T2DM

Question 1

What?

Answer 1

Impaired sensitivity to circulating insulin

Question 2

What is this associated with?

Answer 2

Obesity and sedentary lifestyle.

Question 3

Risk factors?

Answer 3

Age (>40, pr 25 for South Asian)
Family history
Overweight or obese
Asian. African- Caribbean or black African
Sedentary lifestyle
High carbohydrate diet

Question 4

Pathophysiology?

Answer 4

Insulin resistance
-> More insulin required to produce response from cells (to take up & use glucose) -> pancreas beta cells become fatigued and damaged -> produce less insulin -> chronic hyperglycaemia

Question 5

Symptoms?

Answer 5

Often asymptomatic
Polyuria
Thirst and polydipsia
Blurred vision
Genital thrush
Fatigue
Unintentional weight loss

Question 6

Why polyuria?

Answer 6

Blood glucose very high so spills over into urine
Exceeds renal threshold for glucose reabsorption.
Glucose in urine causes osmotic diuresus and causes polyuria.

Question 7

Why blurred vision?

Answer 7

Blood sugar high
Lens shrinks
Vision blurry
Restores as glucose comes down

Question 8

Why genital thrush?

Answer 8

Sugar in urine

Question 9

Symptoms/ signs of complications?

Answer 9

Loss of vision/ retinal bleed or retinal changes

Question 10

Diagnosis?

Answer 10

Fasting glucose ≥ 7.0mmol/l
Random glucose test ≥ 11.1mmol/l
OGTT 2 hour result >11mmol/ l

Question 11

What does HbA1c tell you?

Answer 11

A measure of the average blood glucose levels in the last 6-12 weeks

Question 12

HbA1c in diabetes?

Answer 12

> 6.5%(48mmol) in diabetes.

Question 13

Normal range for HbA1c?

Answer 13

5.7%-6.4%

Question 14

Management?

Answer 14

Patient education
lifestyle advice
Metformin
SGLT2 inhibitors
GLP-1 receptor agonists
Sulphonylureas
Thiazolidinediones (TZD)
DDP4 inhibitors
Insulin

Question 15

Metformin?

Answer 15

1st line oral treatment

Weight neutral

Question 16

SGLT2 inhibitors?

Answer 16

Add on therapy to metformin
CV and renal benefits
Inc risk of thrush, DKA,
E.g. empagliflozin and canafliflozin

Question 17

GLP- 1 receptor agonists?

Answer 17

CVD benefit
Weight loss
Some renal benefit
SE = N&V
E.g. liraglutide

Question 18

Sulphonylureas?

Answer 18

Insulin secretagogues
Gliclazide and glimepride
First line oral agents If intolerant to metformin
Add on 2nd line therapy or triple oral therapy
Assoc hypoglycaemia and weight gain
No CV benefit

Question 19

TZD?

Answer 19

Inc whole body insulin sensitivity
Pioglitazone
Dual or triple therapy 
Not in Heart failure
Weight gain
Fracture risk

Question 20

DDP4 inhibitors?

Answer 20

Insulin secretagogues (only when insulin needed)
Weight neutral
E.g. sitagliptin
Dual or triple therapy

Question 21

Insulin?

Answer 21

When oral agents no longer effective -> injectable
Weight gain
Hypoglycaemia
Continue oral metformin