T2DM

Question 1

pathophysiology

Answer 1

cells in body develop insulin resistance so need more insulin for effect

overtime pancreas gets tired and starts to produce less insulin

= chronic hyperglycaemia

Question 2

risk factors

Answer 2

age 
ethnicicy: black, chinese, south asian 
FHx
obesity 
sedentary 
high carb diet

Question 3

presentation

Answer 3

fatigue
polydipsia 
polyuria 
unintentional weight loss
opportunistic infections 
slow healing 
glc in urine

Question 4

OGTT

Answer 4

in AM prior to breakfast

baseline fasting glc, having glucose drink then measure BG 2hrs later

tests ability of body to cope with carb meal

Question 5

diabetes diagnosis

Answer 5

HbA1c >48
random Glc >11
fasting Glc >7
OGTT > 11

Question 6

Mx

Answer 6

dietary modification
optimise risk factors
monitor for complications
medical management

Question 7

treatment targets: new T2DM

Answer 7

HbA1c 48

Question 8

treatment targets: diabetics moved beyond metformin alone

Answer 8

HbA1c 53

Question 9

first line medical treatment

Answer 9

metformin

titrated from initially 500mg once daily as tolerated

Question 10

2nd line medical treatment

Answer 10

solfonylurea, pioglitazone, DPP-4 inhibitor or SGLT-2 inihbitor

Question 11

3rd line medical treatment

Answer 11

triple therapy with metformin plus two of the 2nd line drugs
or
metformin plus insulin