Type 2 Diabetes Treatment Exam Questions with Verified Solutions (Graded A+)
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Course
Type 2 Diabetes Treatment
Institution
Type 2 Diabetes Treatment
Type 2 Diabetes Treatment Exam Questions with Verified Solutions (Graded A+)
TD2 treatment approach - Answers -The first line of treatment of T2D is a program of diet, exercise and lifestyle modifications (for 2-3 months first)
-NUTRITION. 3-5% weight reduction significantly improves glycemic...
Type 2 Diabetes Treatment Exam Questions with Verified Solutions (Graded A+)
TD2 treatment approach - Answers -The first line of treatment of T2D is a program of diet, exercise and
lifestyle modifications (for 2-3 months first)
-NUTRITION. 3-5% weight reduction significantly improves glycemic control. (plate method or hand
method) eg. choose grains/starch, fruit like the size of a fist, 2 kinds of vegetables--the amount you can
hold with both hands, limit fat to the size of the tip of your thumb, choose meat/protein--the size of
your palm. drink up to 250 ml of low fat milk.
-EXERCISE. moderate to vigorous-intensity Aerobic exercise preferred. 30 minutes of brisk walking, 5
times a week (include resistance exercise at least 2 times/wk). Benefits appear to result from enhanced
insulin sensitivity and increased glucose uptake in muscle and other tissues. (be sure to assess the
patient's health before prescribing exercise regimen, can work up to this target)
-If a patient's A1C < 8.5%: Start metformin
OR lifestyle modifications (diet + exercise) then reassess in 2-3 months then decide on starting
metformin
-if a patient's A1C is ≥8.5 %: Start metformin
AND Consider combo therapy to achieve ≥1.5% A1C
reduction
-if symptomatic hyperglycemia and metabolic decompensation (Polyuria, Polydipsia, Weight loss,
Volume depletion)--> concern about insulin deficiency: initiate insulin +/- metformin
-if after metformin, still not at glycemic target, Add another agent best suited to the individual by
prioritizing patient characteristics (2nd line: up for debate, eventually lead to insulin)
, -Priority patient characteristic is clinical cardiovascular disease --> suggest SGLT2 inhibitor with
demonstrated CV outcome benefit (or Victorza (Liraglutide), a study has been published just recently
regarding its effect on the CV outcomes)
-patient characteristics to consider: Degree of hyperglycemia, Risk of hypoglycemia, Overweight or
obesity, C
Drugs: Sulfonylurea - Answers -There are two generations of sulfonylureas; 1st generation is less potent
than 2nd generation (which are 1000x more potent). 2nd generation SU are preferred, due to their
increased effectiveness and decreased side effects.
-Benefits:
-reduce microvascular complications (10 yr-UKPDS trial) and upon follow up (another 10 yr) reduce
macrovascular complications and death
-reduce A1c by 1-1.5%
-SE:
-*Hypoglycemia*: may be prolonged and more severe than with insulin (generally more prone to
hypoglycemia because can release insulin even when not eating) *therefore NOT administered at night*
(hard to distinguish hypoglycemia and sleeping) and use with caution in the elderly, renal dysfunction,
irregular meals and under certain stress conditions (eg. severe infections, trauma or surgery)
-*Weight gain*: problem in obese patients
-*Allergic reaction*: cannot use if allergic to sulfa compounds
-MOA:
-Binds to receptor at surface of β-cells--the Sulfonylurea receptor on β-cell is coupled to an ATP-
sensitive K+ channel in the plasma membrane. Binding to the receptor causes closing of the K+- ATP
channels, depolarization of the membrane which opens voltage-dependent Ca2+ channels. Increased
Ca2+ in the cell triggers movement of insulin granules to the cell surface, where contents (i.e., insulin)
are released into circulation. These drugs act in a manner similar to that seen with glucose.
-50% of patients lose effectiveness in 5 years
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