T2DM Review

Mechanism of Action

100

Exerts its effects by binding to specific membrane-bound receptors on target tissues (liver, skeletal muscle, and adipose tissue), initiating a cascade of intracellular signaling pathways that regulate the metabolism of carbohydrates, proteins, and fats

Insulin

200

Decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization

Biguanide

300

Inhibit *** protein in the proximal renal tubule, reducing reabsorption of glucose and increasing urinary glucose excretion

SGLT2 Inhibitors

400

Incretin hormone **** analogs, which increase glucose-dependent insulin secretion, decrease glucagon secretion, slows gastric emptying, and improves satiety

GLP-1 Agonists

500

Peroxisome proliferator-activated receptor gamma agonist that increases peripheral insulin sensitivity

Thiazolidinediones

Pathophysiology & Symptomology

100

Symptoms of Hypoglycemia

Anxiety/irritability, dizziness, shakiness, headache, confusion, blurred vision, diaphoresis, hunger, nausea, ataxia, tremors, palpitations, tachycardia

200

Symptoms of Hyperglycemia

Polyuria, polydipsia, excessive hunger, extreme fatigue, blurry vision, dry mouth, fruity breath, slow healing bruises/cuts, tingling, pain, or numbness in hands and feet, erectile dysfunction, vaginal fungal infections

300

T2DM is due to both

insulin resistance and insulin deficiency

400

Damaged pancreatic cells that produce insulin

𝛽−cells

500

Fruity breath, nausea, and acidosis indicate this crisis

Diabetic ketoacidosis (DKA)

Surprise!

100

A1c Threshold for Diagnosis

A1c ≥ 6.5% (≥ 48 mmol/mol)

200

How much physical activity is recommended? 

At least 150 minutes/week of moderate intensity physical activity

300

"Rule of 15"

1.Take 15-20 grams of glucose or fast-acting carbohydrates

2.Recheck blood glucose after 15 minutes

3.If hypoglycemia continues, repeat

4.Once blood glucose is normalized, eat a snack or small meal

400

Treatment Goals (A1c, fasting BG, and 2-hr post-prandial)

A1C < 7.0%

Fasting plasma glucose: 80–130 mg/dL

Peak post-prandial capillary plasma glucose: < 180 mg/dL

500

Microvascular Complications

Retinopathy, diabetic kidney disease, peripheral neuropathy, autonomic neuropathy

Side Effects

100

Insulin

Weight gain, hypoglycemia, hypokalemia, lipoatrophy, lipohypertrophy

200

Thiazolidinediones

Peripheral edema, weight gain, upper respiratory infections, myalgia, bone fractures, heart failure (cause or worsen)

300

SGLT2 Inhibitors

Hypotension, ketoacidosis, weight loss, increased urination, increased thirst, severe UTIs, genital fungal infections

400

Sulfonylureas

Hypoglycemia, weight gain, nausea

500

GLP-1 Agonists

Weight loss, nausea, vomiting, diarrhea

BBW: thyroid carcinoma 

Brand/Generic

100

Lantus

Insulin Glargine

200

Jardiance 

Farxiga

Jardiance = Empagliflozin

Farxiga = Dapagliflozin

300

Trulicity

Ozempic

Trulicity = Dulaglutide

Ozempic = Semaglutide

400

Mounjaro

Mounjaro = Tirzepatide

500

Januvia

Tradjenta

Januvia = Sitagliptin

Tradjenta = Linagliptin