Diabetes - Type 2

Affy MD
Flashcards by Affy MD, updated more than 1 year ago
Affy MD
Created by Affy MD about 8 years ago
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Pham1056 Flashcards on Diabetes - Type 2, created by Affy MD on 04/26/2013.

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Question Answer
List FOUR non-modifiable factors that may contribute to the onset of type 2 diabetes mellitus Age. •Ethnicity. •History of polycystic ovary disease. •Family history (parents or sibling). •Gestational diabetes. •Large birthweight baby.
Describe the mechanism of action of the incretins Incretins are peptide hormones. Produced by endocrine cells in epithelium of small intestines in response to meals. Stimulate beta cells to release more insulin in response to same glucose load.
List FOUR modifiable factors that may contribute to the onset of type 2 diabetes mellitus Overweight or obese - BMI > 25 kg/m2 Lack of physical activity Hypertension or dyslipidaemia Pre-diabetes
Describe the MOA of first-line hypoglycaemic agent for Type 2 Diabetes? Metformin - Biguanide Oral Hypoglycaemic Agent especially for patients with >25-BMI. Stimulation of the AMPK enzyme involved in insulin signalling and hepatic glucose production.
What is the dose for Metformin? 500 mg OD with food for 2 weeks, then 500 mg BD for 2 weeks and then 500 mg TDS with food; max 2g/day.
What are the Side Effects for Metformin? Anorexia, GIT, reduced vitamin B12 absorption. (No Hypos).
What are the Cautions and Contraindications of Metformin? Cautions: Renal impairment. CI: Ketoacidosis
What is the first OHA if the patient is not overweight (<25 BMI)? Example? Sulphonylureas; Gliclazide. Insulin secretagogues, require functioning B-cells.
What is the MOA (Mode of Action) of Sulphonylureas? Stimulate the pancreas to release insulin. Bind to SUR on K-ATP channels on cell membrane of pancreatic B-cells. Block K-ATP channels, this depolarises B-cells activating voltage sensitive Ca2+ channels which leads to influx of Ca2+ and insulin secretion. Insulin enters the portal circulation, where it inhibits hepatic glucose production.
What are the side effects and caution of Sulphonylureas? Dose related hypoglycaemia most common side effect. Appetite stimulate - weight gain. GIT. Caution - mild to moderate renal disease and in liver disease.
What is the MOA of Meglitinides? Examples of drug names? Non-sulphonylurea secretagogues. Stimulate insulin release from the pancreas relative to glucose levels. Decreased insulin release at low blood glucose levels, therefore less risk of hypoglycaemic episodes. Repaglinide and Nateglinide.
Side effects for Meglitinides? Risk of hypoglycaemia. Hypersensitivity reactions (rash, itch. urticaria) GI effects with repaglinide.
Define Diabetes A chronic disease characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action or both.
Counter-regulatory hormones are...? And they do...? Glucagon, Adrenaline, Cortisol and Growth Hormone. Increase liver glucose production
What is normal blood glucose? 18mg/dl = 1mmol/L
Describe the microvascular and macrovascular complications of Type 2 Diabetes Macrovascular disease: Myocardial infarction, stroke and peripheral vascular disease Microvascular disease: Retinopathy, Nephropathy
What are the early signs of hypoglycaemia? Early signs include weakness, hunger, anxiety, dizziness, sweating, palpitations, irritability and tremor (Early signs are due to effects of adrenaline/NA) Blurred vision, drowsiness, confusion, lack of judgement & self control due to low brain glucose (CNS effect).
What blood glucose level does early signs of hypoglycaemia begin? Symptoms are not apparent until blood glucose levels fall below 3.5 mmol/L
What is the management of hypoglycaemia if patient is conscious? 10-20g oral glucose: •2 teaspoons of sugar •100ml coca cola •200ml milk Repeat in 10-15 min if symptoms persist Follow with carbohydrate meal until recovery
What is the management of a hypoglycaemic patient if unconscious? It is a medical emergency. Glucagon s.c, i.m., or IV for acute insulin. OR 50ml glucose 20% IV infusion
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