T2DM Flashcards
(33 cards)
Briefly describe the pathophysiology of T2DM
- Insulin resistance
- Reduced production of insulin
What are the three main symptoms of T2DM?
- Polydipsia
- Polyuria
- Weight loss (unintentional)
Describe the oral glucose tolerance test (OGTT)
- Patient is fasted overnight
- Baseline fasting plasma glucose is measured
- 75g glucose drink given
- 2 hours later, plasma glucose is measured again
What are the diagnostic criteria for T2DM in each of the following…
- HbA1c
- Random glucose
- OGTT
- Fasting glucose
- HbA1c > 48 mmol/mol
- Random glucose > 11 mmol/L
- OGTT > 11 mmol/L
- Fasting glucose > 7 mmol/L
What is the cut-off value for diagnosing pre-diabetes on HbA1c?
42 mmol/mol
What are the long term complications of poorly controlled T2DM? How can these be classified?
Microvascular:
- Diabetic neuropathy, nephropathy and retinopathy
Macrovascular:
- IHD and MI
- Stroke
- Hypertension
Infection-related complications:
- Bacterial, e.g. skin/soft tissue infections, UTIs
- Fungal, e.g. candidiasis
Describe the conservative management of diabetes
Lifestyle modification:
- Exercise
- Weight loss
- Smoking cessation
- Optimise management of other medical conditions
NICE guidelines recommend the following HbA1c treatment targets in T2DM…
- 48 mmol/mol in new T2 diabetics
- 53 mmol/mol in diabetics who have moved beyond metformin alone
Briefly describe the first, second and third line pharmacological management of T2DM
First line:
- Metformin alone, titrated up as tolerated
Second line:
- Metformin plus any ONE of the following: pioglitazone, sulfonylurea, DPP4-i or SGLT2-i
Third line:
- EITHER Metformin plus any TWO of the following: pioglitazone, sulfonylurea, DPP4-i or SGLT2-i
- OR Metformin plus insulin
A patient is established on maximum metformin monotherapy but their blood glucose remains high. What is the cut off-value for initiating second line therapy?
58 mmol/mol
A patient is established on maximum metformin monotherapy AND pioglitazone, but their blood glucose remains high. What is the cut off-value for initiating third line therapy?
58 mmol/mol
What is the initial starting dose/frequency of metformin?
500mg OD
Which class does metformin belong to?
Metformin is a biguanide
How does metformin work?
Increases insulin sensitivity
What are the common side effects of metformin?
- GI upset
- Lactic acidosis
Pioglitazone is a thiazolidinedione. How does it work?
Increases insulin sensitivity
Pioglitazone may increase the risk of…
Bladder cancer
Give an example of a sulfonylurea
Gliclazide
How do sulfonylureas work?
Stimulate insulin release (from the pancreas)
Sulfonylureas increase the risk of episodes of…
Hypoglycaemia
Which anti-diabetic medications can cause:
a) Hypoglycaemia
b) Weight gain
c) Weight loss
a) Sulfonylureas (e.g. gliclazide) and insulin
b) Pioglitazone and Sulfonylureas (e.g. gliclazide)
c) GLP-1 mimetics (e.g. exenatide) and SGLT2 inhibitors (e.g. empagliflozin)
What are incretins?
Hormones produced in the GI tract. They are secreted in response to large meals and reduce blood sugar by the following mechanisms:
- Increase insulin secretion
- Inhibit glucagon production
- Slow absorption by the GI tract
The main incretin is…
Glucagon like peptide 1 (GLP-1)
Incretins are inhibited by an enzyme called…
Dipeptidyl peptidase 4 (DPP-4)
