Diabetes mellitus: type 2 Flashcards
1
Q
Describe the epidemiology of type 2 diabetes
A
- ) Obese
- ) Older
- ) More common is African and South Asian populations
2
Q
What are the main risk factors for developing type 2 diabetes?
A
- ) Obesity
- ) Low physical activity
- ) Older age (?)
- ) Hypertension
- ) Hypercholesterolaemia
- ) Family history
- ) Genetics: twins
3
Q
Describe the pathology of type 2 diabetes
A
- ) Develop insulin resistance due to B-cell dysfunction: B cell mass reduces. This leads to hyperglycaemia due to lower levels of insulin secretion
- ) Get beta cell hypertrophy and hyperplasia
4
Q
Causes of type 2 diabetes (diseases that lead to it)
A
- ) Pancreatic causes: pancreatitis/pancreas removal/trauma/pancreatic destruction (haemochromatosis + cystic fibrosis)/pancreatic cancer
- ) Cushing’s disease (body makes too much cortisol)
- ) Acromegaly
- ) Pheochromocytoma (tumour of adrenal gland)
- ) Hyperthyroidism
- ) Pregnancy
5
Q
Key signs and symptoms to identify
A
- Generally is asymptomatic: diagnosis can be made at eye routines where you see proliferative blood growth
- If it is very severe, can develop signs of hyperglycaemia (polyuria and polydipsia)
6
Q
Investigations for diabetes?
A
- ) HbA1C test: this will test the proportion of H in RBC that has glucose stuck to it. This changes v slowly so gives a good indication - if its higher than 47mmol/L then this is diabetes.
- ) Blood glucose test: random (>11.1) or fasting (>7.0) or 2 hours post-prandial (after meal) (>11.1)
7
Q
Investigations for pre-diabetes
A
- ) Impaired Fasting Tolerance (IFG): abnormal fasting glycose result, but not high enough to be diabetes (6.1-6.9 in fasting)
- ) Impaired Glucose Tolerance (IGT): Abnormal 2h post-prandial result but not high enough to be diabetes (7.8-11.0 after 2 hours meal)
- REMEMBER BOTH DENOTE INSULIN RESISTANCE)
8
Q
Describe the management of Pre-diabetes
A
- ) NO MEDS
- ) Lifestyle advice on diet and exercise
- ) Have an annual review:
- Each visit: review results/make targets/educate them/talk about general or specific problems
- Annually: HbALc test/BMI/BP/Plasma lipids/Visual acuity/Urine test/Blood test/Condition of feet/review of CV risk factors
- Discuss (if needed): driving/travel/contraception/erectile dysfunction
9
Q
Management of type 2 diabetes mellitus
A
- ) Lifestyle adcie
- ) Oral hypoglycaemia agents: Metformin is the first line drug
- ) HbAL1c rises to 58mmol/l consider:
- Metformin + sulphonylurea
- Metformin + DPPV inhibitor
- Metformin + pioglitazone
- Metformin + SGLT2i - ) If HBA1c has not decreased, move to triple therapy:
- Metformin + SU + DPP4 inhibitor
- Metformin + SU + pioglitazone
- Metformin + SU/pioglitazone + SGLT-2i
- Insulin based therapy - ) If the triply therapy is not tolerated then
- Insulin
- Metformin + SU + GLP 1 mimetic
10
Q
Review of drugs used in T2DM
A
- ) Metformin
- Is a biganide
- Reduces gluconeogenesis and increases insulin sensitivity
- Side effect: weight loss (from diarrhoea/nausea)
- Kidney issues: can cause lactic acidosis in renal disease
11
Q
Review of drugs used in T2DM: Metformin
A
- ) Metformin
- Is a biguanide
- Reduces gluconeogenesis and increases insulin sensitivity
- Side effect: weight loss (from diarrhoea/nausea)
- Kidney issues: can cause lactic acidosis in renal disease
12
Q
Review of drugs in T2DM: Sulfonylurea
A
- E.g. gliclazide + glipizide
- Works by stimulating B cells to secrete insulin
- Side effects: hypoglycaemia and weight gain
- Don’t use in pregnancy as it can cross placenta
13
Q
Review of drugs in T2DM: DPP4 inhibitors
A
- E.g. sitagliptin
- Inhibitors DPP4: increase effect of incretins e.g. GLP-1, stimulating insulin secretion
- Incretin: hormones released after eating
- Won’t cause weight gain or weight loss
14
Q
Review of drugs in T2DM: Thiazolidinedione - glitazones
A
- E.g. pioglitazone
- Enhance uptake of fatty acids + glucose (basically body is making more fat from glucose and fatty acids)
- Can cause fluid retention: may worsen fluid retention
- Cause weight gain
