Type 2 Diabetes Flashcards Preview

Endocrinology > Type 2 Diabetes > Flashcards

Flashcards in Type 2 Diabetes Deck (64):
1

what are the key physiological changes in T2DM?

insulin resistance
beta cell dysfunction

2

what happens in a normal person when insulin binds to a receptor on a cell?

triggers production of glucose transport proteins to allow glucose to enter the cell

3

what happens if someone is insulin resistant?

receptor is not as responsive to the insulin molecule & therefore less glucose enters the cell causes a build up of glucose in blood

4

PCOS

polycystic ovarian syndrome

5

what is beta cell dysfunction?

major defect in individuals with T2DM, reduced ability of beta-cells to secrete insulin in response to hyperglycaemia

6

what happens initially for increasing insulin resistance?

initially the beta cells compensate

7

what does insulin resistance lead to?

glucotoxicity (hyperglycaemia)
lipotoxicity (elevated FFA, TG)

8

what do glucotoxicity & lipotoxicity lead to?

declining beta cell function

9

which body shape is most commonly associated with T2DM?

apple body shape

10

what is the metabolic syndrome?

high blood pressure
high triglycerides
low HDL
insulin resistance

11

what 4 complications of T2DM can be present at time of diagnosis?

retinopathy
neuropathy
erectile dysfunction
nephropathy

12

what 4 lifestyle changes can be made to help with T2DM?

weight loss
exercise
smoking cessation
improve diet

13

which ethnicity have lower BMI targets due to increased risk of diabetes?

SE Asian populations

14

what can we do to help patients better their self-management?

education
behaviour change
motivational interviewing
personal information sharing

15

health literacy

the wide range or skills & competencies that people develop to seek out, comprehend, evaluate & use health information & concepts to make informed choices, reduce health risks & increase quality of life

16

give an example of a biguanide?

metformin

17

give some examples of sulphonylureas

glicazide
glibenclamide
glimeparide

18

give an example of thiazolidinediones

pioglitazone

19

what is metformin derived form

guanidine

20

what does metformin do

improves sensitivty to insulin

21

what are the doses of metformin tablets that can be given

500mg
850mg
1000mg

22

what is the normal starting dose of metformin?

500mg od or bd

23

what are the effects of metformin

reduces HbA1c by lowering insulin resistance
prevents microvascular & macrovascular complications

24

when metformin is used as a monotherapy, does it cause hypos?

no

25

is metformin do in pregnancy?

nothing it's safe

26

what does metformin do to BP?

minor reduction

27

what does metformin to to triglycerides & LDL?

reduces them

28

what GI side effects does metformin do?

anorexia, nausea, vomiting, diarrhoea, abdo pain, taste disturbance

29

what substances does metformin interfere with?

Vit. B12 & folic acid absorption

30

what other adverse affects can metformin do?

rarely lactic acidosis
liver failure
rash

31

at what eGFR/serum creatinine should metformin be stopped?

eGFR 150

32

at what level of eGFR should metformin dose be halved?

30-45 ml/min

33

what is 1st line management of T2DM?

lifestyle changes

34

what is 1st line therapeutic in T2DM?

metformin

35

what are the 2 most widely used sulphonylureas (SUs)?

glicazide
glipizide

36

what effects do SUs have?

reduced HbA1c
more rapid reduction in hyperglycaemia compared to insulin sensitisers
prevents microvascular & macrovascular complications

37

how do SUs work?

increase insulin secretion

38

what are the adverse affects of SUs?

hypoglycaemia
weight gain
GI upset
headaches

39

when would SUs be first line?

in underweight T2DM

40

what are the rarer adverse effects of SUs?

hypersensitivity
blood dyscrasias
live dysfunction

41

when should SUs be avoided?

severe renal or hepatic failure

42

why was rosiglitazone taken off the market?

concerns over increased risk of MI

43

what are the effects of thiazolidinedones (TZDs)?

reduces HbA1c
prevents macrovascular complications

44

do TZDs cause hypos?

not if used without an SU

45

what happens to weight with TZDs?

increase is very common

46

what is the effect of TZDs on heart conditions?

reduces heart attacks but will make heart failure worse

47

how do TZDs work?

increase insulin sensitisation

48

what MSK problem do glitazone drugs increase the risk of?

hip fractures

49

give an example of an SGLT2 inhibitor?

dapagliflozin
empagliflozin

50

give an example of a drug based on incretins (GLP-1 receptors agonists)?

exenatide
exendin
liraglutide
lixisenatide

51

what is the incretin effect?

the amount of glucose given intravenously to bring the glucose blood level to the same as that of oral glucose will stimulate less insulin to be produced

52

what are incretins?

intestinal secretions of insulin or hormones that help this

53

what cells secrete GIP?

K cells

54

what cells secrete GLP-1?

L cells

55

what is the issue for patients with GLP-1 receptor agonists?

they have to be given by injection

56

give an example of a glitazone

pioglitazone

57

what are the benefits of GLP-1 receptor agonists?

promote insulin secretion from pancreas without hypoglycaemia
suppress glucagon
decrease gastric emptying (early satiety)
act on hypothalamus to reduce appetite, results in weight loss

58

what are the problems with GLP-1 receptor agonists?

nausea
injectable
pancreatitis

59

give an example of a drug based on incretins (DPP4 inhibitors)?

vildagliptin
sitagliptin
saxagliptin
linagliptin

60

what are the benefits of DPP4 inhibitors?

promote insulin secretion from pancreas without hypoglycaemia
suppress glucagon
weight neutral
can be taken orally
nausea not as bad as other drugs

61

what are the problems with DPP4 inhibitors?

not that potent
no weight loss
pancreatitis

62

where in the body do SGLT2 inhibitors act?

in the kidneys to reduce uptake of sugar by about one quarter

63

what's the downside of SGLT2 inhibitors?

causes sugar in the urine which increases thrush & UTIs

64

what insulin regimen is used in T2DM?

basal inulin