Diabetes Lecture 2: Type 2 Diabetes Flashcards Preview

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Flashcards in Diabetes Lecture 2: Type 2 Diabetes Deck (39):
1

How is type 2 diabetes normally caused

Reduced insulin secretion and insulin resistance

2

What does insulin resistance mean

Normally biological effects are not observed at physiological insulin levels

3

What is beta cell dysfunction and describe the phases it goes through

when type 2 diabetics secrete less insulin daily

Phase 1: less insulin initially

Phase 2: exaggerated insulin response- may cause hypoglycaemia 3-4 hours after meal

4

What are the symptoms of type 2 diabetes

Increased thirst and hunger

Increased urination

Fatigue

Blurred vision

Infection

5

What is HYPEROSMOLAR HYPERGLYCAEMIA STATE (HHS)

Medical emergency to do with

Hyperglycaemia
Dehydration and Uraemia

6

How do you screen for type 2 diabetes

Random blood glucose levels

Fasted blood glucose levels

HbA1C levels

7

What are the risk factors for type 2 diabetes

Family history: Parents or sibling has it

Health problems: stroke, hypertension, coronary heart disease, peripheral artery disease

Ethnicity: afro carribean or african, south asian

Age: 40+ years

Waist measurement

BMI: greater than 25

Past: gestational diabetes

has known glucose intolerance or impaired fasting hyperglycaemia

8

What are the macrovascular complications that can occur in diabetic patients

Stroke

Heart attack

Angina

9

What are the microvascular complications that can occur in diabetic patients

Diabetic retinopathy

Erectile dysfunction

Autonomic neuropathy

10

What are the treatment goals of type 2 diabetes

Preserve life

Alleviate symptoms

Achieve good glycemic control- avoid long term complications

Avoid iatrogenic side effects- hypoglycaemia

11

how do you manage type 2 diabetes: DEED

Dietary modification

Exercise

Education

Drug treatment

12

What does the diabetic diet consist of in managing type 2 diabetes

Low fat- low saturated fat

Increase fibre and complex carbs

Weight loss- moderate caloric deficit diet

13

What does exercise consist of in managing type 2 diabetes

Exercise 30 minutes per day

Increases glycemic control, reduces CVD risk

Reduces blood pressure and improves lipid profile

Improves insulin sensitivity

14

What does education consist of in managing type 2 diabetes

Patient aware that good glycemic control will avoid diabetic complications

Diabetic patients have increased mortality and morbidity

Risk of CVD or diabetic retinopathy

Erectile dysfunction

15

What does drug treatment consist of in managing type 2 diabetes

Insulin secretagogues
Stimulates insulin release from pancreas, restores early phase insulin release
Example: Meglitinides and SULPHONYLUREAS

Insulin sensitisers
Metformin

16

Give examples of sulphonylureas

Short acting: Gliclazide or tolbutamide

Long acting: glibenclamide

17

What is the mechanism of action of sulphonylureas and Meglitinides

Increase insulin release from pancreas by binding to sulphonylurea receptor

Closes the K+ ATP channel which causes a rise in intracellular calcium and insulin release

Reduces HbA1c levels by 1.5 to 2%

18

What are the commonside effects of sulphonylureas

Weight gain

Hypoglycaemia

19

Give an example of Meglitinides

Nateglinide- can only be used with metformin

Repaglinide- derivative of glibenclamide

20

What is the mechanism of action of GLICLAZIDE

Promotes insulin secretion from pancreatic beta cells

Binds to the sulfonyl urea receptor (SUR1) which binds and blocks the ATP sensitive potassium channel

Decrease in potassium efflux leads to depolarisation of Beta cells, opens up voltage dependent calcium channels

Activation of CALMODULIN- releases insulin secretory granules

21

What is an insulin sensitiser

Enhances the effect of endogenous circulating insulin, reduces insulin resistance and decrease hepatic glucose production

22

What are the two examples of insulin sensitiser

BIGUANIDES

THIAZOLIDINEDIONES (glitazones)

23

Explain the role of the Biguanide METFORMIN

Increases glucose uptake in skeletal muscle and adipocytes, suppress hepatic glucose generation (gluconeogenesis)

Reduces glucose absorption from the small intestine (high drug concentration)

Suppress appetite, achieves weight loss and has cardio protective effect

Reduces HbA1c levels by 1 to 2%

24

What are the side effects of metformin

GI side effects, anorexia, nausea, pain in abdomen, diarrhoea

minimised with gradual increase to dose or modified release

25

What is the mechanism of action of metformin

Inhibit pyruvate mechanism which increases lactic acid production

Reduces glucose production in liver and decrease glucose absorption

Involves activating AMP activated protein kinase in liver and skeletal muscle

26

Give an example of Thiazolidinediones and risks associated with it

Pioglitazone

Risk in heart failure and bladder cancer patients

27

What is the mechanism of action of thiazolidinediones

Bind to PPAR-gamrha (peroxisome proliferator activated receptor gamma)

Regulates: gene transcription, enhances glucose and fatty acid uptake, utilises adipocytes, reduce secretion of cytokines that inhibit insulin action

Reduce glucose output of liver

28

What is an inhibitor of gastrointestinal glucose absorption

Acarbose

29

What is an mechanism of action of acarbose

Alpha-glucosidase inhibitor that reduces glucose uptake in small intestine

Slows digestion and absorption of glucose after a meal

30

Explain how therapies based on glucagon like peptide 1 (GLP-1) work

Glucagon release from alpha cell is regulated by pancreas secreting insulin

When stimulated, it has roles of slowing gastric emptying, slowing digestion and nutrient absorption, moderating blood glucose levels

31

Give examples of Dipeptidylpeptidase 4 inhibitors

Saxagliptin

Sitagliptin

32

Explain the mechanism of action of Dipeptidylpeptidase 4 inhibitors

Inhibits DPP-4 which decreases GLP-1 degradation which leads to increased insulin secretion and decrease glucagon secretion

33

Give examples of GLP-1 mimetic analogues

EXENATIDE and liraglutide (delivered by subcutaneous injection)

34

What is the mechanism of action for GLP-1 mimetic analogues

DPP4 resistant analogues that bind to and active GLP-1 receptor

Leads to increased insulin secretion, decrease of glucagon secretion, slow gastric emptying and promotes weight loss

35

How do selective sodium glucose co-transporter 2 (SGLT-2) inhibitors work and give examples of them

Dapaglifozin

Independent insulin mediated glucose control pathways, SGLT-2 block the reabsorption of glucose in the kidneys and promote urinary excretion

36

When is insulin used in type 2 diabetes

When impossible to control good glycemic control with oral hypoglycaemic drugs

Often given alongside metformin etc

37

What is gestational diabetes

Diabetes that occurs during the first time in pregnancy

38

How do you monitor for gestational diabetes

Routine tests for glycosuria

39

How do you treat gestational diabetes

Lifestyle modification

Exercise

First line: insulin therapy or some oral hypoglycaemic drugs