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TYPE 2 DIABETES - Coggle Diagram

- - - - MANY HAVE HTN AND HIGH CHOLESTEROL
  - - - red-brown, round or oval patches
      - scaly then flat and indented; skins
    - - velvety light brown to black skin thickening; flexures, axillae, and neck
    - - red-yellow lesions; atrophic skin--> shiny and transparent--UNCOMMON
  - - - recurring or persistent infections: C. albicans, boils, furuncles; cystitis
    - - Hand hygiene, avoid exposure
      - flu and pneumococcal vaccine
  - - - sensory neuropathy and PAD are major risk factors
      - other factors: clotting abnormalities, impaired immune function, autonomic neuropathy
      - SMOKING INCREASES RISK
    - - annual monofilament screening
    - - decreased blood flow= decreased O2, WBCs, and nutrients causes longer wound healing, increased risk for infection
  - - - laser photocoagulation
        
        most common
        
        laser destroys ischemic areas of retina
      - vitrectomy
        
        aspiration of blood, membrane, and fibers inside the eye
      - iluvien
        
        injectable micro-insert that delivers corticosteroids flucinolone acetonide for 36 months
      - Vascular endothelial growth factor (VEGF) blocking drugs--reduce inflammation
  - - - hypertension
      - genetics
      - smoking
      - CHRONIC HYPERGLYCEMIA
    - - If albuminuria present, drugs to delay progression: ACE INHIBITORS and ANGIOTENSIN II RECEPTOR ANTAGONISTS
      - control of hypertension and blood glucose levels in a healthy range: imperative
  - - - reduced nerve conduction and demyelination
      - ischemic damage to peripheral nerves
    - - most common form
      - affects hands and/or feet bilaterally; "stocking-glove neuropathy"
      - loss of sensation, abnormal sensations, pain, and paresthesias
        
        pain--burning, cramping, crushing, tearing; worse or only occurs at night
    - - paresthesias--tingling, burning, itching; "walking on pillows or numb feet"
      - very sensitive
      - complete or partial loss of sensitivity to touch or temperature is common
      - FOOT INJURY AND ULCERATIONS may occur without patient ever having pain
      - SMALL MUSCLES OF HANDS AND FEET MAY BE AFFECTED CAUSING DEFORMITY AND LIMITED FINE MOVEMENT
- - - - women, especially adolescents
      - decrease insulin--"diabulimia" causes weight loss, hyperglycemia, and glycosuria
      - many consequences
- - - - sulfonylureas, meglitinides, DPP-4 inhibitors, and GLP-1 receptor agonists
      - increase insulin production
    - - Biguanides and thizolidinediones
      - Increase uptake and use of glucose
      - decrease insulin resistance
    - - Alpha Glucosidase Inhibitors
        
        delay absorption of starches
      - DPP-4 Inhibitors
        
        increase activity of incretins
      - GLP-1 receptor agonists and amylin
        
        decrease gastric emptying
    - - Biguanides, thiazolidinediones, and DPP-4 inhibitors
      - decrease hepatic glucose production
    - - SGLT Inhibitors
      - decrease glucose production
  - - - rapid acting inhaled insulin
      - administered at beginning of each meal or within 20 minutes after starting a meal
      - used in combination with long acting insulin
      - common adverse reactions: hypoglycemia, cough, throat pain or irritation
  - - - DAY OR TWO BEFORE AND AT LEAST 48 HOURS AFTER WHEN SERUM CREATININE WNL
    - - RENAL, LIVER, CARDIAC DISEASE: lactic acidosis
      - iodine based contrast medium can cause AKI
      - excessive alcohol intake
  - - - Metformin (Glucophage)
        
        most effective 1st line treatment for type 2
        
        available as immediate release, extended release, and liquid forms
        
        Action: reduces glucose production by liver
        
        enhances insulin sensitivity
        
        improves glucose transport
        
        may cause weight loss
        
        used in prevention of type 2 diabetes
    - - Action: increases insulin production from pancreas
      - major side effect: hypoglycemia
      - EXAMPLES
        
        Glipizide (Glucotrol)
        
        Glyburide (Glynase)
        
        Glimepiride (Amaryl)
    - - action: increases insulin production from pancreas
      - rapid onset: decreases risk of hypoglycemia
      - Patient education
        
        take 30 min to just before each meal to mimic normal response to eating
        
        do not take if skip a meal
      - EXAMPLES
        
        Repaglinide (Prandin)
        
        Nateglinide (Starlix)
    - - "Starch Blockers"
        
        slow down absorption of carbohydrate in small intestine
      - take with first bite of each meal
        
        check 2 hour postprandial glucose to determine effectiveness
      - EXAMPLES
        
        Acarbose (Precose)
        
        Miglitol (Glyset)
    - - INCRETIN HORMONES
        
        increases insulin synthesis and release from pancreas and decreases hepatic glucose production when glucose levels are normal or elevated; DDP-4 inactivate incretin hormones
      - Action: DDP-4 inhibitors block action of DDP-4 increases insulin release, decreases glucagon secretion, and decreases hepatic glucose production
      - EXAMPLES (Gliptins)
        
        Alogliptin (Nesina)
        
        Sitagliptin (Januvia)
        
        Saxagliptin (Onglyza)
        
        Linagliptin (Tradjenta)
    - - "insulin sensitizers"
      - Most effective in those with insulin resistance
      - improve insulin sensitivity, transport, and utilization at target tissues
      - EXAMPLES
        
        Pioglitazone (Actos)
        
        Rosiglitazone (Avandia)
      - RARELY USED BECAUSE OF ADVERSE EFFECTS
- - - - Hb A1C > 6.5
      - Fasting glucose > 126
  - - - ineffective insulin--doesn't carry glucose into cells, effectively
      - Not enough--unable to carry glucose