T1 L13: Type 2 diabetes

Question 1

What is the usual clinical diagnosis for T2 diabetes mellitus?

Answer 1

Blood glucose >11.1 mmol + symptoms
Blood glucose >11.1 mmol x2
HbA1c >48 mmol/mol

Question 2

What is T2 diabetes mellitus?

Answer 2

There is insulin resistance and abnormal beta-cells which cannot produce enough insulin to keep the blood glucose normal

Question 3

What impact does maternal hyperglycaemia have on foetal development of diabetes mellitus?

Answer 3

It causes intrauterine growth retardation that leads to a reduced beta-cell mass resulting is diabetes

Question 4

What are some possible aetiologies for the development of T2 diabetes mellitus?

Answer 4

• Old age
• Ectopic fat deposition in pancreas
• Change in gut microbiota
• Glucotoxicity and lipotoxicity
• Hyperglycaemia during pregnancy

Question 5

What is epicardial fat a strong risk-factor for?

Answer 5

Vascular disease

Question 6

Why is ectopic fat so bad?

Answer 6

Because it doesn’t behave like normal fat does since it doesn’t actually belong anywhere

Question 7

What does ectopic fat produce?

Answer 7

• Free fatty acids that cause atherogenesis and insulin resistance
• Cytokines that cause inflammation and insulin resistance
• Procoagulant factors (PAI1)

Question 8

What are some side-effects of developing T2 diabetes?

Answer 8

Hyperglycaemia 
Dysregulation of lipid metabolism 
High levels of proinflammatory cytokines
High levels of free radicals
Increased susceptibility to infection

Question 9

What is maculopathy?

Answer 9

When the leaked fluid builds up at the macula, leaking into the retina causing swelling. It’s a complication of diabetes

Question 10

What is a cataract?

Answer 10

A clouding of the normally clear lens of the eye

1% reduction in HbA1c reduces cataract risk by 19%

Question 11

What is Cheiroarthropathy?

Answer 11

A disorder in which finger movement becomes limited as the hands become waxy and thickened

Question 12

What are bones like in patients with T2 diabetes?

Answer 12

Mechanically weaker so there is an increased risk of fractures in spite of normal bone density

Question 13

Which lipoprotein is potentially anti-inflammatory and therefore considered good?

Answer 13

HDL

Question 14

Which lipoproteins are potentially proinflammatory?

Answer 14

LDL and VLDL

Question 15

What screening is given to people with T2 diabetes to enable early treatment?

Answer 15

Eyes

• Retinal photography
• Laser treatment when required

Kidneys

• Measure urine albumin (EMU)
• Control blood pressure
• ACE inhibitors and ARB’s

Feet
-Screening for neuropathy and vascular disease

Question 16

How can neuropathy be looked for when someone has diabetes?

Answer 16

Using a filament or a doppler probe to work out if the blood vessels are working properly

Question 17

What are some pharmacological interventions for T2 diabetes?

Answer 17

• Reduce insulin resistance
• Increase insulin production/secretion
• Prevent reabsorption of filtered glucose
• Provide insulin replacement

Question 18

What are some obesity surgeries provided for people with T2 diabetes?

Answer 18

Sleeve gastrectomy
Roux en Y Bypass
Gastric bypass