Pathophysiology, Principles of Managing a New Type 2 – include lifestyle factors

Question 1

What are the core defect which occur which give rise to T2DM ?

Answer 1

• Insulin resistance and β-cell dysfunction due to genetic susceptibility
• Caused by a combination of genetic susceptibility, obesity and western lifestyle

Question 2

Describe the concept of insulin resistance

Answer 2

• Insulin receptor is not as responsive to the insulin molecule ==> less glucose enters the cell.
• This results in a build up of glucose in the blood

Question 3

What causes insulin resistance ?

Answer 3

1. Ectopic fat accumulation and increased FFA circulation along with increased inflammatory mediators (CRP)
2. These inhibit serine kinase responsible for phosphorylation of Insulin receptor substrates-1 (IRS-1) resulting in insulin inhibition
3. Which therefore reduces insulin-stimulated glycogen synthesis due to reduced glucose transport

Question 4

Describe what β-cell dysfunction is

Answer 4

Reduced ability of β-cells to secrete insulin in response to hyperglycaemia

Question 5

Which is the first defect to arise which leads someone on the path to developing diabetes?

Answer 5

1. Initially β-cells compensate for insulin resistance
2. As β-cell function declines, blood glucose levels increase

Question 6

Specifically how does insulin resistance lead to β-cell dysfunction ?

Answer 6

1. Insulin resistance causes glucotoxicity (hyperglycaemia) and lipotoxicity (elevated FFA’s and TG’s)
2. This damages β-cells leading to β-cell dysfunction

Question 7

At the usual time of diganosis of diabetes how badly has β-cell function been affected ?

Answer 7

Decreased to 50% of normal β-cell function

Question 8

Is β-cell dysfunction reversible ?

Answer 8

There has been some evidence to show possible normalisation of β-cell function associated with decreased with decreased pancreas and liver triacylglycerol

Question 9

What are the 2 main different ways people might put weight on and which is more strongly associated with the development of T2DM?

Answer 9

Apple and pear

• Apple = person puts weight on in a central distribution
• Pear = person puts weight on there hips

Apple is more strongly associated with development of T2DM (think there putting more weight on around the abdomen which is where the pancreas is)

Question 10

Is diabetes mainly managed by the patient themselves or health care professionals ?

Answer 10

The majority of management is done by the patient themselves - hence the key importance of education in diabetic patients

Question 11

What factors can affect an individuals ability to self-manage there diabetes ?

Answer 11

• Education - health literacy
• Motivation etc

Question 12

Define health literacy

Answer 12

The degree to which individuals have the capacity to obtain, process and understand basic health information needed to make appropriate health decisions

Question 13

What are some of the things patients with diabetes are educated about ?

Answer 13

• Healthy eating
• Weight loss
• Complications/prevention of them
• Foot care
• Activity