Week 7: Type 2 DM

Question 1

DKA in which type of DM

Answer 1

Either Type 1 or 2 DM

Question 2

Antibody testing negative for Type 1 or 2 DM

Answer 2

Question 3

C-peptide testing for Type 1 or 2 DM

Answer 3

Question 4

C-peptide testing

Answer 4

Injected insulin does not have C-peptide

Type 1 DM shouldn’t have C-peptide

if you don’t know what type of DM they have

Question 5

Low C-peptide levels at Dx DM1 or DM2

Answer 5

could be either if DM1 in early Dx

DM2 late in Dx can be low

Question 6

Epidemiology of DM

Answer 6

Question 7

Increased adiposity in DM2

Answer 7

Question 8

Type 2 DM mechanism

Answer 8

increased adiposity

increased energy intake

ectopic FAs accumulation

so what happens is there are breakdown products from FA deposition and interfere with insulin signaling leading to insulin resistance and can lead to DM2

ability for pancreas to keep up with excess insulin secretion can decrease leading to DM2

Question 9

Risk for DM2

Answer 9

Question 10

Methods for Dxing DM2

Answer 10

• Fasting glucose level (1 day)
• oral glucose tolerance (1 day)
• HbA1c (~ 3 months) (glycosylated Hb)
  *

Question 11

Diagnostic criteria for DM2

Answer 11

Also random glucose of >200 mg/dL

Question 12

Treatment options for DM2

Answer 12

• Metformin

w/ Heart disease

• SGLT-2 inhibitors
• GLP-1 inhibitors
• TZDs
• Sulfonylureas

Question 13

1st line therapy for DM2

Answer 13

Metformin

Question 14

Metformin Effects

Answer 14

• Suppresses hepatic glucose production (gluconeogenesis)
• Increase insulin sensitivity
• Increase peripheral glucose uptake
• Decrease GI absorption of glucose

Question 15

Metformin Side effects

Answer 15

GI intolerance/Diarrhea

Question 16

Natural history of DM

Answer 16

aging is a bitch

Question 17

SGLT-2 Inhibitors effects

Answer 17

inhibits SGLT-2 channel in the proximal tubule of the nephron

prevents reabsorption of Glucose and Na

loses calories in the urine and diuretic effect for blood pressure

Question 18

List of SGLT-2 Inhibitors

Answer 18

Question 19

GLP-1 Agonists effects

Answer 19

Normally when we eat carbohydrates the L cells of the small intestines secrete GLP-1 and it acts on a variety of receptors

GLP-1 receptors in the:

• β cells of the pancreas ((augment glucose-dependent insulin secretion *only increased insulin secretion during meals preventing low blood sugars* unlike sulfonylureas)
• Alpha cells of the pancreas (reduce postprandial glucagon secretion reducing glucose output from the liver)
• Stomach (slows down emptying of the stomach helping them feel full sooner and also slows down the absorption of carbohydrates)
• CNS (promotes satiety and reduces appetite)

Glucose lowering and reduction of weight

Don’t see a lot of hypoglycemia,

Question 20

GLP-1 Agonists Side effects

Question 21

Caveat of GLP-1 agonists

Answer 21

When GLP-1 is secreted from the small intestines, it is rapidly inactivated by DPP-4

GLP-1 agonists are resistant to DPP-4 degradation)

Question 22

DPP-4 inhibitors

Answer 22

inactivate DPP-4 preventing the inactivation of endogenous GLP-1

don’t see a lot of hypoglycemia

Question 23

List of GLP-1 agonists

Answer 23

Question 24

List of DPP-4 inhibitors

Answer 24

Question 25

TZDs AKA

Answer 25

Thiazolidinediones

Question 26

TZDs effects

Answer 26

Stimulate nuclear PPARγ receptors causes enhanced insulin sensitivity

Question 27

TZDs side effects

Answer 27

Risks of weight gain, fluid retention, fractures

Question 28

Names of TZDs

Answer 28

Pioglitazone

Question 29

DM that promote weight loss

Answer 29

GPL-1 agonists SGLT-2 inhibitors

Question 30

DPP-4 inhibitors and weight

Answer 30

actually weight neutral

Question 31

Sulfonylureas effects

Answer 31

help the pancreas make more insulin Glucose in glucose transporter and glycolysis and TCA to generate ATP ATP less K+ leaves islet cell and depolarizes cell and voltage-gated Ca2+ channel opens causing Ca2+ influx and causes insulin exocytosis and secretion Sulfonylureas inhibits the K+ channel in substitution of ATP to cause depolarization and insulin secretion Problem is that it doesn't matter if the patient is eating or not

Question 32

Sulfonylureas side effects

Answer 32

* hypoglycemia * Weight gain

Question 33

Sulfonylureas benefits

Answer 33

improved glucose control

Question 34

Sulfonylureas MOA

Answer 34

Stimulate pancreatic insulin secretion by K+ leak channel inhibition