T1 L13:Type 2 Diabetes Mellitus

Question 1

what is DM t 2 (3m)

Answer 1

A CONDITION WHERE
THE BLOOD GLUCOSE
IS ABOVE
AN INTERNATIONALLY ACCEPTED LEVEL

insulin resistance + Beta Cells
Which cannot produce enough Insulin
To keep the blood glucose Normal

Question 2

what blood glucose levels are used to diagnose dm 2 (3m)

Answer 2

Glucose = or > 11.1 mmol/l +Symptoms

Glucose = or > 11.1 mmol/l x 2

HbA1c = or > 48 mmol/mol ( 6.5% )

Question 3

what tests can be used to diagnose dm 2

esp if not sure ie pregnant patient

Answer 3

75 g Glucose Tolerance test

Diabetes Mellitus:

• Fasting plasma glucose = / > 7 mmol/l
• 2 hour plasma glucose = / > 11.1 mmol/l
• Impaired Glucose Tolerance
• -2 hour glucose between 7 -11 mmol/l

-Impaired Fasting Glucose
Fasting glucose between 6 – 6.9 mmol/l

Question 4

what cells are damaged in the pancreas due to t2 diabetes

Answer 4

Islet cells

Question 5

what are the characteristics of islet cells that signify t2

Answer 5

A deficit in β-cells

Increased β-cell apoptosis, 
Extracellular amyloid deposits derived from IAPP

Question 6

what happens to IAPP (amylin) in t2

Answer 6

Islet amyloid polypeptide (IAPP, amylin) is secreted from pancreatic islet β-cells and converted to amyloid deposits in type 2 diabetes.

Question 7

what colour stain are amylin when testing for t2

Answer 7

green

Islet amylin polypeptide Polymers(amylin is co-secreted with Insulin

Question 8

what is the aetiology of t2

pre-birth

Answer 8

Genetic-polygenic

Fetal programming -epigenetic

• maternal hyperglycaemia
• intrauterine maternal growth retardation

Total: reduce the beta cell mass

Question 9

what are other aetiological factors that are responsible for t2

Answer 9

Beta cell regression ( Sox 5 gene )

Old age

Change in the gut microbiota

Question 10

what cells become resistant to insulin

Answer 10

liver

muscle

fat cells

Question 11

where is fat deposited in t2 diabetes

Answer 11

Epicardial fat : - strong risk factor for CVD

Visceral fat

Question 12

what are the effects of ectopic fat

(5m)

(& what are 2 of their effects )

Answer 12

Increase in:

Free fatty acids
-insulin resistance -atherogenic lipids

cytokines

• insulin resistance
• inflammation

Procoagulant factors (PAI1)

Question 13

what physical trait statistic is vital in t2

Answer 13

waist circumference

Question 14

what age groups are more likely for t2

Answer 14

age 55-64

prevalence is above 70% among from 45 upwards.

Question 15

what are the side effects of t2 diabetes

(morbidity related )

(5m)

Answer 15

Hyperglycaemia per se

     Dysregulation of Lipid metabolism

     High levels of Proinflammatory cytokines

     High levels of  Free radicals 

     Increased susceptibility to Infection

Question 16

what is maculopathy and what is it caused by

Answer 16

damage of eye and blood vessels due to too high a blood glucose for too long

can cause cataracts

Question 17

what treatments are available for ppl with renal disease in t2 diabetes

Answer 17

Dialysis

Haemodialysis for chronic renal failure

Question 18

what can the treatment of hyperglycaemia reduce

Answer 18

microvascular disease -retinopathy, neuropathy….

Question 19

what can glycosylation of connective tissue cause

Answer 19

Cheiroarthropathy

Question 20

what occurs to the bones of t2

2m

Answer 20

Mechanically weaker

Increased Fractures x2
-In spite of normal bone density

Question 21

what are the 2 main processes that occur with t2 diabetes

Answer 21

Dyslipidaemia & Proinflammatory state

Question 22

what happens to the lipoprotein profiles of t2

Answer 22

Increase in : VLDL,chylomicrons and LDL

decrease in anti-inflammatory lipids like HDL

Question 23

what is the 3 main processes that occur in atherosclerotic lesion

Answer 23

1) dyslipoproteinemia
2) inflammation

3) Thrombosis

Question 24

what is the 3 main processes that occur in atherosclerotic lesion

Answer 24

1) dyslipoproteinemia
2) inflammation

3) Thrombosis

Question 25

what is stage 1 in treating T2

Answer 25

Lifestyle-

diet and exercise

Question 26

what treatments are available for hypertension caused by t2

Answer 26

• dyslipaemia -statins
  to treat hypertension

-use of aspirin

Question 27

what type of screening is available for ppl with early t2 diabetes

(3 anatomical features- 5m)

and for 2 of them what can we use to treat the diseases within that organ/feature

Answer 27

Eyes

• Retinal Photography
• Laser treatment when required

Kidneys

• Measure urine albumin ( EMU)
• Control Blood Pressure
• ACE inhibitors & ARBs(angiotensin receptor blocker )

Feet
-Screen for neuropathy & Vascular disease

Question 28

what obesity type surgeries are available

Answer 28

• Sleeve Gastrectomy
• Roux en Y Bypass
• Gastric Band

Question 29

what do pharmacological drug target in t2

Answer 29

• Reduce Insulin Resistance
• Increase Insulin production /secretion
• Provide Insulin replacement

Question 30

what are healthy levels for t2 diabetes

Answer 30

• HbA1c 6.5 – 7.5 % (48 – 58 mmol/mol)
• BP 120 -140 /80
• LDL < 2.0 mmol/l
• Non HDL cholesterol < 2.78