize its own insulin better

Answer 6

sensitizer

Question 7

Metformin should be avoided when GFR is less than…

Answer 7

…45ml/min

Question 8

Long term metformin therapy can be associated with a low…

Answer 8

…B12 level (may manifest as a peripheral neuropathy, diabetic neuropathies don’t occur for first 10 years so early onset might indicate this)

Question 9

Sulfonylureas are cleared primarily by the…

Answer 9

…kidneys (need GFR >45ml/min to avoid hypoglycemia)

Question 10

When B cells fail and become ineffective at producing insulin, what happens to sulfonylureas?

Answer 10

They lose functionality only facilitate secretion of insulin

Question 11

Meglitinides (name 2 examples) vs sulfonylureas

Answer 11

Meglitinides (repaglinide and nateglinide) are rapid onset oral agents for diabetes to stimulate insulin release and short duration taken with each meal and are not sulfa derivatives and are also safe with renal insufficiency, but like sulfonylureas are not effective with B cell failure

Question 12

Pioglitazone function and ADR’s/contraindications (1)

Answer 12

• Insulin sensitizer drug that is also very good at increasing HDL
• leads to weight gain due to edema (contraindicated in congestive heart failure patients)

Question 13

Acarbose function and big ADR

Answer 13

• Drug that slows carbohydrate absorption resulting in A1C change of .5% for type 2 diabetes management
• ADR is GI intolerance

Question 14

Welchol drug class, function, mech of action, ADR (1)

Answer 14

• Bile acid sequestrants
• A1C reduction supplemental to management of diabetes
• Unknown mechanism
• GI intolerance

Question 15

Bromocriptine is not used for diabetes because….

Answer 15

….its has a large ADR in the form of bad nausea

Question 16

The incretin effect

Answer 16

Refers to how GLP-1 is secreted upon ingestion of food entering the small intestine which enhances insulin secretion from the B cells dependent on the glucose levels as well as decreases excess glucagon (reducing strain on liver) and turns off appetite urges. This prolongs lifespan and health of B cells.
GLP-1 is not or very little secreted in type 2 diabetics, so GLP-1 agonists that tweak the molecule to lengthen its very short half life allow for injection once a week

Question 17

DPP-4 inhibitors work at the incretin system by…

Answer 17

…blocking breakdown of patient’s own incretin hormones raising their own GLP-1 levels several fold in type 2 diabetics

Question 18

SGLT2 inhibitors action

Answer 18

Typically 100% of glucose is filtered into the nephron, but at the proximal tubule almost all absorbed along Na+ by SGLT2 transporter, can allow for urination out of about 100grams/day of glucose (weight loss and calorie loss as well), this also lowers blood pressure by dragging fluid with because we are losing glucose and sodium, worry is entering diabetic ketoacidosis

Question 19

SGLT2 inhibitors increases risk of ___ because of sugar buildup in the bladder and genitourinary tracts

Answer 19

-UTI

Question 20

SGLT2 inhibitors demonstrate reduction in…

Answer 20

…Reduction in cardiovascular death, MI, stroke, and all cause mortality in all patients with type 2 diabetes (this is rare and big! Even cardiologists are using this in patients without diabetes, and are also renal protective in patients with type 2 diabetes OVER ACEI’s and ARBs)

Question 21

4 benefits of SGLT2 inhibitors and list the 4 agents

Answer 21

• Diabetes treatment
• Weight reduction
• Cardiovascular disease protection
• Renal protection

-Ivokana, farxiga, jardiance, steglatro

Question 22

Modified AACE algorithm

Answer 22

-A1C <7.5% suggest monotherapy (metformin, GLP-1 or SGLT-2 inhibitors)
A1C >7.5% but <9% suggest dual therapy (metformin + GLP-1, SGLT-2 inhibitors)
-A1C >9% if no acute hyperglycemic symptoms use dual therapy, if acute symptoms use insulin plus oral agents

Question 23

Insulin mixtures ending in -lin vs -log

Answer 23

Lin corresponds to rapid acting component being regular insulin (works within 30 min), log correspodns to rapid acting component being humalog (acts within 15 min)

Question 24

Injectible combo therapy basal insulin + GLP-1 Analog usage

Answer 24

Administered once a day for type 2 diabetics because they still have some B cell function they can respond after a meal in a glucose dependent manner, alongside having a basal value for in between meals