T1 L13 Type 2 DM Flashcards
What is diabetes mellitus?
Condition where blood glucose is above an internationally accepted level
What is the clinical diagnosis of diabetes mellitus in terms of blood results?
Glucose ≥11.1mmol/l + symptoms
Glucose ≥ 11.1mmol/l x 2
GbA1c ≥48mmol/mol (6.5%)
Describe the results of the 75g glucose tolerance test and what they indicate
Diabetes mellitus:
Fasting plasma glucose ≥7mmol/l
2 hour plasma glucose ≥11.1mmol/l
Impaired glucose tolerance:
2 hour glucose between 7-11mmol/L
Impaired fasting glucose:
fasting glucose between 6-6.9 mmol/l
What is type 2 diabetes?
Insulin resistance and beta cells which can’t produce enough insulin to keep blood glucose normal
What are the epigenetics of type 2 diabetes?
Fetal programming:
- maternal hyperglycaemia
- intrauterine growth retardation
What are some possible aetiological factors for type 2 diabetes?
Beta cell regression Old age Other pancreatic pathology Change in gut microbiota Glucotoxicity and lipotoxicity
What things are produced by endocrine organs that lead to ectopic fat?
Free fatty acids:
- insulin resistance
- atherogenic lipids
Cytokines:
- insulin resistance
- inflammation
Procoagulant factors
What age group is most likely to be overweight or obese?
55 to 64
What does the nurses health study attribute diabetes to?
BMI >23
Lack of exercise
Unhealthy diet
What are the side effects of type 2 diabetes that lead to morbidity?
Hyperglycaemia Dysregulation of lipid metabolism High levels of pro inflammatory cytokines High levels of free radicals Increased susceptibility to infection
How does diabetes lead to retinopathy?
Blood glucose too high for too long
How does diabetes lead to cataracts?
Increased generation of polyols from glucose
Describe bone in type 2 diabetes
Mechanically weaker
Risk of fractures is double despite having normal bone density
What should be done in type 2 diabetes?
Prevent the diabetes
Improve the hyperglycaemia
Reduce cardiovascular risk factors
Screen for complications so they can be treated early
How can you treat dyslipidaemia?
Statins
What screening should be done for eye health?
Retinal photography
Laser treatment when required
What screening should be done for kidney health?
Measure urine albumin (EMU)
Control BP
ACE inhibitors and ARBs
What screening should be done for foot health?
Screen for neuropathy
Screen for vascular disease
What are the goals in T2DM?
Lifestyle modification Screen for complications Special clinics for complications (foot, renal, eye) HbA1c 6.5-7.5% BP 120-140/89 LDL <2.0mmol/l Non-HDL cholesterol <2.78
What are the pharmacological goals when treating T2DM?
Reduce insulin resistance
Increase insulin production / secretion
Provide insulin replacement
What metabolic surgery can be done to treat T2DM?
Sleeve gastrectomy
Roux en Y bypass
