T2 DM Flashcards

1
Q

Insulin resistance

  • Cause
  • Associations
A

Causes- humans have become a lot more calorie excess
- Increase in visceral fat= production of FFA, proinflammatory cytokines, procoagulant factors.

Associations

  • Age [>40]
  • Obesity, especially central obesity
  • Hypertension
  • Hyperglycaemia
  • Dyslipidaemia
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2
Q

Main Aetiological causes of T2 DM

A

Decrease in beta-cell mass:

Polygenic factors
- Identical twins showed high incidence.

Maternal hyperglycaemia

Nutrient deficiency in utero–> Intrauterine growth retardation

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3
Q

Other possible aetiological causes of T2 DM

A

Gut bacterial change

SOX-5 gene mutation–>Beta-cell regression

Autoimmune

Old age

Decreased incretin action
- Reduced GLP-1, GIP

Abnormal glucagon action

Glucotoxicity and lipotoxicity

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4
Q

Glucose diagnosis of diabetes

A

Blood glucose

  • > 11mmol/L + symptoms
  • > 11mmol/ L x 2 without symptoms
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5
Q

HbA1c diagnosis of diabetes

A

HbA1c= glycated haemoglobin

Diabetes if HbA1c> 48 mmol/ mol or 6.5%

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6
Q

75 g glucose tolerance test

A

Method of diagnosing T2 DM.

  1. Fasted period.
    - DM if blood glucose > 7mmol/L
    - Impaired fasting if blood glucose is 6-6.9 mmol/L.
  2. Injection of 75g, 2 hrs weight
    - DM if blood glucose> 11.1 mmol/L
    - Impaired glucose tolerance if blood glucose is 7-11 mmol/L
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7
Q

Epidemiology of T2 DM

A

Prevalence

  • 4.6 million
  • Further 12.3 M are at risk

Most prevalent in

  • Older age, >45
  • Overweight [70%]
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8
Q

Pathology of T2 DM

A

Insulin resistance and inadequate insulin production.

Progression

  • Increase in B-cell apoptosis
  • Amyloid deposits from IAPP disrupts beta-cells.
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9
Q

Dyslipidemia and T2 DM

A

In those with T2 DM, there can be high levels of LDL, chylomicrons, VLDL+ their catabolic remnants

  • Proinflammatory
  • Increases atherosclerotic formation

Leads to vascular pathologies
- Coronary heart disease

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10
Q

Major consequences of T2 diabetes

A

Hyperglycaemia

Dysregulation of lipid metabolism

High proinflammatory cytokines + free radicals

Increased susceptibility to infection

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11
Q

T2 DM morbidities

A

Maculopathy/ Retinopathy

Neuropathy

Foot ulcers

Peripheral vascular disease

Cataracts

Cheiroarthropathy

Increased fractures/ weaker bones

Nephropathy

Coronary heart disease/ MI

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12
Q

Preventative treatment for T2 DM

A

Lifestyle modification
- Diet/ exercise, smoking cessation.

Screening

  • Eyes
  • Kidneys
  • Feet: neuropathy and vascular disease.

Taking aspirin to prevent MI/ CV events

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13
Q

Eye screening tests for T2 DM

A

Retinal photography
- Screen for maculopathy/ retinopathy

Using laser eye treatment when required.

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14
Q

Kidney screening

A

Measuring urine albumin [EMU]

Blood pressure

Using ACEi/ ARBs

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15
Q

T2 DM treatment goals

A

Modifying lifestyle and screening for complications

HbA1c+ 48-59 mmol/mol OR 6.5-7.5%

BP controlled= 12-140/180

LDL< 2.0 mmol/L

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