Pathophysiology of Type 2 Diabetes

Question 1

Which two things are required for type 2 diabetes to occur in an individual?

Answer 1

1. Genetic predisposition
2. Environmental factors

Question 2

T2DM is synonymous with insulin resistance

True or false?

Answer 2

False

There must also be impaired glucose tolerance

Question 3

How do pancreatic beta cell respond to initial insulin resistance?

Answer 3

Hyperplasia

Question 4

What occurs later in T2DM as beta cell hyperplasia begins to fail at maintaining normoglycaemia?

Answer 4

Beta cell failure

This causes impaired glucose tolerance and diabetes

Question 5

In T2DM insulin secretion is _________

Answer 5

In T2DM insulin secretion is reduced

Question 6

Glucose uptake in skeleatal muscle and adipose tissue is __________ in T2DM

Answer 6

Glucose uptake in skeleatal muscle and adipose tissue is decreased in T2DM

Question 7

How are both glucagon secretion and hepatic glucose production impacted in T2DM?

Answer 7

Increased

Question 8

In the kidneys there is a ___________ rate of glucose resorption compared with normal

Answer 8

In the kidneys there is a higher rate of glucose resorption compared with normal

Question 9

How is lipolysis impacted in T2DM?

Answer 9

Increases

Question 10

The incretin effect is __________ in T2DM

Answer 10

The incretin effect is decreased in T2DM

Question 11

Presentation of T2DM is accelerated by what?

Answer 11

Obesity

Question 12

How does beta cell dysfunction affect blood sugar levels?

Answer 12

They increase causes hyperglycaemia

Question 13

Chronic hyperglycaemia has a bigger effect on which of the following, microvascular or macrovascular complications?

Answer 13

Microvascular

Question 14

Insulin resistance has a bigger effect on which of the following, microvascular or macrovascular complications?

Answer 14

Macrovascular

Question 15

How can CV risk best be treated in T2DM patients?

Answer 15

1. Statins
2. Anti-hypertensives

Question 16

What is the most effective treatment for T2DM?

Answer 16

Lifestyle changes

(exercise and diet)

Question 17

By how much does metformin typically affect HbA1c?

Answer 17

0.8-2%

Question 18

What are the main therapeutic effects of metformin?

Answer 18

1. Reduce hepatic gluconeogenesis
2. Increase (peripheral) glucose uptake and utilisation by skeletal muscle
3. Reduce CHO absorption
4. Increase fatty acid oxidation

Question 19

High blood pressure in a T2DM patient will be treated preferentially by which drug class?

Answer 19

ACE inhibitors

(age is irrelevant in this instance)

(calcium channel blockers and thiazide diuretics can be used too)

Question 20

What are the 3 main benefits of lowering HbA1c?

Answer 20

1. Reduce incidence of diabetes end points
2. CV risk decrease
3. Microvascular complications decrease

Question 21

What is the:

a) HbA1c aim
b) Ideal HbA1c level in T2DM?

Answer 21

a) 53mmol/mol
b) 48mmol/mol

Question 22

Females are _______ likely to reach their HbA1c target than males

Answer 22

Females are less likely to reach their HbA1c target than males

Question 23

Sulphonylureas can cause abnormal LFTs

True or false

Answer 23

True

Question 24

Thiazolidinediones (TZDs) should not be used in people with CV risk, but why?

Answer 24

They cause fluid retention

Question 25

Everyone with T2DM and CV risk should definitely be on which 3 drugs?

Answer 25

1. Metformin
2. Statin
3. SGLT2 inhibitor

Question 26

GLP-1 agonists are useful in people who are _________

Answer 26

GLP-1 agonists are useful in people who are obese