Type 2 diabetes lifestyle management and therapeutics Flashcards Preview

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Flashcards in Type 2 diabetes lifestyle management and therapeutics Deck (46):
1

what are the key physiological changes in type 2 diabetes?

insulin resistance

Beta cell destruction

2

what does this describe?

the receptor is not responsive to the insulin molecule and therefore less glucose enters the cell. this results in a build up of glucose in the blood

insulin resistance

3

what causes insulin resistance?

increased inflammatory mediators
ectopic fact accumulation

4

name some things associated with insulin resistance?

intra-abdominal obesity
inactivity
polycystic ovaries
genetics
smoking
fetal malnutrition
aging
hypertension
macrovascular disease
and more

5

as beta cell function declines....what increased?

blood glucose levels increase

6

what can cause a decline in beta cell function

insulin resistance leading to hyperglycaemia (glucosetoxicity) and lipotoxicity (elevated FFA, TG)

7

who has a higher risk of diabetes-apples or pears?

apples

8

name some complications of diabetes?

retinopathy
neuropathy
nephropathy
erectile dysfunction

9

what is the therapy staircase for type 2 diabetes?

diet and exercise

oral monotherapy

oral combination

injection (inuslin) and oral therapy

10

how can diabetic improve their lifestyle?

weight loss
exercise
smoking cessation
improve diet

11

name the biguanide used in type 2 diabetes?

metformin

12

what does metaformin do?

improve sensitivity to insulin

13

what does of metaformin do you normally start on?

500mg 2x day

14

does metformin cause hypos?

no-not when used as a monotehrapy

15

can you lose weight when on metaformin?

yes-it suppresses appetite

16

can metaformin prevent macro and microvascular complications

yes

17

is metaformin safe in pregnancy?

yes

18

can metformin make your periods more regular and improve fertility?

yes

19

name some adverse side effects of metformin

lactic acidosis

liver failure

rash

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

20

when do you not want to use metformin?

if advanced cirrhosis or liver failure
if serum creatinine >150
if eGFR

21

first line treatment for type 2 diabetes

metformin

22

what type of drugs are these?

glicazide
glipizide

sulphonylureas

these 2 are the most common

23

does the sulphonylureas prevent macro and microvascular disease?

only microvascular disease

24

adverse side effects of sulphonylureas?

hypoglycaemia
weight gain

GI upset

headache

25

when should you avoid taking sulphonylureas?

in severe renal or liver failure

26

when do sulphonylureas get used?

after metaformin

or in those who cant tolerate metaformin

27

PPARgamma agonists

TZDs

28

what is pioglitazone

TZD

29

why can TZDs cause heart failure?

they cause fluid retention

30

doe TZDs prevent macro/micro vascular diease?

mainly macrovascular but they do improve microalbuminuria

31

what is dapaglifozin?

SGLT2 inhibitor

work on the incretin pathway

32

what type of drugs are these?

exenatide
exendin
liarglutide
lixisenatide

GLP-1 agonists

33

benefits of GLP-1 agonist

promote insulin secretion from pancreas without hypoglycaemia

suppress glucagon

decrease gastric emptying
weight loss

34

adverse side effects of GLP-1 agonists

nausea

its injectable

pancreatitits

35

what are type of drugs are these?

sitagliptin
saxagliptin
vildagliptin


DDP-4 inhibitors

36

benefits of DDP-4 inhibitors?

no hypos
suppress glucagon
weight neutral

37

not so good about DDP-4 inhibitors?

not that potent
pancreatitits

38

same some SGLT2 inhibitors?

dapagliflozin
canagliflozin
empagliflozin

39

how do SGLT2 inhibitors work?

decrease uptake of sugar in the kidney by making you pee it out!

40

what is the downside to SGLT2 inhibitors?

sugar in urine means more thrush and UTIs

41

when is insulin used in type 2 diabetes?

usually when oral agents arent working

less use of basal-bolus

more use of basal insulin

42

what does alpha glucosidase do?

its an enzyme which breaks down starch and other big sugars to glucose

43

what do alpha glucosidase innibitors do?

delay absorption of glucose so there is a decrease in post prandial increase in blood glucose

44

what type of drug is acarbose?

alpha-glucosidase inhibitor

45

is there a hypo risk with alpha glucosidase innibitors?

no

46

where do SGLT2 inhibitors block the reabsorption of glucose?

proximal tubule