L13 T2DM

Question 1

What is diabetes mellitus?

Answer 1

A CONDITION WHERE
THE BLOOD GLUCOSE
IS ABOVE
AN INTERNATIONALLY ACCEPTED LEVEL

Question 2

Diagnosis of DM

Answer 2

blood glucose more than 11.1mmol/l and symptoms
hba1c more than 48 mmol/mol 6.5%

75g glucose tolerance test
fasting plasma glucose more than 7mmol/l
2 hour plasma glucose more than 11.1mmol/l

Question 3

What is type 2 DM?

Answer 3

A common condition where there is insulin resistance and beta cells not producing enough insulin to keep blood glucose levels normal

Question 4

Islet cells in T2DM

Answer 4

Deficit in B cells in the islet
increased b cell apoptosis
extracellular amyloid deposits

Question 5

Aetiology of T2DM

Answer 5

Genetic - polygenic
fetal programming - maternal hyperglycemia
intrauterine growth retardation
reduced B cell mass
other causes include old age, B cell regression, other pancreatic pathology, change in gut microbiota
glucotoxicity and lipotoxicity

Question 6

What is ectopic fat?

Answer 6

Excess fat that stores elsewhere, like around organs in the gut but also can store between heart and pericardium - Epicardial fat

Question 7

why is ectopic fat a problem?

Answer 7

Your stored up lipids get broken down to free fatty acids which can cause insulin resistance
ectopic fat also produces cytokines - inflammation - insulin resistance
also produces procoagulant factor PAI1

Question 8

How to measure insulin resistance

Answer 8

measure waist circumference

abdominal girth

Question 9

what age group is most likely to be overweight?

Answer 9

55-64

Question 10

what is the problem with T2D?

Answer 10

Hyperglycemia
Dysregulation of lipid metabolism
high levels of proinflammatory cytokines
high levels of free radicals
increased suceptibility to infection
retinopathy when blood glucose too high for too long
increased generation of polyols from glucose - cataracts
A cataract is a clouding of the lens in the eye which leads to a decrease in vision.

Renal disease
neuropathic ulcer - foot
Glyocsylation of connective tissue - Cheiroarthropathy
peripheral vascular disease

Question 11

Bone in T2D

Answer 11

Mechanically weaker

increased fractures

Question 12

what to do ?

Answer 12

Prevent the Diabetes!
Improve the Hyperglycaemia
Reduce the Cardiovascular risk factors
Screen for complication + Treat early

Question 13

Treating T2D

Answer 13

stage 1 - lifestyle -
diet
exercise

Question 14

preventing macrovascular disease in T2D

Answer 14

Lifestyle 
diet exercise and smoking
treat dyslipidemia - statins
hypertension 
use of aspirin

Question 15

Screening to enable early treatment

Answer 15

eyes - Retinal Photography
Laser treatment when required
Kidneys
Measure urine albumin ( EMU)
Control Blood Pressure
ACE inhibitors & ARBs
Feet
Screen for neuropathy & Vascular disease

Question 16

what are the goals for T2D

Answer 16

modify lifestyle 
screen for complications 
specific clinics for complications - foot renal eye
HBA1C 6.5-7.5% 
BP 120-140/80 
LDL less than 2.0mmol/l 
Non HDL less than 2.8