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Year 2 - T2 Theme 1 > L13 - Type 2 diabetes > Flashcards

L13 - Type 2 diabetes Flashcards

1
Q

Blood clinical diagnosis of diabetes

A
  • Glucose = or > 11.1 mmol/l + symptoms
  • Glucose = or > 11.1 mmol/l x 2
  • HBA1c = or > 48 mmol/mol (6.5%)
  • Lower value does not exclude diabetes
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2
Q

Which cells cannot produce enough insulin in type 2 diabetes

A
  • Islet beta cells
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3
Q

What is the islet characterised by in type 2 diabetes

A
  • A deficit in beta-cells
  • Increased beta-cell apoptosis
  • Extracellular amyloid deposits derived from IAPP
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4
Q

What is islet amyloid polypeptide (IAPP, amylin) secreted by

A
  • IAPP is secreted from pancreatic islet beta-cells and converted to amyloid deposits in type 2 diabetes
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5
Q

Type 2 diabetes - aetiological features

A
  • Genetic
  • Polygenic
  • Fetal programming (epigenetic), maternal hyperglycaemia, intrauterine growth retardation
  • Reduced beta cell mass
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6
Q

Type 2 diabetes - less common aetiological features

A
  • Beta cell regression ( Sox 5 gene )
  • Old age
  • Other Pancreatic Pathology
  • Change in the gut microbiota
  • Glucotoxicity & Lipotoxicity
    • later effects

Sox5 regulates beta-cell phenotype and is reduced in type 2 diabetes

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7
Q

Type 2 diabetes mellitus pathophys

A

Reduced incretin effect, glucotoxicity, lipotoxicity –> endocrine gland, beta cell problem –> hormone (insulin) –> organs - fat, liver and muscle resistant

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8
Q

What is epicardial fat a strong risk factor for

A
  • Epicardial fat is a strong factor for vascular disease
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9
Q

Why is ectopic fat a problem

A

Ectopic fat - A problem
An ‘endocrine’ organ producing

• Free fatty acids

  • Insulin resistance
  • Atherogenic lipids

· Cytokines

  • Insulin resistance
  • Inflammation

· Procoagulant factors (PAI1)

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10
Q

Excess fat in which organ is specific to T2DM

A
  • Excess fat in the diabetic pancreas is specific to T2DM and important in preventing normal insulin production
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11
Q

Prevalence of type 2 diabetes in the uk

A
  • 4.6 million people

- 12.3 million at risk

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12
Q

What is type 2 diabetes mostly attributed to

A
  • BMI > 23
  • Lack of exercise
  • Unhealthy diet
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13
Q

Side effects/morbidity related to type 2 diabetes

A
  • Hyperglycaemia per se
  • Dysregulation of lipid metabolism
  • High levels of proinflammatory cytokines
  • High levels of free radicals
  • Increased susceptibility to infection
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14
Q

Effect of high glucose levels on the retina

A
  • High glucose levels for long durations can cause maculopathy/retinopathy
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15
Q

Link between HBA1c levels and cataract risk

A
  • 1% reduction in HBA1c reduces cataract risk by 19%
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16
Q

What is diabetic nephropathy

A
  • Diabetic nephropathy (DN), also known as diabetic kidney disease, is the chronic loss of kidney function occurring in those with diabetes mellitus
  • Protein loss in urine due to damage to the glomeruli may become massive, and cause a low serum albumin with resulting generalised body swelling (edema) and result in
17
Q

What type of ulcers can form as a result of high blood glucose levels

A
  • Neuropathic ulcers
18
Q

Link between haemoglobin A1C and microvascular complications

A

In diabetes mellitus, higher amounts of glycated hemoglobin, indicating poorer control of blood glucose levels, have been associated with cardiovascular disease, nephropathy, neuropathy, and retinopathy

19
Q

What is cheiroarthropathy

A

Diabetic cheiroarthropathy (Limited Joint Mobility, or LJM) is a cutaneous condition characterized by thickened skin and limited joint mobility of the hands and fingers, leading to flexion contractures, a condition associated with diabetes mellitus

  • This occurs due to glycosylation of connective tissue
20
Q

Features of bone in type 2 diabetes

A
  • Mechanically weaker
  • Increased fractures x2
  • In spite of normal bone density
21
Q

Proinflammatory and anti-inflammatory effects of lipoprotein classes and inflammation

A

All the major lipoprotein classes impact in some way on the inflammatory process that leads to development of atherosclerosis. The triglyceride-rich lipoproteins—chylomicrons, very low density lipoprotein (VLDL), and their catabolic remnants—and low-density lipoprotein (LDL) are potentially proinflammatory, whereas high-density lipoprotein (HDL) is potentially anti-inflammatory.

22
Q

Prevention/treatment of T2DM

A
  • Lifestyle manouvres
  • Treatment of dyslipidaemia and hypertension
  • Use of aspirin
23
Q

Screening measures - eyes

A
  • Retinal photography

- Laser treatment when required

24
Q

Screening measures - kidneys

A
  • Measure urine albumin (EMU)
  • Control blood pressure
  • ACE inhibitors and ARBs
25
Q

Screening measures - feet

A
  • Screen for neuropathy and vascular disease
26
Q

Goals of type 2 diabetes mellitus treatment

A 
· Lifestyle Modification
· Screen for complications
· Special clinics for complications
	• Foot, Renal, Eye
· HbA1c  6.5 – 7.5 % (48 – 58 mmol/mol)
· BP   120 -140 /80
· LDL  < 2.0  mmol/l
· Non HDL cholesterol  < 2.78
27
Q

Metabolic/obesity surgerical treatments for type 2 diabetes

A
  • Sleeve gastrectomy
  • Roux en Y bypass
  • Gastric band
28
Q

Objectives of pharmacological interventions in treating type 2 diabetes

A
  • Reduce insulin resistance
  • Increase insulin production/secretion
  • Provide insulin replacement
29
Q

In which conditions is HbA1c not useful for diagnosis of diabetes mellitus

A 
haemoglobinopathies
haemolytic anaemia
untreated iron deficiency anaemia
suspected gestational diabetes
children
HIV
chronic kidney disease
people taking medication that may cause hyperglycaemia (for example corticosteroids)
30
Q

Diagnosis of impaired fasting glucose

A

A fasting glucose greater than or equal to 6.1 but less than 7.0 mmol/l implies impaired fasting glucose (IFG)

Impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l

31
Q

Further tests for individuals with impaired fasting glucose

A

People with IFG should then be offered an oral glucose tolerance test to rule out a diagnosis of diabetes. A result below 11.1 mmol/l but above 7.8 mmol/l indicates that the person doesn’t have diabetes but does have IGT

32
Q

HbA1c in pre diabetes

A

42-47 mol/mol or fasting glucose 6.1-6.9 mmol/l

Year 2 - T2 Theme 1 (20 decks)

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