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YR3: ENDO LO's > Diabetes Mellitus: Type 2 > Flashcards

Diabetes Mellitus: Type 2 Flashcards

1
Q

Define T2DM

A

increased peripheral resistance to insulin action
Impaired insulin secretion
Increased HGO

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2
Q

What are the monogenetic causes of T2DM?

A

MODY

Mitochondrial diabetes

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3
Q

What increases the risk of T2DM? Why?

A

Obesity

Due to the action of adipocytokines

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4
Q

What 3 things may T2DM be preceded by?

A 
Pancreatic disease (e.g. chronic pancreatitis) 
Endocrine disease (e.g. Cushing's, acromegaly, phaeochromocytoma) 
Drugs (e.g. corticosteroids, atypical antipsychotics, protease inhibitors)
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5
Q

Describe the epidemiology of T2DM

A

UK Prevalence: 5-10%
Asian, African + Hispanic > risk
Incidence has increased; linked to increasing prevalence of obesity

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6
Q

What is the nature of T2DM at onset? List 6 presenting symptoms of T2DM

A 
Insidious:
Polyuria 
Polydipsia 
Tiredness  
HHS
Infections (e.g. infected foot ulcers, candidiasis, balanitis)  
CVS RFs: HTN, hyperlipidaemia + smoking
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7
Q

What do you measure on physical examination of a suspected T2DM patient?

A 
Weight
Height
BMI
Waist circumference
BP
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8
Q

What do you check for in suspected T2DM patients on physical examination?

A 
Diabetic foot (ischaemic + neuropathic signs)  
Skin changes
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9
Q

List 6 signs that occur in diabetic foot

A 
Dry skin 
Reduced subcutaneous tissue  
Ulceration  
Gangrene 
Charcot's arthropathy 
Weak foot pulses
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10
Q

List 3 skin changes that may occur in T2DM

A

Diabetic dermopathy: depressed pigmented scars on shins
Necrobiosis lipoidica diabeticorum: well-demarcated plaques on shins or arms with shiny atrophic surface + red-brown edges
Granuloma annulare: flesh-coloured papules coalescing in rings on the back of hands + fingers

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11
Q

Which 3 criteria can permit diagnosis of T2DM?

A

Sx of diabetes + random plasma glucose > 11.1 mmol/L
Sx of diabetes + Fasting plasma glucose > 7 mmol/L
2-hour plasma glucose > 11.1 mmol/L after 75 g oral glucose tolerance test

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12
Q

What must be monitored once a diagnosis of T2DM has been made?

A 
HbA1c 
U+Es 
Lipid profile  
eGFR  
Urine albumin: creatinine ration (detect microalbuminuria)
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13
Q

Describe the stepwise approach in management of T2DM glycemic control

A

At diagnosis: lifestyle + metformin
If HbA1c > 7% after 3 months: + sulphonylurea or basal insulin
If HbA1c > 7% after 3 months + FBG > 7 mmol/L: add premeal rapid-acting insulin

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14
Q

What is the MOA of sulphonylureas? When are they less often prescribed? Give an example

A

Stimulate insulin release by blocking ATP K channel on B cells
In jobs where hypos are undesirable e.g. driving
E.g. Glicazide

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15
Q

What is the MOA of Metformin? What are the side effects?

A

Inhibits hepatic gluconeogenesis

Side effects: GI disturbances, acidosis

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16
Q

What is the MOA of Thiazilodendones? Give an example

A

PPAR-Y inhibitors which decrease insulin resistance

E.g. Pioglitazone

17
Q

What is the MOA of GLP1-like agents? Give an example

A

Used in those where metformin is not having effect. Incretin effect leads to potent insulin sensitising + releasing stimulus.
Exenatide

18
Q

What can be given as a monotherapy if a patient can’t tolerate insulin?

A

Sulphonylurea alone

19
Q

What can be given alongside Metformin and a sulphonylurea?

A

a Thiazolidinedione

20
Q

How are complications of T2DM screened for?

A

Retinopathy: fundoscopy + digital retinal photography.
Nephropathy: U+Es
Neuropathy: diabetic foot examination, microfilament testing, vibration sensing, foot hygiene. Manage painful neuropathy with gabapentine.
Vascular disease: CVS + foot pulse exam
Diabetic foot: educate on risks + prevention. Diabetic shoes + podiatric assessment. X ray for osteomyelitis. Swab for infection

21
Q

What does a T2DM patient need educating about?

A

CVS risks. Should start on statin + lifestyle modification

Specific information in pregnancy + administration of insulin (ie changing injection site to prevent lipoatrophy)

22
Q

What acronym can be used for managing T2DM patients?

A 
INFORM 
Information
Nutrition
Foot education
Organizations
Recognition of hypos
Monitoring CBG
23
Q

What side effects may be seen as a result of taking insulin?

A

Weight gain
Fat hypertrophy at insulin injection sites
Hypoglycaemia- Nausea, tremor, confusion

24
Q

What may mask an overdose of insulin?

A

B blockers
Autonomic neuropathy
Adaptation to recurrent episode

25
Q

What may be caused by illness in T2DM? What are 9 symptoms and signs of this?

A 
Hyperosmolar Hyperglycaemic state:
Confusion
Polyuria
Polydipsia
Weakness
Weight loss
Tachycardia
Dry mucous membranes
Poor skin turgor
Hypotension
26
Q

What is the biochemistry in HHS?

A

High Na+
High glucose
High osmolality
No acidosis

27
Q

List 9 possible neuropathic complications in T2DM

A 
Distal symmetrical sensory neuropathy  
Painful neuropathy 
Carpel tunnel syndrome  
Diabetic amyotrophy 
Mononeuritis  
Autonomic neuropathy 
Gastroparesis (abdominal pain, N + V)  
Impotence  
Urinary retention
28
Q

List 5 possible nephropathic complications in T2DM

A 
Microabuminuria 
Proteinuria 
Renal failure  
Prone to UTI 
Renal papillary necrosis
29
Q

List 5 possible retinopathic complications in T2DM

A 
Background: hard exudates, dots + blots 
Pre-proliferative: cotton wool spots
Proliferative: visible new vessels  
Maculopathy 
Prone to glaucoma, cataracts + transient visual loss
30
Q

List 3 possible macrovascular complications in T2DM

A

Ischaemic heart disease
Stroke
Peripheral vascular disease

31
Q

Describe the prognosis in T2DM

A

Good prognosis with good control (esp. at start)

“Legacy effect”: benefits persist years after tight control

32
Q

How can pre-diabetes be diagnosed?

A

FBG + oral GT test:
Impaired Fasting Glucose (IFG) = FBG 5.6-6.9 mmol/L
Impaired Glucose Tolerance (IGT) = plasma glucose level of 7.8-11.0 mmol/L measured 2 hrs after a 75g OGTT
IFG/ IGT increases risk of developing T2DM

33
Q

What is the aetiology of microvascular complications in T2DM? List 3 examples

A

Glycosylation of basement membrane proteins leads to “leaky” capillaries
Retinopathy
Nephropathy
Neuropathy

34
Q

What is the aetiology of macrovascular complications in T2DM? List 3 examples

A 
Dyslipidaemia
HTN
IHD
CVD
Peripheral gangrene

YR3: ENDO LO's (28 decks)

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