Diabetes Mellitus Type 2

Question 1

what is the definition of diabetes mellitus type 2?

Answer 1

Chronic metabolic condition characterised by insulin resistance and insufficient pancreatic insulin production, resulting in hyperglycemia.

Question 2

what is the epidemiology of type 2 diabetes?

Answer 2

• About 90% of all diabetes cases.
• More common in people of African, African‑Caribbean and South Asian family origin. –can occur in all age groups and is increasingly being diagnosed in children

Question 3

what is the aetiology of type 2 diabetes?

Answer 3

• Decreased insulin secretion, Increased insulin resistance,
• Associated with obesity, lack of exercise, calorie and alcohol intake
• Strong genetic link but no HLA disturbance, polygenic disorder
• More common in males than females

Question 4

what are the risk factors for type 2 diabetes?

Answer 4

Family history, increasing age, obesity and poor exercise, ethnicity (middle easter, south-east asian and western pacific, environment (low birth weight associated with glucose intolerance due to impaired beta cell development)

Question 5

what is the brief pathophysiology of type 2 diabetes?

Answer 5

• insulin resistance develops post insulin receptor
• loss in the norma biphasic response to insulin
• higher insulin levels due to increased glucose production from the liver and reduced glucose uptake in peripheral tissues
• hyperglycaemia and lipid excess are toxic to beta cells leading to further beta cell loss
• circulating insulin levels fall progressing towards absolute insulin deficiency
• Diabetic ketoacidosis tends not to develop as even a small amount of insulin can halt the breakdown of fat & muscle into ketones

Question 6

what are the key presentations of type 2 diabetes?

Answer 6

overweight in the abdominal area, polydipsia, polyuria weight loss and ketosis (only when very advanced with absolute insulin deficiency)

Question 7

what are the signs of type 2 diabetes?

Answer 7

Acanthosis nigricans (a skin condition causing dark pigmentation of skin folds, typically the axillae, groin, and neck), which suggests insulin resistance, high blood glucose

Question 8

what are the symptoms of type 2 diabetes?

Answer 8

polydipsia, polyuria, blurred vision, unexplained weight loss, recurrent infections, and tiredness.

Question 9

what is the first line investigation for type 2 diabetes?

Answer 9

HbA1c levels tested

Question 10

what are the gold standard investigations for type 2 diabetes?

Answer 10

fasting plasma glucose levels, random plasma glucose in presence of signs and symptoms

Question 11

what is the differential diagnoses for type 2 diabetes?

Answer 11

type 1 diabetes, other subtypes of diabetes

Question 12

what is the management for type 2 diabetes?

Answer 12

• Refer the patient to DESMOND, provide advice on lifestyle, advice on measurement of HbA1c levels
• metformin
• sulfonylurea
• insulin (last resort)

Question 13

how should type 2 diabetes be monitored?

Answer 13

HbA1c measured every 3-6 months, every 6 months once continuously 48mmol/mol or less

Question 14

what are the complications of type 2 diabetes?

Answer 14

• heart disease and stroke
• loss of feeling and pain (nerve damage)
• foot problems – like sores and infections
• vision loss and blindness

Question 15

what is the prognosis of type 2 diabetes?

Answer 15

With optimal management, people with type 2 diabetes can live a normal life, but are at risk of multiple complications long term. Life expectancy for people with type 2 diabetes is reduced by an average of up to 10 years

Question 16

what other investigations should be conducted in type 2 diabetes?

Answer 16

• Screen urine for microalbuminuria - to asses for kidney disease
• FBC, U&Es, liver biochemistry, fasting blood sample for cholesterol and triglycerides
• Raised blood pH to look for metabolic acidosis (high H+ and low HCO3-, due to ketoacidosis