T2DM Flashcards
function of insulin
released from the pancreas to help blood sugar enter cells
also signals liver to store glucose for later
*insulin is released when blood sugar enters the bloodstream
why do cells become resistant to insulin
repeated exposure to glucose and insulin makes the cells resistant
> requires the pancreas to release more insulin to incur more of a response for cell uptake of glucose
> beta cells in the pancreas overtime become fatigued and damaged from producing so much insulin
> pancreas can’t produce as much as it once did
> > continued sugar overload in light of insulin resistance and pancreas damage can lead to chronic hyperglycaemia
> > chronic hyperglycaemia can lead to microvascular, macrovascular and infectious complications
who’s at risk (non-modifiable)
older age
ethnicity - black chinese south asian
family history
who’s at risk (modifiable)
obese populations
sedentary lifestyles
high carb diet (refined)
how does T2DM present
check risk factors
fatigue
polydipsia
polyuria
unintentional weight loss
opportunistic infection
slow healing
glucose in urine dipstick
how to screen for pre-diabetics
HbA1C
early treatment can prevent long term complication and it is possible to reverse diabetes with proper diet and lifestyle
what is an OGTT
oral glucose tolerance test
performed in the morning before eating
records fasting plasma glucose before the patient has eaten, they are then given 75g glucose drink and the plasma glucose is measured 2 hours later
how can pre-diabetes be diagnosed
HbA1c
impaired fasting glucose (body struggles to get their blood glucose levels in normal range - without eating)
or
impaired glucose tolerance (struggles to maintain normal range while processing a carbohydrate meal)
HbA1C = 42-47mmol/mol
fasting glucose = 6.1-6.9mmol/l
glucose tolerance = 7.8-11.1mmol/l on OGTT
how can diabetes be diagnosed
HbA1c > 48mmol/mol
random glucose > 11mmol/l
fasting glucose > 7mmol/l
OGTT > 11mmol/l
management of diabetes
lifestyle
advise the patient that T2DM can be reversed - 800 calorie per day deficit
monitor for complications …
ie diabetic retinopathy
management of diabetes (medication)
1st = metformin 500mh Od
2nd = add:
sulfonylurea, pioglitazone, DPP-4 inhibitors, SGLT-2 inhibitors
3rd = triple therapy with metformin and 2nds / insulin
*SIGN guidelines recommend the use of GLP-1 mimetic or SGLT-2 inhibitors in diabetics with CVD risk
why does metformin work
it increases insulin sensitivity and decreases liver production of glucose
*side effects = diarrhoea , abdominal pain
lactic acidosis
which diabetes medication has a side effect of hypoglycaemia
sulfonylurea
(MoA = stimulate insulin release from pancreas)
pioglitazone stuff
‘thiazolidinedione’
increases insulin sensitivity and decreases liver production of glucose
*side effects = HF, fluid retention, weight gain
MoA SGLT-2 inhibitors
stop SGLT-2 protein reabsorbing glucose from urine into the blood > glucose is excreted
eg ‘gliflozin’ ie empagliflozin
T/F can you go into remission if you lose 10-15% weight
T
treatment - lifestyle
weight loss
better diet
exercise
what is the commonest manifestation of diabetic peripheral neuropathy
numbness
what is balanitis
when the head of the penis is swollen and sore
usually caused by candidiasis
is a random blood glucose >11.1mmol/L + symptoms enough to diagnose DM
Yes
when is metformin contraindicated
when eGFR <30mL/minute/1.73m2
when in doubt ! the best lifestyle change is
smoking cessation
what medication would you prescribe to a 65 year old lady from Trinidad and Tobago with a BP of 145/92, has T2DM, hypercholesterolaemia which she manages with metformin and atorvastatin ?
ARB IIs ie lasartan/candesartan
you would prescribe CCBs such as amlodipine first line for afro-caribbean origin patients who do not have T2DM
what clinical feature best indicates for a diagnosis of diabetic peripheral neuropathy
sensory loss in a stocking distribution
what clinical feature best indicates for a diagnosis of diabetic peripheral neuropathy
sensory loss in a stocking distribution
what is the pathophysiological mechanism implicated in the development of diabetic neuropathy ?
advanced glycation end products effects on matrix metalloproteinases
-advanced glycation end products resulting from hyperglycaemia act on specific receptors
what is important to check when patient presents with ED and T2DM
gonadotrophins (LH and FSH)
as this would suggest pituitary cause
which organism is commonly found in diabetic foot ulcers
pseudomonas aeruginosa
> water borne - superficial ulcers may be contaminated by bacteria in wet socks or dressings
which anti-hyperglycaemic drug is most likely to cause a hypo
sulphonylureas - GLICLAZIDE
