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RC Peds Endo 2023 > T2DM > Flashcards

T2DM Flashcards

1
Q

what is GLP-1

A
  • Secreted by L cells of the intestine in response to nutrients
  • Rapidly metabolized by DPP-4
  • Decreases serum glucose
    –Pancreas
    —Stimulates insulin secretion
    —Inhibits glucagon secretion
    —Increases beta cell mass
    –GI tract
    —Slows gastric emptying, leading to lower post-prandial glucose excursion
    –CNS
    —Decreases appetite through central actions on the hypothalamus

*GLP-1 analogues available as injected agents
*DPP-4 inhibitors decrease metabolism of endogenous GLP-1

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2
Q

Prevention of T2DM

A
  • Breastfeeding
  • Lifestyle
  • Improve sleep quality and quantity
  • Decrease sedentary behaviours
  • Increase both light and vigorous physical activity
  • Reducing sugar-sweetened beverage consumption
  • Limit screen time
  • In children with obesity, family-based healthy behaviour interventions
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3
Q

Target A1c T2DM

A

7%

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4
Q

Health lifestyle for T2DM

A
  • 60 minutes daily of moderate-to-vigorous physical activity
    limiting recreational screen time to < 2 hours per day
  • Limiting sedentary (motorized) transport, extended sitting and time spent indoors throughout the day
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5
Q

When to start insulin in T2DM

A

DKA
A1C ≥9.0%
symptoms of severe hyperglycemia

Once-a-day basal insulin

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6
Q

Complications and comorbidities of T2DM

A

Neuropathy
Retinopathy
Nephopathy
Dyslipidemia
Hypertension
NAFLD
PCOS
OSA
Depression
Binge eating

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7
Q

Dx T2DM

A
  • FPG ≥ 7.0 mmoL/L
  • OGTT 2-hour plasma glucose ≥11.1 mmoL/L
  • Symptoms of diabetes and a random plasma glucose ≥11.1 mmol/L
    ○ Sx: polyuria, polydipsia, nocturia and unexplained weight loss
  • HbA1c ≥ 6.5%

HbA1C alone shouldn’t be used for screening

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8
Q

S/E of Metformin

A
  • GI: nausea, diarrhea, abdo pain
  • Lactic acidosis - rare, may be in context of AKI
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9
Q

Neuropathy screening in T2DM
- when and frequency
- screening test

A

yearly starting at dx

questions and exam
symptoms, vibration, touch, ankle reflex

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10
Q

retinopathy screening in T2DM
- when and frequency
- screening test

A

yearly starting at dx

7-standard field- stereoscopic-colour funds photography w interpretation by a trained reader

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11
Q

Nephropathy screening in T2DM
- when and frequency
- screening test

A

yearly starting at dx

first AM ACR (or random)

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12
Q

Dyslipidemia screening in T2DM
- when and frequency
- screening test

A

yearly starting at dx

fasting TC, HDL-C, TG, calculated LDL-C

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13
Q

hypertension screening in T2DM
- when and frequency
- screening test

A

at dx and every dm-related encounter

BP measurement with appropriate sized cuff

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14
Q

NAFLD screening in T2DM
- when and frequency
- screening test

A

yearly starting at dx

ALT and/or fatty liver on ultrasound

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15
Q

PCOS screening in T2DM
- when and frequency
- screening test

A

yearly clinical screening starting at dx for pubertal females

clinical assessment on hx and p/e for oligo/amenorrhea, acne, hirsutism

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16
Q

CVD prevention in T2DM

A

smoking cessation
activity

17
Q

when to start statin in T2DM

A

In children with familial dyslipidemia + a positive FHx of early CV events:
start if the LDL-C level remains >4.1 mmol/L after a 3- to 6-month trial of dietary intervention

18
Q

Who should be screened for T2DM?

A
  • ≥3 risk factors in nonpubertal children beginning at 8 years of age or ≥2 risk factors in pubertal children. Risk factors include:
    1) Obesity (BMI ≥95th percentile for age and gender)
    2) Member of a high-risk ethnic group (e.g. African, Arab, Asian, Hispanic, Indigenous or South Asian descent)
    3) First-degree relative with type 2 diabetes and/or exposure to hyperglycemia in utero
    -4) Signs or symptoms of insulin resistance (including acanthosis nigricans, hypertension, dyslipidemia, NAFLD [ALT >3X upper limit of normal or fatty liver on ultrasound])
  • PCOS
  • IFG and/or IGT
  • Use of atypical antipsychotic medications
19
Q

how to screen T2DM

A

an A1C and a FPG or random plasma glucose

not A1C alone

20
Q

What are high risk ethnic groups for T2DM

A

Asian
Arab
African
Hispanic
Indigenous
South Asian descent

21
Q

physical activity rec

A

≥60 minutes of moderate-to-vigorous physical activity daily,

22
Q

what is OGTT
abnormal?

A

1.75 g/kg (max 75 g) anhydrous glucose dissolved in water
check BG at baseline and 2h later

abnormal = ≥11.1 mmoL/L

23
Q

Metformin

Class:
Mech of Action
Lowers A1C by:
Weight:
SE:

A

Class: biguanide

Mech of Action:
- Enhance insulin sensitivity in liver and peripheral tissues by activation of AMP-activated protein kinase
- Inhibits hepatic glucose production

Lowers A1C by: 1%

Weight: Neutral

SE: GI symptoms (Nausea, diarrhea)
Lactic acidosis

24
Q

Where is GLP1 secreted
What does it do
What degrades it

A

secreted by L-cells in the small intestine in response to food

increases insulin secretion proportionate to BG concentrations
suppresses glucagon
prolongs gastric emptying
promotes satiety.

rapidly degraded by DPP- IV

25
Q

GLP1 RA

Class:
Drugs:
MOA (3):
A1C decrease:
Weight:
SE:

A

Class: Incretin

Drugs:
Short acting: exenatide, lizisenatide
Long acting: liraglutide, semaglutide, dulaglutide, exenatide ER

LE SLED

MOA (3):
- Increases glucose dependent insulin release
- Slows gastric emptying
- Inhibits glucagon release

A1C decrease: 0.6-1.4%

Weight: loss 1.1-4.4kg

SE: GI side effect
Pancreatitis
Thyroid C Cell malignancy**

26
Q

DPP4i

Class:
Drugs:
MOA (3):
A1C decrease:
Weight:
SE:

A

Class: Incretin

Drugs:
Aloglipton
Linagliptin
Saxagliptin
Sitagliptin

LASS

MOA (3):
- Inhibits the enzyme that breaks down incretins,
Leads to:
- Increases glucose dependent insulin release
- Slows gastric emptying
- Inhibits glucagon release

A1C decrease: 0.5-0.7%
Weight: neutral
SE:
Risk heart failure (saxagliptin)
Pancreatitis
Severe joint pain

27
Q

SGLT2i

MOA:
Drugs:
A1C Reduction:
Weight:
SE:

A

MOA: reduces glucose reabsorption by the kidneys
== glucosuria

Drugs:
Canagliflozin
Dapagliflozin
Empagliflozin

–>CDE

A1C Reduction: 0.5-0.7%
Weight: loss 2-3kg

Side effects:
Genital myocotic infections
UTI
DKA euglycemic (rare)

28
Q

Sulfonylurea

Class:
Drugs:
MOA:
A1C reduction:
Weight:
Side effects:

A

Class: Insulin secretagogue

Drugs:
Gliclazide
Glimepride
Glyburide

MOA: Activates sulfonylurea receptor on B-cell to stimulate insulin secretion

A1C reduction: 0.6-1.2%

Weight: Gain 1.2-3.2kg

Side effects: Hypoglycemia

29
Q

what kind of drug is liraglutide, semaglutide

A

GLP1-agonist

30
Q

what kind of drug is Saxagliptin

A

DPP4i

31
Q

Glimepride -what kind of drug

A

Sulfonylurea
Insulin secretagogue

32
Q

Glyburide - what kind of drug

A

Sulfonylurea
Insulin secretagogue

33
Q

For surgery, meds to stop before surgery, stop day or surgery, dn’t stop

A

Stop 3d before: SGLT2i
Stop 1d before: GLP1a
Stop day of: metformin, sulfonylurea, DPP4i

34
Q

why DM ctrl is important for pregnancy

A

Fetal: higher A1c at the time of conception is associated with:
- Increased the risk of fetal malformations
- Increased risk of intrauterine fetal death / Spontaneous abortion

Maternal:
- pregnancy can worsen diabetes complications = retinopathy
- Improved glycemic control improves fertility
- preeclampsia

RC Peds Endo 2023 (17 decks)

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