L16 T2DM overview Flashcards
DIAGNOSTIC TERMS
i) what level of blood glucose is classed as diabetic with symptoms?
ii) what HbA1c is classed as diabetes? as both mmol/mol and %
iii) what is the gold standard test for diagnosis?
iv) what glucose levels are classed as diabetic for a) fasting plama gluc and b) 2 hour post meal plasma gluc
v) what 2 hour glucose levels are associated with impaired glucose tolerance? what may these patients go on to develop?
vi) what condition may a person have if their fasting glucose is between 6-6.9mmol/l?
a normal blood glucose is 4-5.4 fasting
i) >11.1mmol/l
ii) >48mmol/mol or 6.5%
iii) glucose tolerance test
iv) fasting = >7mmol/l
2 hour post prandial = >11.1mmol/l
v) impaired glucose tolerance = 2 hour glucose 7-11mmol/l
- these patients may go on to develop T2DM/macrovascular complications
vi) fasting glucose 6-6.9 = impaired fasting glucose
WHAT IS TYPE 2 DIABETES?
i) which cells is there an anomaly in? what is this in the context of?
ii) what does this result in?
iii) what is it called when cells cant adequately respond to normal levels od insulin?
iv) what protein in seen in the dysfunctional cells on immunohistochemistry?
i) beta cells in the islets of the pancreas dysfunction in the context of insulin resistance
ii) results in insufficient insulin being produced
iii) insulin resistancee
iv) seee amyloid in pancreatic islets
CAUSES OF BETA CELL PROBLEMS IN T2DM
i) is there a genetic influence? what % concordance is seen between identical twins?
ii) is it mono or polygenic?
iii) name two factors that occur in utero that predispose the foetus to developing T2DM
iv) name two other possible aetiological factors leading to T2DM
v) name two things that happen later on and adversely affect the b cells
i) yes - 90% concordance
ii) polygenic ~60 genes
iii) maternal hyperglycaemia and intrauterine growth retardation
iv) age, change in gut microbiome
v) glucotoxicity and lipotoxicity
INSULIN RESISTANCE & ECTOPIC FAT
i) what group of people is there increased prevalence of IR?
ii) what specific type of fat is thought to cause insulin resistance? explain in context of the pancreas
iii) what does ectopic fat act like? what does it respond to?
iv) what is produced from excess fat that results in insulin resistance and atherogenic lipids?
v) what mediators can be released from fat that contribute to IR and inflammation?
vi) what factor can be released from fat that contributes to blood vessel disease?
i) obese
ii) visceral fat
- fat infiltrating the pancreas can cause beta cell dysfunction
iii) ectopic fact is metabolically active
- can respond to catecholamines
iv) excess fat can produce free fatty acids (results in IR and athero lipids)
v) cytokines can be released from fat that contribute to IR and inflammation
vi) ectopic fat can release procoagulan factors (PAI1) which contrib to bv disease
T2DM & OBESITY
i) what is the most important measurement when looking at metabolic syndrome and IR?
ii) how many people had T2DM in 2017? how many people were at risk
iii) what age group is most likely to be overweight?
iv) what is the prevalence of obesity in 45+?
v) name three factors that 96% of T2DM is attributed to?
vi) name five serious metabolic consequences of T2DM
i) waist circumference
ii) 4.6 million people had it and 12.3 milliom at risk
iii) age group 55-64 most likely to be overweight
iv) 70% from 45+
v) BMI >23, lack of exercise, unhealthy diet
vi) metab consequences - hyperglycaemia, dyslipidaemia, increased proinflamm cytokines, high levels of free radicals, increased suscep to infection
T2DM AND EYE PROBLEMS
i) what can be described as microvascular damage to the small blood vessels in the eye due to diabetes?
ii) what causes this?
iii) what does increased generation of polyols from glucose cause? reducing what can reduce the risk of this?
i) retinopathy
ii) caused by glucose too high for too long
iii) increased gen of polyols from glucose can cause cataracts
- reduce HbA1c (1% decrease reduces risk by 19%)
OTHER COMPLICATIONS OF T2DM
i) what organ problems can arise?
ii) why do ulcers develop in the feet?
iii) what can happen to connective tissue?
iv) does T2DM impact on bone density?
v) name two bone problems seen
i) renal impairement - may need dialysis
ii) long nerves to the foot are damaged and also develop peripheral neuropathy which can make the ulcers worse
iii) glycosylation of connective tissue - stiffening of tissue
iv) no impact on bone density
v) bones are mechanically weaker and increased risk of fracture
T2DM AND MICROVASCULAR DISEASE
i) name three microvascular complications of diabetes?
ii) what did the UKPDS study show?
iii) what type of lipoproteins are increased in diabetic patients?give two examples
iv) what happens to LDLs in diabetes?
v) what do atherogenic lipoproteins cause?
vi) what other type of vascular disease is common?
i) retinopathy, renal disease and neuropathy
ii) that good control of hyperglycaemia reduces both micro and macro vasc complications
iii) increased inflammatory lipoproteins eg chylomicrons and VLDL
iv) LDLs get glycosylated and become more atherogenic/proinflammatory
v) inflammatory substances cause inflammatory reactions in athero plaque, cap dissolves and contents spill = CLOT
vi) peripheral vascular disease
T2DM MANAGEMENT
i) what is the first thing to do?
ii) what drugs can be given to reduce dyslipidaemia and hypertension?
iii) what drug is given if there is a known or very high risk of coronary artery diseaase? what is a risk of this?
iv) what three things should be screened? give an example of the process for each
v) what may absence of pedal pulses indicate?
i) lifestyle modification and reduce blood sugar
ii) statins for dyslip and ACEis or ARBs for hypertension
iii) give aspirin if high risk of CAD - can cause GI bleeding
iv) screen eyes - retinal photography once per year
kidneys - measure urine albumin early in morning
feet - screen for neuropathy and vascular disease
v) peripheral vascular disease
TREATING T2DM
i) name three pharmacological interventions
ii) name three surgical interventions
iii) what is the main surgical intervention offered?
iv) at what BMI may surgery be offered to T2DM patients?
i) reduce insulin resistance - metformin, increase insulin production or provide insulin replacement
ii) sleeve gastrectomy, roux en y bypasas, gastric band
iii) mainstay of sx treatment is sleeve gastrectomy
iv) BMI >35
