diabetes type 2

Question 1

what is type 2 diabetes

Answer 1

combo of insulin resistance and b-cell failure resulting hyperglycaemia

insulin production not enough to overcome insulin resistance

relative deficiency
not usually DKA

Question 2

stages of development of T2D

Answer 2

normal
fasting glucose levels ≤6mmol/L
OGTT <7.7mmol/L
HbA1C <42mmol/mol

intermediate state
impaired fasting glycaemia
impaired glucose tolerance
pre-diabetic/non-diabetic hyperglycaemia

T2D
fasting glucose levels ≥7mmol/L
OGTT ≥11mmol/L
HbA1C ≥48mmol/mol

Question 3

what happens in long-duration type 2 diabetes

Answer 3

beta-cell failure -> complete insulin deficiency

Usually on insulin at this point stopping would risk ketoacidosis

Question 4

what happens to glucose uptake in skeletal muscle and HGO

Answer 4

skeletal muscle - less uptake of glucose

HGP- increased: lower insulin and increased glucagon action

Question 5

genetic types of T2D

Answer 5

monogenic

polygenic

Question 6

what is monogenic

Answer 6

Single gene mutation ==> Diabetes (MODY=Maturity-onset diabetes of the young)
‘Born with it, always going to develop diabetes

Question 7

what is polygenic

Answer 7

Polymorphisms increasing risk of diabetes
‘Not born with it but high risk and may develop later depending on other factors’

Question 8

how to assess GWAS in T2D

Answer 8

2 groups- people with AND without T2D

nucleotide changes present in T2D but not control group

assess effect size

Question 9

SNP- the one that stood out/individual vs group risk

Answer 9

TCF7L2

Each individual SNP has only a mild effect on risk

Cumulative effect of all SNPs have a bigger effect

Question 10

T2D diagnosis

Answer 10

First line test for diagnosis is HbA1c.

1x HbA1c >=48mmol/L with symptoms

Or

2x HbA1c >=48 mmol/mol if aysymptomatic

Question 11

difference between T1D/TD2

Answer 11

T2D: Insufficient insulin (NOT ABSENT) for prevention of hyperglycemia but sufficient insulin for suppression of lipolysis and ketogenesis.

Question 12

hyperosmolar hyperglycaemic state

Answer 12

Presents commonly with renal failure.
often following Infection/MI

Question 13

what is the GI incretin effect

Answer 13

The relative increase in insulin in response to oral glucose compared to IV glucose.

Relevant for treatment T2dm.

Question 14

GLP-1 agonist
name
how to administer
effects

Answer 14

Liraglutide, Semaglutide
Injectable –daily, weekly
Decrease [glucagon]
Decrease [glucose]
Weight loss

Question 15

Gliptins (DPPG-4 inhibitor)
effects

Answer 15

Increase half life of exogenous GLP-1
Increase [GLP-1]
Decrease [glucagon]
Decrease [glucose]
Neutral on weight

Question 16

how to reduce remission of T2DM

Answer 16

Gastric bypass surgery
very low calorie diet for 3-6 months

but not cure