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Endocrine > Pathophysiology of Type 2 Diabetes > Flashcards

Pathophysiology of Type 2 Diabetes Flashcards

1
Q

What factors contribute to the development of insulin resistance?

A

Genetic predisposition and obesity lifestyle factors

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2
Q

What does insulin resistance cause?

A

Compensatory beta cell hyperplasia, leading to beta cell failure

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3
Q

What does early beta cell failure cause?

A

Impaired glucose tolerance = progresses to diabetes as beta cell failure progresses

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4
Q

What are the factors linked to hyperglycaemia?

A

Increased incretin effect, decreased insulin secretion
increased lipolysis, increased glucose reabsorption, neurotransmitter dysfunction, decreased glucose uptake, increased hepatic glucose production, increased glucagon secretion

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5
Q

What contributes to the susceptibility of an individual to type 2 diabetes?

A

Genetic component, foetal development, postnatal nutrition

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6
Q

What adaptions occur in the cells during type 2 diabetes?

A

Beta cell mass expansion, insulin secretion

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7
Q

Failure of what processes are linked to type 2 diabetes?

A

Glucolipotoxicity, oxidative stress, ER stress, de-differentiation

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8
Q

How do weight and insulin resistance change as the disease progresses?

A

They both increase

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9
Q

What affect does obesity have on disease progression?

A

It accelerates the disease presentation

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10
Q

What is type 2 diabetes a disease of in most people?

A

Disease of beta cells

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11
Q

How does beta cell dysfunction cause microvascular disease?

A

Beta cell dysfunction causes hyperglycaemia = chronic hyperglycaemia leads to microvascular disease

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12
Q

How can progression of microvascular disease be reduced?

A

By intensive glucose control

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13
Q

How is CVD risk best treated?

A

Through use of statins and anti-hypertensives

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14
Q

What is the first step of treating someone with type 2 diabetes?

A

Lifestyle advice = information, reduce weight by 5-10%, give exercise target
Medications = metformin, may need statin/ACE inhibitor

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15
Q

What does metformin do?

A

Decreases hepatic gluconeogenesis = increases peripheral glucose uptake

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16
Q

What are the adverse effects of metformin?

A

GI effects, lactic acidosis

17
Q

What are the diabetic outcome of metformin?

A

Reduce HbA1c by 0.8-2.0%
Get weight to neutral
No hypoglycaemia

18
Q

What are factors that lead to failure to meet glycaemic targets?

A

Younger patient, female, obese, not at BP/lipid targets, more complex glucose lowering therapy, poor adherence to drugs and lifestyle changes

19
Q

What is the first step of drug prescription for type 2 diabetes?

A

Metformin

Sulphonylurea if intolerant to metformin

20
Q

What is the second step of drug prescription for type 2 diabetes?

A

Add sulphonylurea
Use TZD if hypoglycaemia a concern
Use DPPIV if weight gain a concern

21
Q

What is the third step of drug prescribing for type 2 diabetes?

A

Add TZD
Use DPPIV if weight gain a concern
Use insulin if osmotic symptoms or rising HbA1c
Use GLP-1 if BMI > 30mg/kg

22
Q

How should glycaemic targets be created?

A

Must be individualised, as should glucose lowering therapies

23
Q

What is the optimal first line drug for treating type 2 diabetes?

A

Metformin (unless contra-indicated)

24
Q

What is the foundation of any type 2 diabetes treatment programme?

A

Diet, exercise and education

25
Q

What should be the major focus of therapy for type 2 diabetics?

A

Comprehensive CV risk reduction

26
Q

How does sulphonylurea act?

A

Blocks beta cell KATP channels = increases first and second phase insulin secretion
Efficacy reduced at higher doses

27
Q

What are the diabetic outcomes for sulphonylurea?

A

Reduce HbA1c by 1.0-2.0%
Increase weight gain by 2kg
Increase hypoglycaemia

28
Q

What are the adverse effects of sulphonylurea?

A

Abnormal LFTs, increased CHD

29
Q

What are some features of GLP-1 and DPPIV?

A 
GLP-1 = injected, affects hypoglycaemia when used in combination
DPPIV = oral, weight stays the same or decreases
30
Q

How does glitazone work?

A

PPAR gamma inhibitor = increases peripheral glucose uptake

31
Q

What are the diabetic outcome for glitazone?

A

Decrease HbA1c by 0.6-1.5%

Increase weight gain by 3.5 kg

32
Q

What are the adverse effects of glitazone?

A

Fracture risk increase, hepatotoxicity, fluid retention

33
Q

What is the general treatment plan for type 2 diabetics?

A

Therapeutic lifestyle change = results in remission in 10-15%
Monotherapy
Combination therapy (not insulin)
Combination therapy with insulin

Endocrine (42 decks)

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