T2DM Flashcards
(13 cards)
What is HbA1c and how is it used to diagnose T2DM
HbA1c - glycated haemoglobin
Haemoglobin is a protein in red blood cells that carries oxygen through the body
When glucose in the blood attaches to haemoglobin, it forms a molecule called glycated haemoglobin (HbA1c)
The more glucose in the blood the more HbA1c
For T2DM - assess long term blood sugar control - average over last 2-3 months
6.5% (48mmol/L or higher)
What are the main treatment options for T2DM
Diet modification
Weight loss if BMI > 25kg/m2
Oral medications
Insulin
Physical activity
Fundamentals of diet management in T2DM
- moderate intake of carbohydrate - low GI diet
- encourage healthy BMI between 20-25kg/m2
- calculate initial requirements and -500kcal to promote weight loss if BMI >25kg/m2
- ideal body weight (kg) = height2 x desired BMI
Critique the use of low calorie/low carb diets in T2DM
- improved glycaemic control - low carb diets reduce postprandial glucose spikes
- both low calorie and low carb diets promote weight loss
- lower carb diets so lower insulin demand
In your A-F assessment what factors would you consider for someone with T2DM
Anthropometry - weight, height, BMI , waist circumference, MUAC
Biochemistry - HbA1c, blood glucose diary, B12 levels, lipid profiles, eGFR to assess kidney function
Clinical - past medical history, mediations, insulin regime, any diabetic complications, age of diagnosis, levels of knowledge
Dietary - portion sizes, preference, types of carbs, meal pattern, dietary requirements, alcohol intake, drinks of choice through the day - sugar?, fruit and veg intake, intake of saturated fats, intake of high sugar foods and drinks
Extra information - social information - home life, family support, occupation, shift patterns, socioeconomic circumstances, ethnic group, cooking abilities, physical activity
Biguanides
how do they work
potential side effects
E.g. metformin
- decreased hepatic gluconeogenesis - reduces livers production of glucose
- increase insulin sensitivity - improves the uptake and use of glucose by peripheral tissues like muscle so more responsive to insulin
- don’t cause weight gain or hypoglycaemia
Side effects
- gastrointestinal distress - nausea, diarrhoea, abdominal discomfort, metallic taste
- vitamin B12 deficiency - can impair absorption long term
- lactic acidosis - rare but serious - particularly in those with renal impairment, liver disease, alcohol abuse
Blood glucose targets
Hypo - <4mmol/l
Hyper - >10mmol/L
Before meals : 4 to 7mmol/L
Pregnant women blood glucose targets
Fasting: below 5.3mmol/L
One hour after meals: below 7.8mmol/L
After 2 hours: below 6.4mmol/L
Cholesterol targets in diabetes
Total: <4mmol/L
LDL : <2mmol/L
HDL : >1mmol/L for men and 1.2mmol/L for women
Blood pressure for diabetes
T1DM : <135/80mm/Hg
T2DM : <140/80mm/Hg
Waist circumference for diabetes
Males:
90cm for south Asian
94cm for others
Females:
80cm for all
Sulphonylureas
How do they work
Potential side effects
E.g. gliclazide, glipizide
- act directly on pancreas (acts on beta cells) to stimulate insulin production
- rapidly lowers blood glucose levels
Side effects
- hypoglycaemia
- weight gain - due to insulin levels
- gastrointestinal upset - nausea or abdominal discomfort
- allergic reactions - rare
GLP-1s
How they work
Side effects
E.g. ozempic (semaglutide)
- mimics action of glucagon like peptide-1, a natural hormone released from the gut after eating
- stimulates glucose dependent insulin secretion when blood glucose is elevated
- inhibits glucagon secretion
- delays gastric emptying
- promotes satiety and reduces appetite - weight loss
Potential side effects
- gastrointestinal - nausea, vomiting, diarrhoea, constipation
- pancreatitis - rare but serious
- gallbladder disease - weight loss and slowed gastric emptying - increase risk of gallstones
