1: T2 DM pathophysiology and management

Question 1

What is the prevalence of Type 2 diabetes in Scotland?

Answer 1

Around 5%

Question 2

The prevalence of Type 2 diabetes is increasing but its incidence is remaining the same.

Why?

Answer 2

Aging population

Question 3

Which disease has a stronger genetic component - Type 1 or Type 2 diabetes?

Answer 3

Type 2 diabetes

Question 4

What do beta cells do to compensate for insulin resistance in Type 2 diabetes?

Answer 4

Increase in number

hyperplasia

Question 5

What pre-diabetic state of hyperglycaemia occurs before the onset of Type 2 diabetes?

Answer 5

Impaired glucose tolerance

Question 6

Which cells fail to cause impaired glucose tolerance?

Answer 6

Beta cells

Question 7

Type 2 diabetes has a massive genetic component - what do these genes usually affect the function of?

Answer 7

Beta cells

Question 8

In Type 2 diabetes, cells have a reduced ___ to insulin.

Answer 8

sensitivity

Question 9

What sort of relationship exists between BMI and Type 2 diabetes risk?

Answer 9

Higher BMI = Higher risk of diabetes

Question 10

Why does obesity accelerate the onset of Type 2 diabetes?

Answer 10

Obesity causes insulin resistance

Question 11

Beta cell dysfunction in Type 2 diabetes leads to the state of ___, which over time causes ___ complications.

Answer 11

hyperglycaemia

microvascular complications

Question 12

How is the risk of microvascular complications reduced in Type 2 diabetes?

Answer 12

Glycaemic control

diet, exercise, drugs

Question 13

(Impaired glucose sensitivity / Insulin resistance) is strongly linked to the onset of macrovascular disease.

Answer 13

Insulin resistance

Question 14

Independent of diabetes drugs, how is cardiovascular disease risk reduced in those diagnosed with Type 2 diabetes?

Answer 14

According to Tayside guidelines:

If age > 40, add atorvastatin

If BP > 130/80 mmHg, add anti-hypertensive (usually an ACE inhibitor)

Question 15

What is the first line drug for all patients diagnosed with Type 2 diabetes?

Answer 15

Metformin

Question 16

What dose is metformin prescribed at initially?

What is this dose then increased to?

Over how long?

Answer 16

500mg (BD)

Increased to 1g (BD)

Over 4-6 weeks

Question 17

How does metformin reduce blood glucose concentration?

Answer 17

Decreases hepatic gluconeogenesis

Increases peripheral glucose uptake

Question 18

What is metformin’s effect on weight?

Answer 18

Weight neutral

Question 19

When should the use of metformin be avoided?

Answer 19

In patients with renal impairment

Question 20

In terms of HbA1c targets:

The ideal level is < ___ mmol/mol, but if levels drift upwards, you should aim to have the patient below ___ and never above ___.

Unless the patient is elderly, in which case you’d relax the target up to __.

Answer 20

Ideally < 48 mmol/mol, if upward drift then aim for < 53 and don’t allow it to exceed 58

Elderly target is between 53 - 75 mmol/mol

Question 21

Metformin (increases / reduces) your risk of coronary heart disease.

Answer 21

reduces risk of CHD

Question 22

What are two important side effects of metformin?

Answer 22

GI upset - nausea; vomiting; diarrhoea

Lactic acidosis

Question 23

If a patient was already showing osmotic symptoms or they couldn’t tolerate metformin, what would you give them along with 3 months of lifestyle modification?

Answer 23

Sulphonylurea

Question 24

Generally, if a patient’s glycaemic control was poor, would you

a) increase the dose of drugs they are taking
b) add more drugs?

Answer 24

Different for specific cases but generally you want to add more drugs