Type 2 diabetes lifestyle management and therapeutics

Question 1

what are the key physiological changes in type 2 diabetes?

Answer 1

insulin resistance

Beta cell destruction

Question 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

Answer 2

insulin resistance

Question 3

what causes insulin resistance?

Answer 3

increased inflammatory mediators

ectopic fact accumulation

Question 4

name some things associated with insulin resistance?

Answer 4

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

Question 5

as beta cell function declines….what increased?

Answer 5

blood glucose levels increase

Question 6

what can cause a decline in beta cell function

Answer 6

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

Question 7

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

Answer 7

apples

Question 8

name some complications of diabetes?

Answer 8

retinopathy
neuropathy
nephropathy
erectile dysfunction

Question 9

what is the therapy staircase for type 2 diabetes?

Answer 9

diet and exercise

oral monotherapy

oral combination

injection (inuslin) and oral therapy

Question 10

how can diabetic improve their lifestyle?

Answer 10

weight loss
exercise
smoking cessation
improve diet

Question 11

name the biguanide used in type 2 diabetes?

Answer 11

metformin

Question 12

what does metaformin do?

Answer 12

improve sensitivity to insulin

Question 13

what does of metaformin do you normally start on?

Answer 13

500mg 2x day

Question 14

does metformin cause hypos?

Answer 14

no-not when used as a monotehrapy

Question 15

can you lose weight when on metaformin?

Answer 15

yes-it suppresses appetite

Question 16

can metaformin prevent macro and microvascular complications

Answer 16

yes

Question 17

is metaformin safe in pregnancy?

Answer 17

yes

Question 18

can metformin make your periods more regular and improve fertility?

Answer 18

yes

Question 19

name some adverse side effects of metformin

Answer 19

lactic acidosis

liver failure

rash

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

Question 20

when do you not want to use metformin?

Answer 20

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

Question 21

first line treatment for type 2 diabetes

Answer 21

metformin

Question 22

what type of drugs are these?

glicazide
glipizide

Answer 22

sulphonylureas

these 2 are the most common

Question 23

does the sulphonylureas prevent macro and microvascular disease?

Answer 23

only microvascular disease

Question 24

adverse side effects of sulphonylureas?

Answer 24

hypoglycaemia
weight gain

GI upset

headache

Question 25

when should you avoid taking sulphonylureas?

Answer 25

in severe renal or liver failure

Question 26

when do sulphonylureas get used?

Answer 26

after metaformin or in those who cant tolerate metaformin

Question 27

PPARgamma agonists

Answer 27

TZDs

Question 28

what is pioglitazone

Answer 28

TZD

Question 29

why can TZDs cause heart failure?

Answer 29

they cause fluid retention

Question 30

doe TZDs prevent macro/micro vascular diease?

Answer 30

mainly macrovascular but they do improve microalbuminuria

Question 31

what is dapaglifozin?

Answer 31

SGLT2 inhibitor work on the incretin pathway

Question 32

what type of drugs are these? exenatide exendin liarglutide lixisenatide

Answer 32

GLP-1 agonists

Question 33

benefits of GLP-1 agonist

Answer 33

promote insulin secretion from pancreas without hypoglycaemia suppress glucagon decrease gastric emptying weight loss

Question 34

adverse side effects of GLP-1 agonists

Answer 34

nausea its injectable pancreatitits

Question 35

what are type of drugs are these? sitagliptin saxagliptin vildagliptin

Answer 35

DDP-4 inhibitors

Question 36

benefits of DDP-4 inhibitors?

Answer 36

no hypos suppress glucagon weight neutral

Question 37

not so good about DDP-4 inhibitors?

Answer 37

not that potent | pancreatitits

Question 38

same some SGLT2 inhibitors?

Answer 38

dapagliflozin canagliflozin empagliflozin

Question 39

how do SGLT2 inhibitors work?

Answer 39

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

Question 40

what is the downside to SGLT2 inhibitors?

Answer 40

sugar in urine means more thrush and UTIs

Question 41

when is insulin used in type 2 diabetes?

Answer 41

usually when oral agents arent working less use of basal-bolus more use of basal insulin

Question 42

what does alpha glucosidase do?

Answer 42

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

Question 43

what do alpha glucosidase innibitors do?

Answer 43

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

Question 44

what type of drug is acarbose?

Answer 44

alpha-glucosidase inhibitor

Question 45

is there a hypo risk with alpha glucosidase innibitors?

Answer 45

no

Question 46

where do SGLT2 inhibitors block the reabsorption of glucose?

Answer 46

proximal tubule