Feb 13 - Diabetes Type II

Question 1

What is characteristic of diabetes type II?

Answer 1

Insulin resistance and insufficient insulin

Question 2

What does diabetes often result in?

Answer 2

Lower limb amputations
Renal failure
Cardiovascular events

Question 3

What is the definition of type II diabetes?

Answer 3

Diabetes that ranges from insulin resistance with relative insulin deficiency to a predominant secretory defect with insulin resistance

Question 4

Symptoms of type II diabetes due to high blood sugar may include what?

Answer 4

Increased thirst
Increased hunger (especially after eating)
Dry mouth
Frequent urination
Unexplained weight loss (even though you are eating and feel hungry)
Fatigue (weak, tired feeling)
Blurred vision
Headaches
Loss of consciousness (rare)

Question 5

Name three diagnostic tests for diabetes

Answer 5

FPG
2hPG in 75g OGTT
A1C

Question 6

What are the advantages of FPG?

Answer 6

Established standard
Fast and easy
Single sample

Question 7

What are the disadvantages of FPG?

Answer 7

Sample not stable
Day-to-day variability
Inconvenient to fast
Glucose homeostasis in single time point

Question 8

What are the advantages of 2hPG in 75g OGTT?

Answer 8

Established standard

Question 9

What are the disadvantages of 2hPG in 75g OGTT?

Answer 9

Sample not stable
Day-to-day variability
Inconvenient, unpalatable
Cost

Question 10

What are the advantages of A1C?

Answer 10

Convenient
Single sample
Low day-to-day variability
Reflects long term [glucose]

Question 11

What are the disadvantages of A1C?

Answer 11

Cost
Affected by medical conditions, aging, ethnicity
Standardized, validated assay required
Not used for patients under 18, pregnant women or suspected T1DM

Question 12

What are the risk factors for diabetes type II?

Answer 12

Family history
Obesity
Physical inactivity
Race or ethnicity
Impaired glucose tolerance
Impaired fasting glucose
HbA1c 5.7-6.4%
Hypertension (>140/90 mmHg)
Low HDL cholesterol
High triglycerides 
History of gestational diabetes
History of vascular disease
Acanthosis nigricans 
Polycystic ovary disease

Question 13

What is used for glucose regulation?

Answer 13

Insulin
Glucagon
Amylin

Question 14

Describe abnormal glucose regulation

Answer 14

Impaired insulin secretion
-gut hormones (GLP-1 and GLP)
-incretin effect
Insulin resistance (muscle, liver, adipocyte)

Question 15

What is prediabetes?

Answer 15

Defined as a state which places individuals at high risk of developing diabetes and its complications, is diagnosed by any of the following criteria: IFG, IGT, A1C

Question 16

What are the goals of therapy in type II diabetes?

Answer 16

Reduce risk, ameliorate symptoms, reduce mortality, and improve quality of life
Set goals for glycemia, blood pressure, and lipids
Blood glucose levels
Hemoglobin A1c
Get to the target within 3-6 months of diagnosis

Question 17

How is the initial choice of therapy determined?

Answer 17

It depends on glycemia
If initial A1C is below 8.5%, then start metformin or reassess in 2-3 months then decide on starting metformon
If initial A1C is equal to or above 8.5%, start metformin and consider combo therapy to achieve at least a 1.5% reduction in A1C