Endo 15 - Aetiology and Treatment of T2DM Flashcards
What tests are performed to diagnose diabetes and what are the defining values?
Fasting Blood Glucose
normal - <6
impaired fasting glucose = 6-7
diabetes = >7
Glucose tolerance test
normal = <7.8
impaired fasting glucose = 7.8-11.1
diabetes = >11.1
State 3 factors that influence the pathophysiology of T2DM
Genetics
Intrauterine environment
Adult environment
Why is intrauterine environment important in the pathogenesis of T2DM?
epigenetic changes that take place in utero
What is MODY?
Mature onset diabetes of the youn
autosomal dominant
ineffective pancreatic beta cell insulin production
What type of babies are more likely to develop T2DM in later life?
smaller babies
How does insulin resistance lead to hypertension?
causes dyslipidaemia and stimulates mitogenic pathway causing smooth muscle hypertrophy
= increased blood pressure
What eventually happens to the beta cells in T2DM?
Insulin resistance damages the beta cells and eventually leads to beta cell failure
Describe what happens to beta cell reserve and insulin resistance with age.
Beta cell reserve decreases, insuline resistance increases
Describe the presentation of a typical patient with T2DM
obese
insulin resistance and insulin secretion deficient
hyperglycaemia and dylipidaemia
acute and chronic complications
What dietary changes can someone with T2DM make to reduce the effect of missing first phase insulin release?
Complex carbohydrates to release glucose more slowly
What happens to glucose clearance in T2DM?
Decreased
What happens to hepatic glucose output in T2DM?
Increased
What normally happens to insulin secretion as insulin resistance builds up?
More insulin secreted to compensate
Which adipocytes are particularly marked for breakdown of triglycerides?
Omental
What happens to fatty acids when they go into the liver?
cannot be used to make glucose so converted to very low density lipoproteins
What is the problem with VLDL?
highly atherogenic
Describe how gut microbiota is implicated in T2DM?
important in host signalling and host metabolism
What is a common side effect of diabetes treatment?
Weight gain
Which diabetes treatment does not cause weight gain?
Metformin
What are the complications of T2DM?
Stroke MI neuropathy retinopathy nephropathy hypoglycaemia
What dietary measures are recommened for someone with T2DM?
Decreased fat
decreased refined carbs
increased complex carbs
increased soluble fibre
What is orlistat?
Pancreatic lipase inhibitor
reduces break down of fats in intestines thus reducing absorption of fat
State 5 classes of drugs used to treat T2DM
Metformin - insulin sensitiser
Sulphonylureas - makes pancreas produce more insulin
Alpha-glucosidase inhibitors - prolong absorption of glucose
thiazolidinediones - addresses peripheral insulin resistance
GLP-1 agonists - increase insulin secretion
When should you not use metformin?
Severe liver failure
severe cardiac failure
mild renal failure
