Diabetes Mellitus - Type II Diabetes Mellitus

Question 1

Modifiable Risk Factors of Type II Diabetes Mellitus (3).

Answer 1

1. Obesity.
2. Sedentary Lifestyle.
3. High Carbohydrate (Refined Carbohydrate) Diet.

Question 2

Non-Modifiable Risk Factors of Type II Diabetes Mellitus (3).

Answer 2

1. Older Age.
2. Family History.
3. Ethnicity - Black, Chinese, South Asian.

Question 3

Aetiology of Type II Diabetes Mellitus.

Answer 3

A relative deficiency of Insulin due to an excess of Adipose tissue.

Question 4

Pathophysiology of Type II Diabetes Mellitus (4).

Answer 4

1. Repeated exposure to Glucose and Insulin develops resistance.
2. More insulin is required to produce a response.
3. Overtime, the pancreatic B-cells become fatigued and are damaged.
4. They produce less = chronic hyperglycaemia.

Question 5

Clinical Presentation of Type II Diabetes Mellitus.

Answer 5

1. Fatigue.
2. Polydipsia and Polyuria.
3. Unintentional Weight Loss.
4. Opportunistic Infections.
5. Slow Healing.

Question 6

Investigations of Type II Diabetes Mellitus.

Answer 6

1. OGTT.

Question 7

Method of OGTT (4).

Answer 7

1. Perform AM before Breakfast.
2. Take Baseline Fasting Plasma Glucose Result.
3. Give 75g Glucose Drink.
4. Measure Plasma Glucose 2 Hours Later.

Question 8

Diagnostic Criteria of Type II Diabetes Mellitus (4B).

Answer 8

1. HbA1C > 48 mmol/mol.
2. Random Glucose > 11 mmol/L.
3. Fasting Glucose > 7 mmol/L.
4. OGTT 2 Hour > 11 mmol/L.
   A. Symptomatic + 1 of 1-4.
   B. Asymptomatic + 1-4 2 separate occasions.

Question 9

When can HbA1C be inaccurate for Diagnosis?

Answer 9

1. Haemoglobinopathy.
2. Haemolytic Anaemia.
3. Untreated IDA.
4. Suspected Gestational Diabetes.
5. Kids.
6. HIV.
7. CKD.
8. Medications that cause Hyperglycaemia e.g. Corticosteroids.

Question 10

Management of Type II Diabetes Mellitus (4).

Answer 10

1. Dietary Modification.
2. Optimisation of Other Risk Factors.
3. Monitoring for Complications.
4. Medical Management.

Question 11

Dietary Modification in Type II Diabetes Mellitus (2).

Answer 11

1. Vegetables and Oily Fish.

2. Low Glycaemic and High Fibre Diet.

Question 12

Treatment Targets of Type II Diabetes Mellitus (2).

Answer 12

1. HbA1C < 48 mmol/mol for newly diagnosed.

2. HbA1C < 53 mmol/mol for those who have moved beyond Metformin alone.

Question 13

Medical Management of Type II Diabetes Mellitus.

Answer 13

1. 1st Line : Metformin.
2. 2nd Line (when HbA1C > 58) : Sulphonylurea, Pioglitazone, DPP-4 Inhibitor or SGLT-2 Inhibitor.
3. 3rd Line : Triple Therapy (Metformin + 2 2nd Lines) or Metformin + Insulin.

Question 14

Which medications are preferred in Cardiovascular disease for 2nd Line Drugs? (2)

Answer 14

1. SGLT-2 Inhibitors.

2. GLP-1 Mimetics.

Question 15

What is Pre-Diabetes?

Answer 15

An indication that the patient is heading towards Diabetes - not fitting the full diagnostic criteria.

Question 16

Diagnosis of Pre-Diabetes (3).

Answer 16

1. HbA1C : 42-47 mmol/L.
2. Impaired Fasting Glucose : Fasting Plasma Glucose 61.-6.9mmol/L.
3. Impaired Glucose Tolerance : 2 Hour Plasma Glucose 7.8-11.1 mmol/L (OGTT) AND Fasting Plasma Glucose < 7.0.

Question 17

What is Impaired Fasting Glucose?

Answer 17

The body struggles to get their blood glucose levels into normal range, even after a prolonged period without eating carbohydrates.

Question 18

What is Impaired Glucose Tolerance?

Answer 18

The body struggles to cope with processing a carbohydrate meal.

Question 19

Management of Pre-Diabetes (2).

Answer 19

1. Education and Lifestyle Changes.

2. No Medical Treatment.