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Endocrinology > Type 2 Diabetes > Flashcards

Type 2 Diabetes Flashcards

1
Q

What is the pathology of Type II Diabetes?

A

Combination of:

  1. Resistance to insulin (often preceding high levels of circulating insulin due to lifestyle factors)
  2. Destruction/impaired secretion of insulin from beta-cells

85% of people with diabetes

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2
Q

What are the risk factors for TIIDM?

A

NON-MODIFIABLE

  • Ethnicity: Asian, African, Caribbean
  • Gestational diabetes
  • Family history

MODIFIABLE

  • Obesity
  • Physical inactivity
  • Low fibre, high glycaemic diet
  • Drug: thiazide, steroids

ASSOCAITED CONDITIONS

  • Metabolic syndrome
  • Polycystic ovarian syndrome
  • Pre-diabetes
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3
Q

What are the symptoms of TIIDM?

A

Similar symptoms to T1DM - polyuria, polydipsia

Often present w/ complications of disease

  • Peripheral vascular disease
  • CVA/MI
  • Hyperosmolar non-ketotic coma (HONK)
  • Recurrent infection (UTI/Candidiasis)
  • Pruritus
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4
Q

What are the signs of TIIDM?

A

Increased BMI
Retinopathy
Peripheral neuropathy

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5
Q

What are the glucose investigations for TIIDM?

A
  1. FASTING GLUCOSE PLASMA (gold)
    - Diabetes = > 7.0 mmol/L + SYMPTOMS (Random glucose > 11.1 mmol/L)
    - Pre-diabetes = 6.1 - 6.9 mmol/L (TIIDM)
    - Normal = < 6.0 mmol/L
  2. HBA1C (reflect hyperglycaemia over preceding 3 months)
    Diabetes = 48mmol/mol or > 6.5%
    Pre-diabetes = 42 - 47 mmol/mol or 6.0 - 6.4% (TIIDM)
    Normal = < 41 mmol/mol or < 5.9%
  3. Plasma/urine ketones = +ve
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6
Q

What other investigations should be conducted in suspected T11DM?

A

Fasting lipid profile
= high LDL/low HDL

Serum creatinine & eGFR
=renal insufficiency

Retinal examination
=retinopathy

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7
Q

What are the principles of diabetic management?

A
  1. Conservative treatment = lifestyle changes
  2. Medical diabetic drug treatment = dictated by HbA1C levels
    - Two pathways I) those that can tolerate metformin & ii) those that can’t tolerate metformin
    - Culminate in need for insulin
  3. Modification of other diseases
    e. g. anti-HTN, antiplatelet, statin (Atorvastatin)
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8
Q

What dietary advice can be given to T11DM?

A
  • High fibre
  • Low glycaemic index of carbs
  • Low fat dairy products/oiy fish
  • Control intake of sat fats
  • Discourage foods markets specifically for diabetes (expense)
  • Limit sugar allowance

Aim to lose 5-10%

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9
Q

What are the HbA1C target levels?

A

Lifestyle = 48 mmol/mol (6.5%)

Lifestyle + metformin = 48 mmol/mol (6.5%)

Includes any drug which may cause hypoglycaemia (e.g. lifestyle + sulfonylurea) = 53 mmol/mol (7.0%)

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10
Q

What is the drug treatment for those that tolerate metformin?

A

STEP 1 (monotherapy)
IF HbA1C = > 6.5%
=Offer METFORMIN

STEP 2 (Dual therapy)
IF HbA1C = >7.5% then metformin + drug from:
-SULFONYLUREA
-GLIPTIN
-PIOGLITAZONE
-SGLT2 Inhibitor

STEP 3 (Triple Therapy)
IF HbA1C still >7.5%
→ metformin + gliptin + sulfonylurea
→ metformin + pioglitazone + sulfonylurea
→ metformin + sulfonylurea + SGLT-2 inhibitor
→ metformin + pioglitazone + SGLT-2 inhibitor
OR INSULIN (metformin should be continued)

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11
Q

If standard triple therapy not tolerated and BMI > what is the regime?

A

Metformin +
Sulphonylurea +
GLP-1 Mimetic

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12
Q

What is the MOA of metformin?

A

Acts peripherally to increase sensitivity of cells to insulin and therefore increase glucose uptake

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13
Q

What is the treatment course of metformin?

A
  • Usually one tablet straight after a meal (may be two)

- Lifelong treatment

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14
Q

What is test are run for metformin?

A

U&E bloods before starting treatment and then annually

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15
Q

What are common side effects of metformin?

A

Nausea + Vomiting
Diarrhoea

Complication: lactic acidosis (can be fatal)

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16
Q

What are the contraindications of metformin?

A

Renal impairment
Ketoacidosis
Low BMI

17
Q

What is the drug profile of sulphonyureas?

A

E.g. GLICAZIDE

  • Stimulate insulin release from pancreas
  • SE: weight gain, hypoglycaemic risk
  • Can use in renal failure
  • Teratogenic
18
Q

What is the drug profile of GLIPTINS?

A

E.g. -Alogliptin

  • DDP4 inhibitors causing increase incretin levels which causes inhibition glucagon, stimulation insulin decrease gastric emptying and blood absorption
  • SE: decrease appetite
  • Not that potent
19
Q

What is the drug profile of pioglitazone?

A

-Activate PPARs resulting in increased insulin sensitivity

SE: Weight gain, oedema, hypoglycaemia, increase risk of fractures

20
Q

What is the drug profile of SGL2 inhibitors?

A

E.g. -gliflosine

  • Decrease glucose reabsorption in kidney
  • SE weight loss, postural hypotension (if BP drops too much), increase UTI risk (glucose in urine)

Endocrinology (13 decks)

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