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Endocrine > Management of Type 2 diabetes > Flashcards

Management of Type 2 diabetes Flashcards

1
Q

Type 2 diabetes presentation

A

asymptomatic
with complications
non-specific = tiredness, persistent skin infection
weight changes
nocturia
blurred vision
macrovascular disease - MI, stroke
microvascular disease - blurred/loss of vision, neuropathy
at pregnancy

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2
Q

Non-pharmacological management of Type 2 diabetes

A

weight loss
lifestyle changes - diet
stop smoking
alcohol in moderation
physical activity - 150 mins/week

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3
Q

List some oral medications that can be used to treat Type 2 diabetes

A

biguanides
sulphonylureas
meglitinides
alpha glucosidase inhibitors
thiazolidinediones
DPP4 inhibitors
SGLT2 inhibitors

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4
Q

List 2 injectable medications that can be used to treat Type 2 diabetes

A

insulin
GLP1 analogue

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5
Q

How does biguanides (metformin) work to treat Type 2 diabetes?

A

increase glucose utilisation, anaerobic glycolysis and lactate production in gut

in liver - increases insulin signalling, decrease glucagon activity, reduces gluconeogenesis and glycogenolysis

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6
Q

Describe metformin

A

reduces fasting blood glucose
weight neutral, low risk of hypoglycaemia

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7
Q

Metformin side effects

A

abdominal symptoms - nausea, diarrhoea
lactic acidosis in presence of renal failure

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8
Q

How do sulphonylureas help treat Type 2 diabetes?

A

block ATP sensitive potassium channels on the beta cell plasma membrane, through SUR 1
results in exocytosis of stored insulin
reduction in fasting blood glucose

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9
Q

Sulphonylureas side effects

A

hypoglycaemia
weight gain

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10
Q

Name some sulphonylureas

A

Glibenclamide
Gliclazide
Glipizide
Glimepiride

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11
Q

Name some meglitinides

A

natiglinide
repaglinide

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12
Q

How do metaglinides help treat Type 2 diabetes?

A

non-sulphonylurea insulin secretalogue, need residual beta cell function
binds to benzamido site of SUR1 on beta cells
relatively rapid onset and short duration of action

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13
Q

Meglitinides side effects

A

hypoglycaemia
weight gain

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14
Q

Name an alpha glucosidase inhibitor

A

acarbose

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15
Q

How do alpha glucosidase inhibitors help treat Type 2 diabetes?

A

prevents cleaving of complex carbohydrates into monosaccharides
prevents glucose absorption in the intestine
glucose leaves with stool

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16
Q

Side effects of alpha glucosidase inhibitors

A

flatulence
diarrhoea
hypoglycaemia uncommon

17
Q

How do thiazolidinediones help treat Type 2 diabetes?

A

agonists of peroxisome proliferator activated receptor gamma, a receptor expressed in adipose tissue, muscle, liver, beta cells, vascular endothelium

promotes adipogenesis, insulin sensitivity, tissue glucose uptake, reduces inflammation

reduced hepatic gluconeogenesis, reduces circulating levels of free fatty acids

18
Q

Name a thiazolidinedione

A

pioglitazone

19
Q

Thiazolidinediones side effects

A

low risk of hypoglycaemia
oedema
weight gain
increased fracture risk
contraindicated in heart failure, uninvestigated macroscopic haematuria and bladder cancer

20
Q

How do DDP4 inhibitors help treat Type 2 diabetes?

A

inhibits DDP4 which degrade GLP1 and GIP
causes elevation of circulating levels of incretin hormones - GLP1 and GIP

resulting in enhancement of nutrient induced insulin responses during feeding

21
Q

Name some DDP4 inhibitors

A

sitagliptin
saxagliptin
linagliptin
alogliptin

22
Q

What are patients being treated with DDP4 inhibitors at risk of?

A

pancreatitis

23
Q

SGLT2 inhibitors MOA

A

competitive inhibition of SGLT2 results in elimination of 60-90g glucose/day

shown improvement in renal and cardiovascular outcomes

insulin independent

reduces BP and weight

24
Q

Adverse effects of SGLT2 inhibitors

A

low risk of hypoglycaemia
increased risk of genital and urinary tract infections
hypovolaemia
dizziness
euglycaemix and hyperglycaemic DKA

25
Q

Name some SGLT2 inhibitors

A

dapagliflozin
empagliflozin
canagliflozin

26
Q

GLP1 receptor agonists MOA

A

GLP1 receptor agonists increase level of incretin hormone which increase insulin secretion

reduction in glucagon secretion
enhance satiety
delay gastric emptying
result in weight loss
reduction in BP

27
Q

Name some GLP 1 agonists

A

exenatide
liraglutide
lixisenatide

28
Q

Insulin side effects

A

hypoglycaemia
weight gain

29
Q

Diabetes complications

A

retinopathy
neuropathy
nephropathy

Endocrine (21 decks)

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