L13 - Type 2 DM Flashcards
what is a usual clinical diagnosis
75g glucose tolerance test
- —DM fasting glucose, 2 hour glucose
- –impaired glucose tolerance: 3 hour glucose
- —impared fasting glucose
Blood
• 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
• 75 g Glucose Tolerance test
Diabetes Mellitus
• Fasting plasma glucose = / > 7 mmol/l
‘ 2 hour plasma glucose = / > 11.1 mmol/l
Impaired Glucose Tolerance
• 2 hour glucose between 7-11 mmol/l
Impaired Fasting Glucose
• Fasting glucose between 6 — 6.9 mmol/l
df of T2DM
A COMMON CONDITION WHERE THERE IS INSULIN RESISTANCE and Beta cells Which cannot produce enough Insulin To keep the blood glucose Normal
causes of T2 DM
causes
what do these lead to
what are other factors which may increase risk
Seen in high percentage of identical co-twins
Genetic
Polygenic
• Fetal Programming (Epigenetic )
—-Maternal Hyperglycaemia
— Intrauterine growth retardation
—->Reduced Beta cell mass
Other possible aetiological factors ' Beta cell regression ( Sox 5 gene ) Old age Other Pancreatic Pathology ' Change in the gut microbiota • Glucotoxicity & Lipotoxicity later effects
what can glucotoxicity and lipotoxicity lead to
the reduced increin effect means that the endocine gland beta cells are less effective at secr insulin
insulin resistance can cause XS fat deposits where?
what is this a strong risk factor for
xs :
subcutaneous fat
visceral fat
epicardial fat
vascular disease
ECTOPIC FAT
what can this act as
what does it produce
what can XS fat in the diabetic pancreas prevent
AN “ENDOCRINE” ORGAN Producing
FREE FATTY ACIDS
Insulin resistance
Atherogenic lipids
CYTOKINES
Insulin resistance
— Inflammation
• Procoagulant factors ( PAII)
XS fat in the diabetic pancreas can prevent normal insulin production
Prevalence of T2 DM
in uk
how many and and how many at risk
how has adult obesity changed in past years?
What age group is most likely to be overweight
what is the prevalence of overweight and obesity
- 6 million peeople
- 3 mil at risk
risen a lot
most likely to be overweight or obese is 55-64 – but small margin
prev of obesity and OW above 70% among 45 upwards
Iwhat is 96% of diabetes atributed to? acc nurses health study
BMI > 23
lack of exercise
unhealthy diet
—-prevention better than cure
what are the serious side effects / morbidity of T2DM related to?
Serious side Effects / Morbidity related to
Hyperglycaemia per se
Dysregulation of Lipid metabolism
High levels of Proinflamatory cytokines
High levels of Free radicals
Increased susceptibility to Infection
what are th effects of prolonged raised blood glucose levels
RETINOPATHY
—maculopathy
CATARACT
- -increased generations of polyols from glucose
- -1% reduction in HBA1c reduces cataract risk by 19%
RENAL DISEASE
–will require haemodialysis for chronic renal failure
NEUROPATHIC ULCER
GLYCOSYLATION OF CONNECTIVE TISSUE
— eg Cheiroarthropathy
How is bone like T2 DM
mechanically weaker
fractures are incr 2x (in spite of normal bone density)
Consequences of the dyslipidaemia and proinflammatory state
coronary artery disease
also:
- -raised chylomicrons, VLDL and catabolic remnants and LDL
- ——-proinflam
- -decr HDL
- ——–anti inflam
atherosclerotic lesion
peripheral vascular disease
What to plan in terms of treatment
prevent diabates
improve hyperglycaemia
reduce CVS risk factors
screen for complicationa nd treat early
TREATING T2 DM
what steps can be taken
in terms of prevention and treatment and medication
lifestyle
- -diet / exercise / smoking
- -eg walk the dog
treatment of
- -dyslipidaemia (STATINS)
- -hypertension
use of aspirin
What screening can be done and what does this enable
enables early treatment
EYES
retinal photopgraphy
laser treatment when req
KIDNEYS
measure urine albumin EMI
control blood kidney
ACE inhibitors and ARBs
FEET
screen for neuropathy and vascular disease
