Pathophysiology and management of T2DM

Question 1

What 2 things lead to insulin resistance?

Answer 1

Genetic predisposition

Obesity lifestyle factors

Question 2

What does early beat-cell failure cause?

Answer 2

Impaired glucose tolerance

Question 3

What does late Beta-cell failure lead to?

Answer 3

Diabetes

Question 4

What is the omnious octet associated with hyperglycaemia?

Answer 4

Decreased:
-Incretin effect
-Insulin secretion
-Glucose uptake
Increased:
-Glucagon secretion
-Hepatic glucose production
-Lipolysis
-Gluose reabsorption
Neurotransmitter dysfunction

Question 5

What happens to risk of T2DM with increasing BMI?

Answer 5

Also increases

Question 6

Who has increased risk of T2DM?

Answer 6

Women

Asian people

Question 7

What contributes to susceptibilty of developing T2DM?

Answer 7

Genetic component
Foetal environment
Postnatal nutrition

Question 8

What adaptation is involved in the development of T2DM?

Answer 8

Beta-cell mass expansion

Insulin secretion

Question 9

What is involved in beta cell failure?

Answer 9

Glucolipotoxicity
Oxidative stress
ER stress
De-differentiation

Question 10

What is strongly associated with the development of macrovascular complications?

Answer 10

Insulin resistance

Question 11

How is CV risk treated?

Answer 11

Statins

Anti-hypertensives

Question 12

What can lead to hypoglycaemia in patients with T2DM?

Answer 12

Tight glycaemic control

Question 13

If a patient is symptomatic how may they be diagnosed?

Answer 13

Single blood test
RBG > 11.1
FBG >7

Question 14

If a patient is NOT symptomatic how may they be diagnosed?

Answer 14

Repeat test

Question 15

How is T2DM treated initially?

Answer 15

Lifestyle and dietary advice

Question 16

What is the first line drug for T2DM?

Answer 16

Metformin

500mg-> 1000mg

Question 17

How does metformin work?

Answer 17

Decreases hepatic gluconeogenesis

Increasing peripheral glucose

Question 18

Does metformin cause hypoglycemia?

Answer 18

No

Question 19

What are some side effects of metformin?

Answer 19

GI side effects

Lactic acidosis

Question 20

What is HbA1c?

Answer 20

Measure of glucose control of a patient over 3 months

Question 21

What are the SIGN guidlines for normal HbA1c?

Answer 21

<48

Question 22

What could cause failure to reach HbA1c targets?

Answer 22

Young
Female
Obese
Not at BP targets
Poor adherance
Reluctance to intensify treatment
HbA1c

Question 23

What is the 2nd line treatment for diabetes?

Answer 23

Sulphonylurea

Question 24

How do sulphonylureas work?

Answer 24

By blocking beta-cell Katp channel and increasing insulin secretion

Question 25

What are some side effects of sulphonylureas?

Answer 25

Weight gain Hypoglycaemia Abnormal LFTs Increased risk of chronic heart disease

Question 26

What is Glitazone?

Answer 26

PPARy activator

Question 27

How does glitazone work?

Answer 27

Increasing peripheral glucose uptake

Question 28

What are side effects of glitazone?

Answer 28

Weight gain Increased fracture risk Hepatotoxicity Fluid retention