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Endocrinology > Diabetes mellitus type 2 > Flashcards

Diabetes mellitus type 2 Flashcards

1
Q

Define T2DM

A

Characterised by increased peripheral resistance to insulin action, impaired insulin secretion & increased hepatic glucose output

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2
Q

Aetiology of T2DM

4

A
  • Genetic & environmental
  • Few monogenic causes of diabetes ( e.g MODY, mitochondrial diabetes)
  • Obesity increases risk (due to action of adipocytokines)

Can occur secondary to

  • pancreatic disease (e.g chronic pancreatitis)
  • endocrine disease (e.g Cushing’s, acromegaly, phaechromocytoma, glucagonoma)
  • drugs (e.g corticosteroids, atypical antipsychotics, protease inhibitors)
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3
Q

Epidemiology of T2DM

Uk, ethnicities, link

A

5-10% prevalence in UK

Asians, africans & hispanics at greater risk

incidence increased in past 20 yrs linked to increasing prevalence of obesity

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4
Q

Presenting symptoms of T2DM

7

A
  • may be incidental finding
  • polydipsia
  • polyuria
  • tiredness
  • may present with hyperosmolar hyperglycaemic state (HHS)
  • infections (e.g infected foot ulcers, candidiasis, balanitis)
  • assess cardiovascular risk factors: hypertension, hyperlipidaemia & smoking
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5
Q

Signs of T2DM on physical examination

5

A 
Calculate BMI
Waist circumference
Blood pressure
Diabetic foot (ischaemic & neuropathic signs)
Skin changes (rare)
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6
Q

Investigations for T2DM - diagnosis

3

A

1 or more:

  • symptoms of diabetes & random plasma glucose >11.1mmol/L
  • fasting plasma glucose >7mmol/L
  • 2 hr plasma glucose >11.1mmol/L after 75g oral glucose tolerance test
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7
Q

Investigations for T2DM - monitor

5

A 
HbA1c
U&Es
lipid profile
eGFR
urine albumin: creatinine ratio (look for microalbuminuria)
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8
Q

Management of T2DM - glycaemic control

4

A

1) at diagnosis: lifestyle + metformin

2)
if HbA1c >7% after 3 months: lifestyle + metformin + sulphonylurea or basal insulin

3) if HbA1c >7% after 3 months: lifestyle + metformin + basal insulin
4) if HbA1c >7% after 3 months & fasting blood glucose >7mmol/L: add primal rapid acting insulin

(sulphonylurea may be given as a monotherapy if patients cannot tolerate metformin)
(pioglitazone (thiazolidinedione) may also be given alongside metformin & a sulphonylurea)

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9
Q

Prognosis for T2DM

general + 4 pre diabetes

A

Good prognosis w/ good control

Pre-diabetes diagnosed based on fasting blood glucose & oral glucose tolerance test:

  • impaired fasting glucose (IFG): 5.6-6.9mmol/L
  • impaired glucose tolerance (IGT): plasma glucose 7.8-11.0mmol/L measured 2 hrs after 75g oral glucose tolerance test

IFG or IGT => high risk of developing T2DM

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10
Q

Signs of diabetic foot

6

A
  • dry skin
  • reduced subcutaneous tissue
  • ulceration
  • gangrene
  • Charcot’s arthropathy
  • weak foot pulses
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11
Q

Skin changes in T2DM

3

A

Necrobiosis lipoidica diabeticorum - well demarcated plaques on shins/arms w/ shiny atrophic surface & red brown edges

Granuloma annulare - flesh coloured papules coalescing in rings on back of hands & fingers

Diabetic dermopathy - depressed pigmented scars on shins

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12
Q

Investigations for T2DM

2 group

A

Diagnosis

Monitoring

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13
Q

Management of T2DM

4 groups

A

Glycaemic control
Screening for complications
Pregnancy
HHS

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14
Q

Management of T2DM - screening for complications

5

A 
Retinopathy
Nephropathy
Vascular disease
Diabetic foot
Cardiovascular risk factors (e.g. BP, cholesterol)
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15
Q

Management of T2DM - pregnancy

A

Requires strict glycaemic control & planning

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16
Q

Management of T2DM - HHS

2

A

Management similar to DKA

Except use 0.45% saline if serum Na+ > 170mmol/L

17
Q

Complications of T2DM

5 groups

A 
HHS
Neuropathy
Nephropathy
Retinopathy
Macrovascular
18
Q

Complications of T2DM - HHS

6

A 
Due to insulin deficiency 
Marked dehydration 
High Na+
High glucose
High osmolality 
No acidosis
19
Q

Complications of T2DM - neuropathy

9

A 
Distal symmetrical sensory neuropathy
Painful neuropathy 
Carpel tunnel syndrome 
Diabetic amyotrophy 
Mononeuritis 
Autonomic neuropathy
Gastroparesis (abdo pain, N&V)
Impotence
Urinary retention
20
Q

Complications of T2DM - nephropathy

5

A 
Microalbuminuria
Proteinuria
Renal failure
Prone to UTI
Renal papillary necrosis
21
Q

Complications of T2DM - retinopathy

5

A 
Background
Pre proliferative 
Proliferative 
Maculopathy
Prone to glaucoma, cataracts & transient visual loss
22
Q

Complications of T2DM - macrovascular

3

A

Ischaemic heart disease
Stroke
Peripheral vascular disease

Endocrinology (29 decks)

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