Diabetes Mellitus - Type 2 Flashcards

1
Q

Define Type 2 Diabetes Mellitus

A

Chronic syndrome of impaired metabolism characterised by peripheral target-tissue resistance to insulin action, impaired insulin secretion and raised hepatic glucose output

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2
Q

Aetiology of Type 2 Diabetes Mellitus

A

Insulin resistance + impaired secretion -> hyperglycaemia
Background genetic predisposition + ageing, physical inactivity, obesity

Insulin resistance usually affects the liver, muscle and adipocytes

Secondary to: chronic pancreatitis, haemochromatosis, pancreatic cancer, Cushing’s, acromegaly, phaeos, steroid use

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3
Q

Symptoms of Type 2 Diabetes Mellitus

A

Asymptomatic

Tiredness/fatigue 
Blurred vision
Infections (foot ulcers, candidiasis, balantitis, pruritus vulvae, cellulitis, UTI)
Polyuria, polydipsia, nocturia
Paraesthesia
Polyphagia 
Unintentional weight loss
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4
Q

Signs of Type 2 Diabetes Mellitus on examination

A

Acanthosis nigricans
Obesity

Diabetic foot: dry skin | reduced SC tissue | corns + calluses | ulceration | gangrene | Charcot’s foot | Pedal pulses weak/absent

Rare skin changes: Necrobiosis lipoidica diabeticorum, granuloma annulare, diabetic dermopathy

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5
Q

Investigations for Type 2 Diabetes Mellitus

A

Fasting plasma flucose >6.9
Random plasma glucose > 11.1 (+symptoms)
Oral glucose tolerance test >11.1
HbA1c >48

Urinary/Plasma ketones: negative (differentiate from T1)
ABPI: Suggests PAD
Urinary albumin excretion: may be increased (end-organ damage)
ECG: ?ischaemia
Fundoscopy: detect retinopathy
Albumin:creatinine ratio: detect microalbuminuria (nephropathy)

Fasting C peptide: >1 (differentiate from T1)
Fasting lipid profile: dyslipidaemia (More common T2)
Serum Cr and eGFR: Detect renal insufficiency

CXR: ?Charcot’s foot

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6
Q

Conservative management for Type 2 Diabetes Mellitus

A
First line before medication
Personalised self-management 
 - Limit caloric intake 
 - Moderate physical activity (3-4 aerobic a week)
 - Weight loss
 - Reduce alcohol intake
 - Smoking cessation
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7
Q

Medical management for Type 2 Diabetes Mellitus

A
  • Glycaemic control
    Start with Metformin
  • BP management
    Start with ACEi/ARB
  • Lipid management
    Atorvastatin (dose depends on underlying disease)
  • Antiplatelets (bg cardiovascular disease)
    Aspirin
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8
Q

What are the types of glycaemic control drugs for Type 2 Diabetes Mellitus and which cause weight gain/loss

A

=> Insulin sensitisers

  • Metformin (biguanide): Reduces insulin resistance (Wt loss)
  • Thiazolidinedione (Pioglitazone): insulin sensitiser (PPAR-y receptor) (Wt gain)

=> Insulin provider

  • Insulin
  • Sulphonylureas (glibenclamide): insulin secretagogue (K+ channel blocker) (Wt gain)
  • Metaglinide (repaglinide) (Wt gain)

=> Incretin enhancers

  • GLP-1 (liraglutide, exenatide): stimulate insulin, suppress glucagon secretion (Wt loss)
  • Gliptins: DPP4 inhibitors to reduce breakdown of GLP-1 (weight neutral)

=> Glucose excretors:

  • SLGT-2 inhibitos (anagliflozin): inhibitis sodium glucose transporter -> renal glucose reabsorption inhibited (Wt loss, risk of necrotising fasciitis)
  • Alpha-glucosidase inhibitors (acarbose): delays + prolongs absorption of carbs
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9
Q

Complications of Type 2 Diabetes Mellitus

A
End stage renal disease
Blindness
Amputation
Cardiovascular disease
Congestive heart failure 
Stroke 
Infection
Periodontal disease
Neuropathy 
Depression
Obstructive sleep apnoea
DKA 
Non-ketotic hyperosmolar state/HHS
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10
Q

What is HHS

A

Hyperosmolar hyperglycaemic state

Due to insulin deficiency

Longer history (1 week) of:
Collpase/confusion
Dehydration
Nause + vomiting

Features:
Marked dehydration
Hypernatraemia
Hyperglycaemia (>35)
Hyperosmolar >240)
NO acidosis
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11
Q

Prognosis for Type 2 Diabetes Mellitus

A

UKDSP showed intensive therapy for glycaemic control reduces risk of development and progression of diabetic microvascular complications
Early control reduces risk for MI and all-cause mortality

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