Endo - T2DM Flashcards
What is T2DM?
→ combination of insulin resistance + beta-cell failure result in hyperglycaemia
→ Associated with obesity but not always
→ resultant chronic hyperglycaemia may initially be managed by changes to diet / weight loss and may even be reversible
→ over time glucose lowering therapy including insulin, is needed
What contributes to the insulin resistance in T2DM?
→ genetic risk
→ obesity
Can DKA be a feature of T2DM?
yes
When can T2DM present in a person’s life?
→ commonly thought to be only a condition of late adulthood
→ literally in every decade tho
What is the trend in prevalence of T2DM? Why?
→ varies enormously
→ increasing prevalence
→ occurring + being diagnosed in younger groups
→ greatest ethnic groups moving from rural to urban lifestyle
What are the stages of development for T2DM?
→ normal state = normal glucose + insulin production + insulin resistance
→ intermediate state = impaired fasting glucose + impaired glucose tolerance + pre-diabetic or non-diabetic hyperglycaemia + increasing insulin production + insulin resistance
→ T2DM = low insulin production + insulin resistance
What are the fasting glucose levels for someone with impaired fasting glucose?
6 < x < 7 mmol/L
What are the glucose levels after an OGTT for impaired glucose tolerance?
7.7 < impaired glucose tolerance < 11 mmol/L
What are the HbA1c levels for pre-diabetic or non-diabetic hyperglycaemia
42 < pre-diabetic or non-diabetic hyperglycaemia < 48 mmol/L
What is relative insulin deficiency?
Insulin is produced by pancreatic beta-cells but not enough to overcome insulin resistance → can’t have DKA under usual hyperglycaemic episodes
What is long-duration T2DM?
→ beta-cell failure may progress to complete insulin deficiency
→ usually on insulin but can’t come off at risk of DKA
What happens to the first phase insulin release in T2DM?
doesn’t exist
What happens to uptake of glucose in muscles in T2DM?
reduced insulin action = less uptake of glucose in skeletal muscles
What happens to hepatic glucose production in T2DM? Why?
reduced insulin action = increased hepatic glucose production + increased glucagon action
What is the relationship between insulin resistance and insulin secretion in T2DM?
→ as insulin resistance increases, insulin secretion also increases
→ directly proportional
What is MODY?
→ maturity onset diabetes of the young
→ monogenic inheritance of Diabetes, can’t avoid it
What is the polygenic risk of T2DM?
→ polymorphisms increasing the risk of diabetes
→ not born with it but could develop it later depending on other factors